The incredible subway violinist story

On January 12, 2007, Joshua Bell, one of the world's top violinists, strolled into the L' Enfant plaza metro station in Washington, DC, pulled out his $3.5 million Stradivarius violin and began playing. Joshua had, evenings before, played before a sold out crowd in Boston where people gladly paid $100 per ticket to hear him perform. But, on this morning, during rush hour, Bell was playing in this metro station for free.

During his 45 minute concert, nearly 1100 people passed by, and 27 paused to put money into his violin case ($32 and change was collected in all). Only seven actually stopped to listen, despite his world class performance of six extremely well performed classical violin solos.

This event was an experiment sponsored by the Washington Post. The Post was confirming what psychologists (particularly those interested in ecological or environmental influences on behavior) already knew. People's perceptions are greatly influenced by situational or contextual variables. We are apt to expect to hear a great concert in a concert hall, but not in a subway station.

You can see (and hear) a filmclip of Joshua playing his free performance here.

What lessons should we take away from this event, now over two years passed? Well, for one thing, there is the lesson that if we are attentive and in the moment, we are more likely to recognize what is taking place in our lives and to thus benefit from the beauty when it is there. Beyond this, it seems likely that another lesson is that good wine can be sipped and enjoyed from a paper cup, just as poor wine can be found masquerading in elegant crystal wineglasses.

Deception preys on assumption, but truth exists independent of its surroundings. Life is all around us to enjoy. Next time you pass by a performing musician working to supply the air with beauty, take a moment to enjoy them, feed their empty case, and thank them for making the world a more beautiful experience. Everyone will feel better as a result.

What makes a good health care experience?

With the fast appointment, and equally sudden withdrawal of Tom Daschle as Secretary of Health and Human Services, what had been growing momentum behind long overdue health care reform was derailed, and we hope only temporarily sidetracked. Daschle, a veteran of Congress and one who had experienced many attempts at health care reform, was viewed as a very solid and informed choice for the post. Those who have read his book, know that he is an advocate for practical and doable change, recognizing that what many see as the ultimate destination, a single payer system, may require some interim steps. His plan would amalgamate existing government care programs, require that everyone be covered with affordable insurance for a basic level of health care services, and remove politics from decision making by creating a federal health board with confirmed appointees (like the Federal Reserve Board) to oversee the system.

Personally, while some of Daschle's plan characteristics have merit, I am a proponent of going for the whole enchilada now and proposing a single payer system to get rid of greedy profit motivated health insurance companies now. Why allow profit at the expense of health and life? And why spend even one more penny on marketing, advertising or competition when the money can and should go to delivering care and prevention?

Let's do what we have to do now to make the system affordable, accessible, fair, accountable, universal, portable, and responsible. By responsible, I mean a system that devotes resources to health promotion and prevention, a system that aims to promote well-being rather than just ameliorate disease after it has occurred, and a system that recognizes that responsible lifestyle change is more than half the battle in keeping people well. Health is related to happiness and happiness is related, inextricably, to doing what makes life worth living, with those we love, and in supportive communities. Beyond these basic philosophical changes, why not pay providers more for keeping their patients healthy? Rewarding them for listening to and counseling their patients about lifestyle (not just exercise and nutrition) might also be a nice addition.

Think about your idea of a good healthcare experience. I have had primary care delivered by angels and by robots. By people who listened and believed I knew my own body, and those who were so focused on arriving at a diagnosis, (or getting to their next appointment) that they cared little about my experience of illness. Incredibly, the Washington Post had an article recently about an Ethiopian-born physician who is also a novelist (Abraham Verghese) who proposes that medical schools teach their students about the importance of the life stories of their patients. This advice is, on the one hand, good news— and on the other, incredible in its acknowledgment that medical curricula are woefully out of touch. I doubt it is coincidental that my favorite primary care practitioners are physicians who were first trained as nurses, pharmacists or therapists. In fairness to medical schools, (not that any is really warranted) it is incredibly difficult to change the curriculum in a medical school, even a smidgeon.

So, what characteristics do you think make for a good health care encounter? Share them here, and perhaps a medical educator or two who believes in the importance of the humanities will stop by and take note.