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Greiner enrolled in medical school at KU after earning a degree in anthropology from Brown University in 1991. As a teenager in Topeka, he did not dream of becoming a doctor. At Brown, he took courses in neuroscience that made a medical degree seem like something worth pursuing.
At first, Greiner resented the way his instructors made medical school feel like boot camp with a lot of Latin.
"They start shoving all these facts at you, and the sort of underlying message is, if you don't memorize all these facts about biochemistry and physiology and anatomy, then you're going to kill people," he says. "You're going to fuck up, and people will die, and it's going to be your fault."
In addition to his issues with the way he was being taught, he felt the profession was generally too cold and paternalistic. "Health care and medicine is very dehumanizing and, I think, has a lot of problems," he says. Greiner set out to memorize the necessary facts and ace the necessary tests because he wanted to be able to change the system from within.
Greiner, who is 42, gravitated toward public health, a field that recognizes that there's more to medicine than diagnoses and cures. With his anthropology background, he responded to the idea that culture, environment and behavior affect disease and health in important ways. He chose to do his residency in family medicine, seeing it as a logical place for someone with an interest in public health. Family docs, after all, are anthropologists of sorts, forming a picture of their communities with every new patient who walks through the door.
At the time, family medicine was a popular specialty. By 1993, a majority of workers with employer-sponsored health insurance received some form of managed care. Family docs were seen as the quarterbacks in this system, which was designed to reduce unnecessary medical costs
Alas, capitation — health maintenance organizations paying doctors a fixed sum to cover each patient in a practice — was rejected by the public.
"They thought doctors were getting money and then withholding care and then profiting more by withholding that care," Greiner says. "So they saw it as a conflict of interest to do less to people."
Today, the system is biased in the opposite direction. Insured patients generally receive more care than they need. Physicians receive payment for the services they perform, not for keeping people well. The model rewards a doctor who, for example, orders tests on a mole that looks benign. "I might just say, 'Well, let's just cut it out and send it to the pathologist,'" Greiner says.
Greiner would like to see a system that puts more emphasis on prevention and helping people live better, healthier lives.
"Most of what we do in medicine and health care is sick care," he says. "We wait until people get sick, and then we try to do heroic things to get them OK for a while. And a lot of that, we're only getting them OK for a short period of time, and their quality of life is going to suck."
As Greiner sees it, the challenge is to deliver the best health to the largest number of people. To test for possible solutions, he's going into areas where sickness and disease are most prevalent.
It's a Tuesday in May, and Greiner and a team of students and researchers are assembling at KU Med for a trip to an American Indian reservation.
Greiner is dressed in a blue button-down shirt and tan pants. The team members wear red T-shirts bearing the logo of the American Indian Health Research and Education Alliance, an effort supported by KU Med's Department of Preventive Medicine. Equipment necessary to stage a health fair is being packed into the vehicles that will make the trip to the reservation of the Ioway Tribe of Kansas and Nebraska.