American Health Care Is Sick–and Its Workers Are, Too – Scientific American

By | August 30, 2019

American medical students, physicians and nurses: There’s good news and bad news.

The bad news is that our health care system and many of its workers are sick. The good news is that we can heal them. We should waste no time in starting.

Health care is a big business, and our system reimburses hospitals and health care workers for caring for the sickest people rather than healthiest ones. This process depletes healers’ energy and often causes them to become exhausted and sick. That means all of us who work in or study to work in health care are at risk. To break this vicious cycle, we need self-scrutiny and willingness to change.

The sickness in our health system mirrors a larger breakdown in society. Unchecked capitalism drives us to feel separated and in competition with each other. This mindset attacks the very root of community and personal health, where deep connection, shared purpose and intentional interdependence are found.

And what, exactly, is health?  I believe health is best expressed as the ratio between our biological age (our body’s real age) and our chronological age (our birthday age): to be healthy is to have the lowest possible biological age. There is overwhelming evidence that our biological state deeply reflects our perception of our life, our mindset and our mental state. Studies unequivocally show that perceptions of chronic stress, loss of social capital and social isolation accelerate biological aging and shorten our lifespan. As one example, using Nobel laureate Elizabeth Blackburn’s research on telomeres (the repetitive nucleotide sequences at the end of each chromosome), we find that perceiving chronic stress in our lives accelerates biological aging dramatically.

What is the relevance to us? Look at America today. Our societal habits drive chronic stress, social isolation and constant competition. I can only rise if you fall: classic scarcity and a fixed mindset that causes “dis-ease” or disease. We compete for jobs, spouses, money, power, likes on social media, our children’s college or positions on a travel sports team. Our lifestyle is making us sick.

The health care delivery system both reflects society’s ills and reinforces them.

Health-professions students and workers live in chronically stressful environments—responsible for an increasingly sick population, which they are expected to repeatedly rescue from failure. To heal others, our health care professionals need healing themselves.

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These healers are part of a business ecosystem that includes insurance companies, competing health systems and governmental agencies and regulators that create glaring inefficiencies in care delivery.

This system may maximize the acute care model, but its very nature is causing its providers to become sick themselves. It is not sustainable. Today in the U.S., we spend about 20 percent of our GDP on health care—almost twice as much as any other country. While we have excellent sick-care services, our overall outcomes are among the worst in the Westernized world.

What is the solution? I believe it is getting back to our roots, which is the healing profession of medicine.

Doctors and health care providers are the key protagonists in the value chain, but have been funneled into a complicated business ecosystem for many years. Our students take the Hippocratic oath, which professes one’s commitment to the time-honored profession and art of medicine. To all of you I say: We need to remember this commitment to our healing profession. As we update this oath, we need to also commit to healing our healers.

Studies show that people who work in “cognitive” fields, like medicine, need more than money to keep them happy and manage their stress. They seek autonomy, mastery and purpose. But we’ve applied the assembly-line model to the cognitive field of health care. Highly efficient system engineering works in the assembly-line model but tends to exhaust the cognitive workers found in health care. So many of them feel like cogs in a machine, where the transactional nature of the field dwarfs their own energy to heal others. They become sick. Nearly half of U.S. doctors report burnout. This has driven a growing discussion about how to “heal the healers.”

At West Virginia University, we strive to be a leader in healing and to change our delivery model to one of collaboration and team.

At our health care delivery system, WVU Medicine and nationally, we are at a fork in the road in our profession.

The moment from which change can and must spring forth.

I came back home to my West Virginia roots after 30 years in Ohio. West Virginia is the right place for an experiment of reconnecting our professionals to our field’s deep purpose. To create a healing environment for those who care for others. We have a strong tradition of community here, and surprising openness to change.

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That’s why WVU and WVU Medicine have succeeded in recruiting 500 physicians in the last four years from around the country.

At the core of our philosophy is community and purpose—something America appears to be losing. We are changing the university and health care delivery system culture, and innovating an ecosystem that impacts our community, our training program, and our delivery system and network. We’re changing our curriculum to infuse threads of health and well-being in hopes of creating a sort of holistic “East meets West” approach that avoids the reductionist tendency of the dominant stream.

Here are some examples:

  • We have opened a collaborative dialogue with our physician and health care leaders to create shared decision-making with local autonomy to implement changes. This “bottoms up” approach ensures that we are engaging our professionals to deliver on our critical promises—serve the state of West Virginia and its residents, change health care from sick to well care, and focus on supporting our healers so that they can heal others.
  • We have a quality-of-life program that focuses on offerings for students, faculty and staff including yoga, mindfulness, concerts (from students, faculty and staff), poetry, art, pop-up events, a farmers’ market, a health sciences museum, a theater, outdoor relaxation spaces, walking paths and a community garden.
  • We bring experiential learning into the curriculum including making home calls with students, training public health navigators to be local health coaches back in their communities and working with our extension agents in each county to provide healthcare access and help. 
  • Our approach to pain is not opioid-requiring. We don’t ask people “What is your pain?” but rather “What is your function?” We’re not asking how much pain you have but how much function you have. We are the only civilian site in the country where the Defense and Veterans Center for Integrative Pain Management program is deployed. This is a program that focuses on non-opioid treatment for pain and relies on functional recovery of patients versus just pure pain relief. Interventions include yoga, mindfulness, acupuncture, chiropractic, massage, individual and group therapy as well as case management.
  • We are active in our efforts to partner with an insurance company that will work within our system. This new capability will allow us to take premiums for a person’s health care needs over their lifetime. The more ill these patients become, the more we will have to pay out of these premiums. This effect will drive us to further our goal to provide health and well-being programs to our citizens that are community- and family-based. Changing the business model from disease-focus to health-focus is our goal and this facilitates the transition for our delivery system, WVU Medicine.
  • We have an active storytelling thread for patients who have cancer and HIV, which seems to help their problems with chemotherapy and fear of stigmatization. We also incorporate students in our Comprehensive Opioid Addiction Treatment (COAT) program using medication-assisted therapy, individual and group counseling and case management. 
  • We opened tele-ECHO (extending community health outcomes) whereby experts train primary care folks in the COAT program, in HIV and Hepatitis C treatment, in behavioral health and many others. We also have trained many of the state’s first responders to administer naloxone to reduce deaths from opioid overdose and have been working in communities to rebuild health and hope. 
  • Our residential opioid recovery has expanded to focus on job training in a community college, and on work and life skills help (interviewing for a job, keeping a checkbook, etc.). Helping people find jobs is not just giving them work and pay, but primarily a way to enjoy life and to gain purpose. This relieves stress, and that begets health.
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I believe that we human beings are like the fungus in the forest. We look different above the ground but are part of the same interconnected network below the surface. Instead of trying to compete with each other, we should try to work together. That’s how you get harmony, balance and a feeling of wholeness; that’s how you get health.

And I believe we’ll get there. Things may not be perfect today, but that can be precisely how you get transformational change. Our challenge—your challenge—is to rise to the occasion and commit to healing ourselves so that we can heal others.

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