The View from 10,000 Feet

On her flight home from the Lown Conference last week, Mary Mack thought about Victor's essay questioning the mantra that healthcare should be more like air travel. It is a thing of beauty. Read the book and send us your musings.

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Dear Victor,

I recently heard you speak at the Lown Conference in DC and I bought your book, Why We Revolt.  I read it later that day. 

Your book is heartbreaking and beautiful and full of hope for the much needed change in the US health system. There were times, while reading your book, that I sobbed, for I have experienced both the cruelties and the transcendent kindnesses that you speak about. 

On my flight home, I was pondering your passenger/patient as a blur airline analogy;  in your book you write, "...my colleague brought up the pilot with an unexpected twist..."--  your colleague suggested that air travel would be a good template for, "quality improvement" and a, "new vision for healthcare!" Specifically, No need to know the pilot/doctor; no need to know the passenger/patient-- just streamlined efficiency. 

I had an aisle seat on the right, the very first row in coach, with the extra leg room;  just the divider was between first class and economy class. The curtain was open, so I had a perfect view and noticed all the elaborate attention given to the first class passengers. At times it seemed even over solicitous; one passenger said to the attendant respectfully, but with a bit of a sigh "don't worry, I'm absolutely fine." It was clear he just wanted to read and all the "intervention" was unnecessary (I realize there is no harm here, but still it fits). 

In the cramped spaces of coach, I noticed passengers trying to stow their luggage and move about in impossibly small spaces. Someone's bag got caught on another passenger's armrest. Someone dropped something. Someone was bigger than average. Someone in the way back of the plane found nowhere to stow their carry-on bag, and had to backtrack, jostling through the line - kind of panicked - hoping to find room, so they didn't have to check their bag. The airline attendant was displeased.  And someone was traveling with small children and was trying to work to correctly place a child's travel seat. The airline attendant cited the rules and regulations. The mom quickened her pace, trying to work with the seatbelt. A thin woman, yet her backside was blocking the aisle. 

The airline attendant became annoyed and judgmental, other passengers in line were becoming surly and grumbling, tired of the continued hold up. Cruel comments were made. 

It had become a negative and impossible environment inside that economy class section of the plane!  Passengers lacked compassion and understanding for one another, and the attendants blamed some passengers for the "unnecessary" hassles and delays. 

The passengers in coach are under cared for and the folks in first class are - from what I saw - overly cared for. 

Thank you for writing such a great book. I look forward to your next. 
All the best to you!
Mary Mack