The Journey

So I’ve finally settled in since arriving in Santa Barbara.  The little Jetta was packed to the brim for the trek.  I said goodbye with a family sendoff from our Caribou in Edina on Sunday morning around 9am and drove until around midnight, stopping in Rock Springs, WY.  The day was really uneventful and I listened to some great audio books.  I was exhausted by the time I got to Rock Springs and I was happy to crash.

Anthony Bourdain’s Kitchen Confidential made the time pass really quickly.  I loved the book and it was interesting to see the many similarities between medical training and becoming a chef.  He really lets you know what it is like training to cook and made some thoughtful points.  One that stuck out was that for the majority of the people that prepare our food at restaurants, cooking is not an art but a craft.  I always viewed cooking as an art, mixing and matching flavors to hit all the taste buds.  However, he makes an important distinction, pointing out that the best line cooks can reliably pump out many, many meals each night without really thinking about the recipe given them.  Experimentation with flavors is discouraged for everyone but the executive chefs; the cooks can even lose their jobs for trying something fancy.

That really struck me because, as medical students, we always heard about the “art of medicine.”  Our  attending would make a unique care decision because of their gut instinct, chalking it up to this infamous “art.”  The patient id splendidly and the attending smiled at the team, winking, saying we all have more time until we’ve learned the “art.” Anyway, I realized how the current system and coming changes to the system, especially in primary care, will make the docs craftsmen instead of artists.  Not only that, it will penalize “art” much like they do in the food business. The sheer numbers of patients that are going to have to reside in the US system will ensure the need for “line cook” docs.

I’ve already seen it happening with Evidence-based medicine (EBM), emphasis on the BM.  Guidelines are drafted by a committee of 15 to 20 experts, the guidelines are then spewed to the line cooks, each happy to be paid for following the rules with each and every patient.  Just like most recipes are fine and fill you up no matter who prepared them, most guidelines get the job done.   But if only that doc had thought before prescribing that statin because your LDL was 141.  Or if the line cook just thought before initiating insulin therapy on every diabetic with a Hgb A1C >9.   Cookie cutter medicine/EBM/line cooking gets the numbers through, but man, we probably miss out on some masterpieces from thinking, “artist” docs in the form of significantly better lives for patients….
Anyway, Anthony Bourdain made for good thinking and an interesting listen on that first day.

I left around 9am the next morning and drove until midnight again, reaching San Jose, CA.  The day included a bs Nevada speeding ticket and a monster rock to the windshield.  Needless to say,  I fell into a dingy Motel 6 bed, woke up with bites all over my legs, showered, and got out of there.

I stopped to see my friend Ben in Palo Alto and was able to visit the Stanford Entrepreneurship Accelerator which was cool to see. I also stopped at my Aunt’s in Monterey on my way down to Santa Barbara.  Having been here for two days, it is goin to be a good year…

More to come on the amazing property I found through Craigslist, my new pets, and the guesthouse I’ve outfitted for the year…thanks for reading