Thoughts At A Wedding

It was the "golden hour" of the day. My wife and I were at a former 19th century Yankee

estate in Massachusetts, converted into a venue for weddings and other joyous and notable occasions.

A late day sun streamed through the fall leaves festooning from a dense collection of

hundred-year-old trees, which framed two stone posts, each crowned with a medley of

autumnal flowers, only outshone by the couple as they looked at one another on the

occasion of their marriage.

The bridal couple was elegantly yet traditionally dressed. The bride was in luminous white,

with her dress' train falling perfectly some six feet onto freshly mown grass as she faced her

soon to be husband; she wore no veil. The groom was in a navy-blue tuxedo, not tails,

adorned by a bright corsage, its colors fitting to the season. They beamed with the joy

befitting the occasion. A half dozen wedding bridesmaids and grooms fanned out from each

of the soon to be newlyweds.

Their close friend officiated the occasion. Her comments underlined the wonder and elation of the couple's match.

The groom was in his early 30s, the son of my very dear friend of many decades, a leader in

my field. I had come to know the groom when he sought ideas about his choices for graduate education in public health.

The couple were now translating love into marriage.

I wondered about the medical and public health professional journeys the wedding couple

would face. Our country is beset with healthcare chaos, worsening social division, and a

federal government that was tossing science overboard, while serving up the business of

healthcare to the vultures of equity owned and managed healthcare.

For doctors (nurses too), clinical care is now increasingly managed by MBAs and CEOs. Their primary goal is profit - not quality care, kindly delivered, for patients, nor is it humane and intellectually stirring working conditions for direct care doctors and nurses. Burnout and "moral injury" (practicing at sub-standard levels that clinicians know to be driven by money not patients) have become primary reasons for healthcare professionals fleeing direct patient care.

For patients and families, the difficulty getting an appointment have grown worse.

Moreover, a government shutdown may seriously erode essential public health and protections and make today's toxic healthcare work environment even more so.

An early career health professional may find jobs hard to find and those available may be in

for-profit hospitals and clinics, which are growing in number and already showing serious

quality problems, like higher rates of death (in for-profit hospitals).

As for a career in Public Health, the US has a madman, anti-science ideologue as Cabinet

Secretary, who is gutting the public's health. The damages ahead from decimating safe and

effective vaccines will be legion, for children and adults. Jobs will become scarcer and

science-based policies over-run by dangerous ideologies. Research funding, including work in infectious disease, is being torn apart. Diseases like measles and Covid will once again be deadly. Women's reproductive rights will continue to be destroyed by HHS funding cuts and extremist right-wing policies.

There is much more purposeful bleeding of American health and public health to frighten we patients, families, and professionals, with no end in sight.

Bleak, I must say. But not irremediable. Dedicated professionals, unrelenting advocacy, and public demands for what is due us are powerful agents for saving and restoring a healthcare environment that will serve our families and the general public.

Now is not the time for patients and families to stay quiet and surrender to services we know do not meet our needs. Now is the time to speak up in your doctor's office when you know your concerns are not being addressed. A doctor who dismisses your questions and requests for information is a doctor whose office you want to get out of.

Our country greatly needs healthcare professionals like those I witnessed marrying. They are the future of medical care and the public health. May they stay well, strong, and support one another: they embody the brains, determination, and hope we desperately need.

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Lloyd I. Sederer MD, is a psychiatrist, public health doctor, and non-fiction writer.

www.askdrlloyd.com