The Way Of Generative Medicine
By Dr. Kristi Crymes
If only we were sitting together around a fire on a dark night, you would know right away what I mean by generative medicine, why we need it, how to do it, and we’d figure it all out. I would speak to you from my heart and you would nod and sigh with relief. I will imagine it as I type, and you imagine as you read; when we get to the end our hair will smell like campfire and we’ll get to work.
From my cushion and my clinic, I see well-intentioned people, myself included, causing suffering for themselves and others for no other reason than that they are part of a poorly-designed system. This is a hard truth, especially for this family medicine doctor with the best intentions. I went into medicine to relieve suffering not to cause it.
I missed this truth for a long time. This type of suffering can be subtle and hard to perceive because it hides in the status quo. It can also be profound as shown by the events of this last year exposing deep inequities and everyday tragedies in the healthcare system. So it can be both easy to miss and so big it feels impossible to change. Fortunately, my Zen practice and experiences during HEAL/ZL training have helped me not only see what is true, but what is possible and how to bring that possibility through me out into the world.
So there is good news: there is a way for us to have a sustainable, equitable healthcare system which generates true health for society and for the planet, I call it generative medicine. It’s a crazy thing to say and yet it is totally possible and the only sane thing to do. The catch is that we have to create it ourselves.
Generative medicine is what we might have if we use the wisdom of permaculture principles and ethics to design a healthcare system. Permaculture is looking deeply at the ways nature actually works and using those ways as design tools for human systems. Traditionally used to develop sustainable agriculture and landscapes, it is whole-systems design based on 3 ethics: Planet care, People care, and Future care/Fair share. It is an entire field of study which I can only briefly touch on here to the extent that my amateur understanding and this stack of firewood will allow. Ginny has written about the use of permaculture principles in leadership and as it turns out, it can apply to any system that affects people and the planet (which is every system).
You may have noticed that Zen and permaculture are ready companions. At first glance you’ll see awareness, connection, flow and compassion weaving them together. Zen training creates the human condition that is able to see itself and its connectedness to other parts of nature without backing off from the responsibility that has become clear. Permaculture, being a set of design principles, “helps harness creativity and put it to work” in a way that is not only sustainable, but regenerative. It doesn’t just keep a system going, it creates a thriving ecosystem filled with diversity and nurturing connection. In permaculture design, a component’s output is another’s input, every component is connected in some way, and the relationships keep it going, improving and changing. To me, the “perma” in permaculture represents permanent possibility, and that is exactly what our healthcare systems need.
Applying these principles to my every day work as a physician in the American healthcare system has profoundly changed my understanding of the system I thought I was so familiar with: We are all doing the best we can, we have more power than we think we do, and the solutions are right in front of us. What a relief it will be when we get to work and put it all together.
Kristi Crymes, DO, is a family medicine physician, a Zen Leader/HEAL instructor, a member of the board of directors of IZL and a Chosei Zen student. She is pursuing a Permaculture and Social Systems Design Certificate through the Permaculture Women’s Guild.
