In her address entitled “Leading the Dance of Change” at the 2013 AAMC Annual Meeting, Dr. Valerie Williams characterized the American health care system as a dance, a fitting metaphor for the complex interplay of fluidity and form that are necessary for the practice of medicine.
Dance, like health care, involves “a true and equal partnership between the acts of leading and following,” said Williams, requiring balance, learning and the ability to improvise.
Regrettably, the dance of today’s hospitals and clinics is more like a disjointed jig with three left feet, full of “incredible skills and talents” but failing to deliver the high-quality health care that our patients need.
The solution, according to Williams, is to choose new music, new steps and a new dance all together. With a few helpful video clips (including a snippet from everyone’s favorite guilty pleasure show “Pretty Little Liars”), Williams runs through the classics. The waltz, she says, is the “embodiment of tradition,” prescriptive and precise, but not nimble enough for today’s healthcare climate. The twist, although energetic, is “all about personal style” and does not reflect the teamwork we need in medicine. The line dance is too structured and too linear for health care, unforgiving when you fall out of step with your partners.
Then, there is the tango. Each dance its own unique story, told by the gliding steps of the leader and follower in perfect skillful alignment. It’s about passion, practice and the special flair that the partners add to their own storytelling. The tango, Williams asserts, is the dance for the future of medicine.
After sitting in countless sessions discussing the importance of a team-based approach in incorporating the many stakeholders in medicine, I found myself thinking of other dance forms that might more fully characterize the future of health care. The tango, although majestic and captivating, lacks a certain unity, a kind of synergy that plays upon the strengths of all of the different dancers in our health-care system.
And so, I propose a truly team-based dance for the future of health care: bhangra.
Bhangra is a high-energy style of music and dance that hails from the Punjab region of India. Like the institution of medicine, bhangra has a checkered past as a product of intense political, social and religious pressures. Beginning as a rural folk dance to celebrate the harvest, bhangra all but disappeared in practice with the partition of India in 1947, as villages and families were torn apart by hatred and violence. As wounds healed and political reparations were made, a new form of the dance emerged, evolving as it spread throughout the Indian diaspora both in Southeast Asia and abroad.
Today’s form of bhangra, a diverse fusion of modern dance and music, retains classical elements of its folkloric ancestor in its dress and characteristic dance moves, much as you see in the video above. (Which is a shameless promotion of my undergrad bhangra team–go Bhangra Union!) The generations of bhangra practitioners remind me of the generations of physicians in my own profession—widely varied in their tactics and practices, but deeply faithful to the core of the healing arts: our patients.
Bhangra is a collective process, a team-based approach to its development and its performance. Unlike the tango, whose leader-follower duality reminds me uncomfortably of the age-old days of doctor-patient paternalism, each bhangra team is led by a choreographer who incorporates the thoughts of the team into a complex and cohesive dance of poses and formations, carefully accounting for the strengths and weaknesses of each dancer. Through countless hours of practice, through successes and failures, the team evolves and grows, developing a unique identity of its own—a prideful soul—with the art of bhangra at its heart.
In this way, bhangra represents the future of medicine that we so often discuss: a multifaceted team, composed of many different physicians, nurses and allied health professionals, each individual performing his or her own movements as part of the larger group. Through the joyous cures and the bitter failures, the health care team of the future must learn from its past and adapt, always innovating to change the face of medicine.
And herein lies the greatest challenge of bhangra and of our health care system. Each dancer moves to the beat of his or her own drum, a beat whose rhythm and melody comes from the whole collective of his or her training. A classically-trained dancer since the age of five, dancing behind a self-taught breakdancer, dancing next to a person so desperate for physical fitness. At the beginning of the season, these members of the team barely speak the same language, let alone dance the same steps.
And yet, at the final performance, dancing in step as the heavy dhol beat blares, each dancer’s own story shines through. The masterful grace of her classical training, patterned in the perfection of every hand position. The power of his lithe form as he spins across the floor. And her brilliant, tearful smile, lighting up the stage in her bliss at the enormous hurdles she has overcome. These individual moments, shared by the collective as they dance along, give bhangra its power to bring people together.
At our final performance as health professionals, we must embrace these individual moments. The physician who comforts the sobbing newly-widowed. The medical student who sits vigil by the bedside after shift. The social worker who brings a fractured family back together. In forming a team, a team that is truly dedicated to doing the best for our patients, we must learn to speak the same language. We must learn to dance the same steps. We must learn to embrace our individual eccentricities to enhance our practice of medicine.
There will be errors and there will be failures. Many bhangra teams end their dances with a stunt, a high-risk, high-stakes formation that requires mastery, trust and immense coordination, not dissimilar to much of what we do in health care. Dancers get hurt all of the time—I’ve seen a broken toe and a few sprained ankles from stunts gone wrong. In the same way, practitioners and patients will get hurt. In moving forward as a team, we must be open in discussing our failures, seeking help to cope and move forward.
As Williams stated in her address, the practice of medicine is indeed as the cusp of revolution. Whether it is tango or bhangra, we must cast aside the dances of old and embrace a new beat, a new rhythm, to move us into a new era of better care for our patients.
And so, to borrow from Dr. William’s speech, “shall we dance?”
Or, for you bhangra fans out there: “Chak de phatte!”