Tj Host

Wedding Ideas & Inspiration
Patient Engagement

Patient Engagement


– SO HERE IS THE THING. EVEN IF WE HAVE A PERSONALIZED,
PROACTIVE STRATEGY AND PLAN FOR EVERY VETERAN, NOT MUCH WILL CHANGE UNLESS
THEY THEMSELVES ARE ENGAGED. UNLESS IT’S DRIVEN
BY WHAT MATTERS TO THEM, IT WILL SIT ON THE SHELF,
AND IT WILL BE ONE MORE BOX TO BE CHECKED OFF AND ONE MORE
CLINICAL REMINDER WE DID, BUT NOTHING WILL REALLY
TRULY CHANGE. SO WE MUST REMEMBER
THAT THIS ALL STARTS WITH THE VETERAN
AND WHAT MATTERS TO THEM. THEIR HEALTH NEEDS TO BE
IN SERVICE OF THAT WHICH MATTERS TO THEM. THE CORE ISSUE IS THAT PEOPLE
WILL NOT ENGAGE IN BEHAVIOR CHANGE
OR IN THEIR HEALTH CARE UNLESS IT BEGINS WITH THEM. THE PRESIDENT AND CEO OF THE INSTITUTE FOR HEALTH CARE IMPROVEMENTS SAYS IT REALLY WELL. SHE SAYS, “WE NEED TO START “NOT BY ASKING, “WHAT IS THE MATTER WITH YOU?” “WE NEED TO START BY ASKING, “WHAT MATTERS TO YOU?” IF WE LOOK AT THIS FROM
THE PERSPECTIVE OF THE VETERAN, YOU CAN SEE IT STARTS
WITH THEM– WHO ARE THEY,
WHAT MATTERS TO THEM, HOW DO THEY WORK THEIR BODY,
HOW DO THEY REST AND RECHARGE, HOW DO THEY REFUEL
WITH FOOD AND/OR DRINK– AND ALL THE WAY AROUND THOSE
COMPONENTS OF PROACTIVE CARE. YOU CAN SEE THAT THEIR TEAM EXISTS OF A LOT MORE THAN JUST
THE HEALTH CARE PROFESSIONALS. IT MAY INCLUDE FRIENDS,
FAMILY, COWORKERS, SPOUSES, RABBIS, PRIESTS. IT MAY INCLUDE COACHES,
THEIR YOGA TEACHER, WHOMEVER IT IS THAT HELPS
SUPPORT THEIR HEALTH AND WELL-BEING TO GET TO THE END,
THE END GAME– LIFELONG HEALTH AND WELL-BEING,
WHICH, AGAIN, DOESN’T MEAN WE’RE ALL ALWAYS HEALTHY
AND NEVER GET SICK, BUT IT DOES MEAN THAT AS WE GO
THROUGH OUR LIFE, WE OPTIMIZE OUR HEALTH AND
WELL-BEING EVERY STEP OF THE WAY REGARDLESS OF WHAT CONDITIONS
WE’RE DEALING WITH. IF WE TAKE A DEEPER DIVE INTO
WHAT DOES THIS PROCESS LOOK LIKE OR WHAT CAN THIS PROCESS LOOK
LIKE FROM THE PERSPECTIVE OF THE CLINICIAN,
MANY OF THESE PIECES WE DO, BUT IT’S OFTEN VERY FRAGMENTED. THERE’S NOT ONE OVERARCHING
STRATEGY THROUGH WHICH ALL OF THESE CONDITIONS
AND PIECES COME TOGETHER. SO HERE’S A WAY THIS CAN LOOK. WE BEGIN LIKE WE ALWAYS HAVE, WITH A COMPREHENSIVE
HEALTH HISTORY, BUT IT’S AN EXPANDED
COMPREHENSIVE HEALTH HISTORY, ASKING QUESTIONS IN AREAS THAT WE WEREN’T PREVIOUSLY TRAINED TO ASK IN. WE THEN GO INTO
A HEALTH ASSESSMENT, BOTH A HEALTH RISK ASSESSMENT
AND THAT OWN VETERAN’S EXPERIENCE AND REFLECTION
ON THEIR HEALTH– WHAT DO THEY THINK IS IMPORTANT, WHAT’S STRONG AND WEAK, WHERE WOULD THEY WANT TO WORK. THAT’S REALLY IMPORTANT
INFORMATION FOR US TO HAVE. THE TEAM– WHETHER IT’S A PACT TEAM A SPECIALTY TEAM, WHATEVER THE CASE MAY BE– BRINGS THEIR MEDICAL EXPERTISE AND THEIR CLINICAL JUDGMENT IN PARTNERSHIP WITH THE VETERAN,
WHO BRINGS WHAT MATTERS TO THEM, THEIR MISSION, THEIR VALUES,
THEIR PRIORITIES, AND TOGETHER THEY CREATE
A PERSONALIZED HEALTH PLAN. THE PERSONALIZED HEALTH PLAN IS AN OVERARCHING PLAN THAT INCORPORATES THE TREATMENT PLANS AND THE CARE PLANS THAT ALREADY EXIST BUT GOES BEYOND THAT SO THAT THE ONE OVERARCHING STRATEGY EXISTS. SO WHETHER YOU HAPPEN TO BE A PERSON WHO’S DEALING WITH, YOU KNOW, AN ACUTE ISSUE WITH AN INFECTED TOE, YOU’RE STILL GONNA KNOW WHAT MATTERS TO THAT VETERAN, WHAT THEY’RE ABOUT, AND HOW THAT FITS INTO THE WHOLE PLAN, AND THE LAST ELEMENT OF THIS IS SUPPORT IN BOTH ACQUIRING THE SKILLS THAT PEOPLE NEED TO CARRY OUT THE PLAN AND SUPPORTING THEM ACROSS TIME IN DOING IT. THE WHOLE PACKAGE IS THE
PERSONALIZED HEALTH APPROACH. SO THIS SOUNDS LIKE A VERY
EXPANSIVE SHIFT, AND IT IS, BUT IT CAN REALLY COME DOWN
TO JUST A DIFFERENT PERSPECTIVE IN THE WAYS YOU INTERACT
WITH YOUR PATIENTS. TAKE, FOR EXAMPLE, AN
88-YEAR-OLD WOMAN WHO COMES IN AND SHE’S HAD A BONE SCAN,
A DEXA SCAN, RECENTLY AND SHE HAS OSTEOPOROSIS. THE RECOMMENDATION IS FOR HER
TO START A BISPHOSPHONATE, A BONE-BUILDING AGENT. SHE’S INFORMED ABOUT THE ISSUE.
SHE THINKS ABOUT IT. SHE KNOWS ABOUT THE SIDE EFFECTS
BECAUSE YOU’VE INFORMED HER, AND SHE REALLY HAS DECIDED THAT
SHE LOVES HER QUALITY OF LIVE. SHE DOESN’T WANT TO RISK
THE SIDE EFFECTS. SHE’S 88 YEARS OLD, AND SHE,
IN A VERY INFORMED WAY, MAKES THE DECISION NOT TO GO
ON THE BISPHOSPHONATE. SO THAT’S FINE. THAT’S PERSONALIZED
BECAUSE THE DECISION WAS DONE FULLY INFORMED
AND IN PARTNERSHIP WITH HER. WHAT ABOUT THE PROACTIVE PART? THE PROACTIVE PART IS,
THERE ARE THINGS SHE CAN DO TO REDUCE HER RISK
OF A HIP FRACTURE. FOR EXAMPLE, YOU MIGHT
INFORM HER SHE COULD JOIN A CLASS IN TAI CHI,
WHICH HELPS INCREASE BALANCE AND BODY AWARENESS
AND HAS BEEN SHOWN TO DECREASE FALLS
AND REDUCE HIP FRACTURES, REDUCE HIP FRACTURES NOT BECAUSE
THE BONE DENSITY IS HIGHER, BUT REDUCE HIP FRACTURES BECAUSE
THE PERSON IS NOT FALLING. THAT’S SUCH A GREAT EXAMPLE
OF A PROACTIVE APPROACH. OUR MEDICAL MODEL IS,
“WELL, WE’LL GIVE A DRUG TO INCREASE BONE DENSITY,” WHICH
ISN’T WRONG, BUT IT’S LIMITED. A MORE PROACTIVE APPROACH,
“I COULD DO SOMETHING SO THAT I DON’T FALL
OR I’M NOT AS LIKELY TO FALL,” AND IN THE MEANTIME,
SHE MEETS MORE FRIENDS AND HAS MORE SOCIAL CONNECTIONS, WHICH IS ALSO
INCREDIBLY HEALTHY FOR HER. ANOTHER EXAMPLE INTO
HOW JUST THIS APPROACH CHANGES THE STEPS WE TAKE, TAKE, FOR EXAMPLE, A 32-YEAR-OLD
GENTLEMAN WITH MORBID OBESITY. HE COMES IN AND HE “KNOWS”
HE “MUST” LOSE WEIGHT. WHY ARE THERE QUOTES? HE, IN HIS HEART AND IN HIS GUT, NO PUN INTENDED,
ISN’T BOUGHT IN. HE FEELS LIKE
HE’S TRIED SO MANY TIMES AND HAS FAILED SO MANY TIMES. SO, YEAH, HE’S GOING TO SAY,
“YEAH, I WANT TO LOSE WEIGHT.” WELL, REALLY WHAT HE WANTS IS,
HE WANTS TO WANT TO LOSE WEIGHT. HE WANTS TO WANT TO LOSE WEIGHT,
BUT HE’S NOT UP FOR IT. HE FEELS LIKE HE’S FAILED. HE HAS NO CONFIDENCE.
HE’S STRESSED. HE KNOWS IF HE STARTS ANOTHER
DIET, HE’LL FAIL AGAIN. SO THE TEAM LISTENS TO HIM. THEY PERSONALIZE THE PLAN. THEY SAY, “YOU KNOW WHAT? WE’RE NOT GOING TO HAVE
AS OUR GOAL–” EVEN THOUGH,
STRICTLY MEDICALLY SPEAKING, HIS GOAL SHOULD BE
TO LOSE WEIGHT, “WE’RE NOT GOING TO HAVE THAT
AS YOUR GOAL RIGHT NOW. “WE’RE GOING TO HAVE
AS YOUR GOAL TO START BUILDING “SOME STRENGTH AND SOME SKILLS
AND STRESS REDUCTION AND MIND-BODY TECHNIQUES,” AND HE BEGINS TO LEARN HOW TO DO
SOME OF THOSE APPROACHES, AND HE FINDS
THAT HE CAN LEARN THEM. HE FEELS BETTER, MORE RELAXED, AND MORE READY AND EAGER
TO TAKE A NEXT STEP. 3 MONTHS LATER,
HE COMES BACK, AND HE SAYS, “I THINK I’M READY TO BEGIN
THE JOURNEY OF WEIGHT LOSS,” TOTALLY DIFFERENT DOORWAY IN
AND A MORE SUCCESSFUL OUTCOME. THE THING ABOUT THIS APPROACH
TO HEALTH CARE, THE REALLY IMPORTANT
PIECE OF THIS, WHAT DOES IT MEAN
TO BE PROACTIVE? IT MEANS THAT WE DON’T WAIT
FOR THE HEART ATTACK OR THE CANCER DIAGNOSIS
FOR SOMEONE TO HAVE THEIR WAKEUP CALL, AND
I THINK YOU KNOW WHAT I MEAN. MANY OF US KNOW PEOPLE
WHO HAVE SAID, “YOU KNOW, IN SOME WAYS,
THE BEST THING THAT EVER HAPPENED TO ME
WAS MY HEART ATTACK,” “WAS MY CANCER DIAGNOSIS,”
NOT BECAUSE THEY WANTED TO HAVE A HEART ATTACK
OR CANCER, BUT BECAUSE THAT DIAGNOSIS WAS
SO SIGNIFICANT IN THEIR LIFE, THEY RE-EVALUATED
WHAT MATTERS TO THEM. THEY LINED UP THEIR LIFE
IN A DIFFERENT WAY THAT WAS A HUGE BLESSING
AND GIFT. THE VALUE OF THIS APPROACH, A PROACTIVE APPROACH THAT STARTS
WITH WHAT MATTERS TO THE PERSON, IS, IT ALLOWS US TO BEGIN
IN THAT PLACE AND NOT WAIT
FOR THE WAKEUP CALL. WHAT DOES THIS LOOK LIKE FROM
THE PERSPECTIVE OF THE VETERAN? WELL, THERE ARE 4 STEPS– FIRST, THEIR MISSION
FOR THEIR LIFE AND THEIR HEALTH, AND THAT CAN BE ANYTHING
BASED IN WHAT MATTERS TO THEM AT THAT MOMENT IN TIME. IT COULD BE THEY’RE
A HOMELESS VETERAN AND THEIR MISSION IS ABOUT FOOD
AND SHELTER. THERE IS NO MORE IMPORTANT
MISSION THAN THAT. THE FIRST MISSION. THE SECOND–PLAN, A PERSONALIZED HEALTH PLAN
THAT BRINGS TOGETHER ALL ASPECTS OF THEIR HEALTH
AND THEIR HEALTH CARE. THE THIRD–TRAINING,
TRAINING AND SKILL BUILDING SO THEY HAVE WHAT THEY NEED
TO SUCCEED IN THE MISSION, AND THE LAST IS SUPPORT, SUPPORT SO THEY CAN SUCCEED
ACROSS TIME. MISSION, PLAN, TRAINING,
AND SUPPORT, AND WHAT’S REALLY
INTERESTING IS, IF YOU REFLECT ON THE VALUES
AND THE CULTURE OF OUR VETERANS, THESE ARE NOT
NEW CONCEPTS TO THEM. THEY ARE ALL ABOUT MISSION. WHEN THEY WERE ACTIVE DUTY,
THEY OFFERED A TREMENDOUS AMOUNT IN SERVICE OF MISSION, THE MISSION READINESS
OF OUR COUNTRY. THEY WOULD NOT HAVE GONE
TO BATTLE WITHOUT A PLAN, AND THEY WOULDN’T HAVE GONE
TO THEATER WITHOUT HAVING BEEN TRAINED
IN THE SKILLS THEY NEED TO CARRY OUT THE MISSION, AND LASTLY THEIR SUPPORT
AND RELIANCE ON THEIR FELLOW AIRMEN,
SOLDIERS, SAILORS, AND MARINES IS LIKE NONE OTHER
THAT I’VE SEEN. THEY KNOW THAT THEY LITERALLY
LIVE AND DIE BY THOSE TEAMMATES. SO THESE ARE NOT NEW VALUES
TO OUR VETERANS. THEY UNDERSTAND THE IMPORTANCE
OF THEM, AND NOW WE CAN DO THIS IN
SERVICE OF THEIR HEALTH CARE. SO I WANT TO JUST
TAKE A MOMENT AND ASK, IS THIS FUNDAMENTALLY A
DIFFERENT APPROACH TO MEDICINE, YOU KNOW, COMPARED
TO THE WAY WE WERE TRAINED, OR I WAS TRAINED,
AS A PHYSICIAN? AND I ALSO WANT TO SAY
THAT IF I WERE A NURSE OR ANOTHER KIND OF HEALTH
PROFESSIONAL LISTENING TO THIS, I’D BE GOING, “OH, YEAH.
NOW THE DOCTOR GETS IT. NOW IT’S A BIG DEAL,” BECAUSE THESE PHILOSOPHIES
AND APPROACHES ARE FUNDAMENTAL TO MANY HEALING PROFESSIONS,
LIKE NURSING. THIS IS NOT NEW,
SO YOU MAY LAUGH, AND YOU MAY JUSTIFIABLY SAY,
“FINALLY, YOU GOT IT.” THE ISSUE IS THAT NURSING,
FOR EXAMPLE, THOSE PARADIGMS HAVE NEVER BEEN THE DOMINANT PARADIGM
IN THE SYSTEM. SO NOW IT’S TIME TO CHANGE IT,
BUT FROM THE PERSPECTIVE OF THE MEDICAL MODEL, THERE
ARE SOME FUNDAMENTAL SHIFTS. FIRST OF ALL, THE CONCEPT THAT THERE IS AN INNATE
HEALING CAPACITY IS SOMETHING THAT I WAS
NEVER TAUGHT, NEVER. WHAT DO I MEAN BY THAT? DOES THE BODY HAVE THE CAPACITY
TO HEAL ON ITS OWN? WELL, EVEN THOUGH IT’S NOT
PARAMOUNT IN MY THINKING, THE FACT OF THE MATTER IS,
THERE’S TREMENDOUS EVIDENCE THAT WE ARE DESIGNED TO HEAL. WE HAVE AN INNATE CAPACITY
TO HEAL. IT’S NOT LIMITLESS. IT’S NOT THAT WE DO IT,
IT NEVER GETS OVERWHELMED. IT’S NOT IF WE DO
EVERYTHING RIGHT, WE NEVER GET SICK
OR WE NEVER DIE. OBVIOUSLY, WE DO,
BUT IF YOU CAN LOOK AT SOMETHING AS SIMPLE AS A CUT
AND SEE THE BODY HAS TREMENDOUSLY SOPHISTICATED
MECHANISMS TO HEAL, THE BLEEDING IS TO GET
THE INFECTION AND THE POTENTIAL GERMS OUT, AND IF YOU WATCH A CUT ACROSS
A SERIES OF A FEW DAYS, IT IS FASCINATING WHAT HAPPENS,
AND IN THE END THE SKIN REGROWS, AND MANY TIMES YOU CAN’T
EVEN TELL YOU HAD A CUT. WE’RE SO ACCUSTOMED TO IT, WE DON’T SEE
HOW SIGNIFICANT THAT WAS. WHAT ABOUT A BROKEN BONE,
YOU BREAK A BONE? IF THAT BONE IS LINED UP
IN ALIGNMENT, YOU CAN DO NOTHING,
AND THE BODY WILL HEAL. IT WILL REGROW THE BONE.
THAT’S INTERESTING, RIGHT? THINK ABOUT IT
FROM THE PERSPECTIVE OF A MOLECULAR LEVEL. EVEN AT A MOLECULAR LEVEL, THERE ARE VERY SOPHISTICATED
MECHANISMS OF SELF-REPAIR. THERE ARE MOLECULES WHO SPEND
THEIR WHOLE LIFE, POOR THINGS, RUNNING UP AND DOWN
STRAINS OF RNA LOOKING FOR ERRORS
IN THE SEQUENCE. THAT’S WHAT THEY DO. THAT’S WHAT THEY’RE
DESIGNED TO DO. WHEN THEY FIND AN ERROR, THEY SIGNAL TO ANOTHER KIND
OF MOLECULE TO COME IN. THAT MOLECULE HAS AN ENZYME
THAT CUTS THE BONDS THAT TAKE AWAY THE ONE
THAT’S AN ERROR, AND THAT MOLECULE SIGNALS
A THIRD KIND OF MOLECULE THAT COMES IN AND HAS THE SKILL TO REPLACE THAT SEQUENCE
WITH THE RIGHT ONE. THAT IS AMAZINGLY SOPHISTICATED
AND JUST ONE EXAMPLE OF MANY OF THE MULTIPLE LEVELS
IN OUR BODIES AND OUR MINDS THAT ARE DESIGNED TO REPAIR. SO IF YOU UNDERSTAND THAT, THEN OUR ROLE IN MEDICINE
COMPLETELY SHIFTS. WE’RE NO LONGER AT WAR WITH
ANTIBIOTICS AND ANTIPSYCHOTICS AND ANTI THIS AND ANTI THAT. ACTUALLY, ONE WAY OF LOOKING
AT WHAT WE CAN DO IN MEDICINE IS TO SUPPORT THE BODY’S
INNATE HEALING MECHANISM. LET ME GIVE YOU AN EXAMPLE.
PNEUMONIA IS A GREAT EXAMPLE. IN MY PARADIGM, I WAS TAUGHT THAT THE ANTIBIOTIC
CURED THE PNEUMONIA, BUT IN ACTUALITY, WHAT’S
HAPPENING IS THAT THE ANTIBIOTIC IS ABSOLUTELY CRITICAL AND
ABSOLUTELY HELPS AND SAVES LIVES BECAUSE IT REDUCES THE BACTERIAL
LOAD THAT’S IN THE BODY SO THAT THE BODY’S HEALING
MECHANISMS CAN SUCCEED IN FIGHTING THE INFECTION AND THEN HEALING
THE DAMAGED LUNG TISSUE. SO IT’S A VERY DIFFERENT
ORIENTATION THAT ALLOWS YOU TO SEE I CAN BE PROACTIVE ABOUT
HEALTH BECAUSE I CAN SUPPORT AND OPTIMIZE THOSE APPROACHES
AND THOSE THINGS THAT WILL BETTER INFLUENCE
AND OPTIMIZE MY BODY’S OWN CAPACITY TO HEAL. WE KNOW, FOR EXAMPLE,
STRESS LOWERS IMMUNE FUNCTION. WE KNOW VERY COMMONLY THAT
POST-STRESS ILLNESS IS COMMON BECAUSE YOUR IMMUNE FUNCTION,
YOUR ABILITY TO FIGHT INFECTION, IS NOT AT ITS PEAK. SO THESE KINDS OF APPROACHES AND
STRATEGIES REALLY ARE DIFFERENT. IF YOU THINK ABOUT THE CONCEPT
OF A PLACEBO EFFECT– I LOVE THIS, RIGHT–
SO WHAT IS A PLACEBO EFFECT? IN EVERY RESEARCH STUDY,
THERE ARE SOME PATIENTS WHO DO NOT GET
THE ACTIVE INTERVENTION, BUT THEY STILL HAVE
A THERAPEUTIC RESPONSE. THEY GET BETTER WITHOUT THE DRUG OR WITHOUT THE THING
BEING TESTED IN EVERY STUDY, AND SOMETIMES IT’S 30%, 40%, A BIG PERCENTAGE OF PEOPLE
WHO HAVE A PLACEBO RESPONSE. TRADITIONALLY, WE’VE BEEN TAUGHT
TO KIND OF DISREGARD THAT AS LIKE, “WELL, YEAH. WE GOT A CONTROL FOR THAT
IN OUR STUDIES,” BUT IF YOU STOP FOR A MOMENT
AND THINK ABOUT IT, THE PLACEBO RESPONSE IS ONE
OF THE BEST ILLUSTRATIONS OF THE BODY’S CAPACITY TO HEAL. I WANT TO RENAME IT BECAUSE I THINK “PLACEBO”
KIND OF HAS BAGGAGE. WHAT IS IT REALLY? IT’S AN ACTIVATED
HEALING RESPONSE. SO SOMEONE GAVE AN AGENT
THAT ACTIVATED THE BODY, THAT SIGNALED THE BODY,
“IT’S TIME TO HEAL,” AND ON ITS OWN, WITHOUT
AN ACTIVE INGREDIENT, IT HEALED. I WOULD ARGUE THAT THAT
IS THE BEST KIND OF MEDICINE. WE SHOULD BE STUDYING THAT
IN DETAIL AND UNDERSTANDING
HOW TO REPRODUCE THAT BECAUSE IF WE CAN GET
A THERAPEUTIC RESPONSE WITHOUT AN ACTIVE INGREDIENT
AND WITHOUT THE SIDE EFFECTS OR RISKS, WHAT COULD
BE BETTER THAN THAT? SO IT’S VERY INTERESTING
TO UNDERSTAND THIS IS A VERY DIFFERENT
APPROACH TO HEALTH CARE. WHAT ABOUT THE CASES
OF SPONTANEOUS HEALING, PEOPLE WHO WERE NOT
SUPPOSED TO HEAL WHO DID? WE HAVE A LOT TO LEARN
FROM THOSE CASES. THE FINAL DISTINCTION
FROM MY PERSPECTIVE THAT I WASN’T TAUGHT
IN MY BIOMEDICAL TRAINING WAS THE CONCEPT OF HOLISM
AND THAT TRULY THE WHOLE IS GREATER
THAN THE SUM OF THE PARTS. SO IF I CAN CREATE A STRATEGY
THAT’S MULTIDIMENSIONAL AND ADDRESSES A CONCERN
ON MULTIPLE LEVELS, THOSE THINGS CUMULATIVELY
MAY OFTEN, ESPECIALLY IF THE CONDITION
OR THE CONCERN IS MULTIDIMENSIONAL AND COMPLEX, HAVE GREATER IMPACT
THAN MY SINGLE ONE STRATEGY THAT I MAY HAVE BEEN
TRAINED TO DO. PLATO SAID THIS BEST. PLATO SAID, “YOU OUGHT NOT “TO ATTEMPT TO CURE THE EYES “WITHOUT THE HEAD “OR THE HEAD WITHOUT THE BODY, “SO NEITHER OUGHT YOU “ATTEMPT TO CURE THE BODY “WITHOUT THE SOUL…. “FOR THE PART CAN NEVER BE WELL UNLESS THE WHOLE IS WELL.” A FEW OTHER DISTINCTIONS
THAT ARE DIFFERENT FROM THE DOMINANT
MEDICAL PARADIGM– THE ROLE OF MINDFULNESS,
OR AWARENESS, AND, SIMPLY PUT, MINDFULNESS
IS JUST BEING AWARE, BEING FULLY PRESENT,
WHICH GETS HARDER AND HARDER WITH ALL OF THE TECHNOLOGY
IN OUR WORLD THAT HAS OUR ATTENTION
ELSEWHERE. THIS CONCEPT IS EVERY BIT
AS IMPORTANT TO OUR HEALTH AS IT IS TO OUR
HEALTH CARE DELIVERY. IF WE LOOK AT MEDICAL ERRORS,
FOR EXAMPLE, MOST OF THE TIME, THEY’RE
RELATED TO OUR AWARENESS BEING SOMEWHERE OTHER
THAN THE TASK AT HAND. SO THIS IS AS APPLICABLE
TO THE PROVIDER BEING MINDFUL AS IT IS TO THE PATIENT. HOW DO WE BECOME PROACTIVE
ABOUT OUR HEALTH IF WE’RE NOT PAYING ATTENTION
TO OUR CURRENT STATE? IT’S A VERY IMPORTANT SKILL. THE GOOD NEWS IS,
IT’S VERY EASY TO LEARN, BUT IT DOES TAKE CONSCIOUS
AWARENESS AND A NEW SKILL. THE CONCEPT OF THE MIND-BODY
APPROACH IS PHENOMENAL. THE POWER OF THE MIND
TO INFLUENCE OUR HEALTH IS UNSURMOUNTED AND, I THINK,
UNEXPLORED TO LEARN HOW TO DO
THAT MORE EFFECTIVELY, AND THE PLACEBO RESPONSE
IS PROBABLY ONE OF THE BEST EXAMPLES
OF THE MIND-BODY INFLUENCE WORKING AT ITS BEST TO GET
A FULL PHYSIOLOGIC RESPONSE WITHOUT THE ACTIVE INGREDIENT, AND THE LAST THING I WANT
TO TALK ABOUT– AGAIN, A CONCEPT THAT IS VERY,
VERY WELL UNDERSTOOD AND REALLY THE BASIS FOR MOST
HEALING PROFESSIONS, BUT NOT NECESSARILY
THE MEDICAL MODEL, THE BIOMEDICAL,
PHYSICIAN-BASED MODEL– IS, THERE’S A HUGE DIFFERENCE
BETWEEN HEALING AND CURING, AND WHAT DO WE MEAN BY THAT? IF I’M, AS A PHYSICIAN, TRAINED
THAT MY OBJECTIVE AND GOAL IS TO CURE YOUR DISEASE,
WHAT VERY OFTEN HAPPENS WHEN I FAIL, WHEN I FIND
I CAN’T CURE YOUR DISEASE, IS, I FEEL LIKE A FAILURE. THE TEAM FEELS LIKE A FAILURE. WHAT HAPPENS NEXT? WE BEGIN TO PULL AWAY FROM
THAT PERSON, FROM THEIR FAMILY. WE TRANSFER THEIR CARE. WE SEND THEM TO HOSPICE, BUT THE DAMAGE IS DONE
BY PULLING AWAY, AND WHEN WE LEARN
THAT THERE’S SO MUCH MORE THAN JUST CURING THE DISEASE, THAT WHEN WE CAN’T CURE
THE DISEASE, THE CONCEPT OF HELPING
AND HEALING AND SUPPORTING THE PROCESS IS TREMENDOUS. ONE OF THE FELLOWS IN A TRAINING
PROGRAM THAT I USED TO WORK IN HAD A REALLY POWERFUL
EXPERIENCE WHEN HE, WORKING WITH A PATIENT
WHO HAD CANCER, REALIZED THAT SHE
WAS GOING TO DIE, AND HE TOLD HER HE FELT
LIKE HE HAD FAILED HER AND THAT THERE PROBABLY
WASN’T ANY REASON FOR HER TO CONTINUE
TO COME BACK. WHAT SHE TOLD HIM WAS,
“YOU’RE WRONG. “I NEED THIS RELATIONSHIP.
I WANT THIS RELATIONSHIP. “IT’S SUPPORTIVE
AND HEALING TO ME, “AND I WOULD LIKE YOU TO STAY
AND CONTINUE MY CARE THROUGH MY DEATH.” THAT WAS A HUGE WAKEUP MOMENT
FOR HIM. HIPPOCRATES SAID THIS
BEAUTIFULLY. HIPPOCRATES SAID,
“CURE SOMETIMES.” WHEN WE CAN, GREAT,
CURE SOMETIMES. “HEAL OFTEN, AND CARE ALWAYS,”
WISDOM FROM HIPPOCRATES. WE ARE AT A VERY CRITICAL MOMENT
IN THE HISTORY OF MEDICINE, AND I THINK WE HAVE A LOT
TO LEARN FROM LOOKING BACK ABOUT WHEN HAS THERE BEEN
A SIGNIFICANT REVOLUTION OR TRANSFORMATION IN HEALTH
CARE, AND IT’S INTERESTING. REALLY ONLY ONCE, AND IT WAS
ABOUT 100 YEARS AGO. IF WE LOOK BACK AT THE FIRST
REVOLUTION IN HEALTH CARE, WHAT WAS THAT ABOUT? IT WAS REALLY ABOUT MAKING
MEDICINE SCIENTIFICALLY BASED AND STANDARDIZING TRAINING. PRIOR TO 1900s,
MEDICINE WAS PRIMARILY TAUGHT THROUGH FOLKLORE
AND APPRENTICESHIP. SO IN 1910, A REPORT
WAS PUBLISHED CALLED THE FLEXNER REPORT,
AND THAT REPORT WAS PAIRED
WITH A DEMONSTRATION PROJECT, WHICH WAS JOHNS HOPKINS
SCHOOL OF MEDICINE, AND WHAT JOHNS HOPKINS MODELED
WAS REALLY PRETTY MUCH THE CURRENT MEDICAL
EDUCATIONAL MODEL– 4 YEARS OF UNDERGRAD,
4 YEARS OF MEDICAL SCHOOL, TWO YEARS OF BASIC SCIENCE,
TWO YEARS OF CLINICAL. THE WHOLE THING WAS LAID OUT
IN THIS REVOLUTIONARY APPROACH THAT WAS DEFINED IN THE REPORT AND THEN MODELED
WITH JOHNS HOPKINS, AND WHILE WE’LL NEVER KNOW
FOR SURE, I WOULD ARGUE THAT IF THE REPORT
HAD BEEN PUBLISHED AND THE DEMONSTRATION PROJECT
HADN’T HAPPENED, NOT MUCH WOULD HAVE CHANGED. SO WHERE WE ARE NOW
IS THE OPPORTUNITY FOR THE SECOND REVOLUTION
IN HEALTH CARE AND, INTERESTINGLY,
100 YEARS LATER. THE OPPORTUNITY FACING US NOW IS
TO CREATE 21st-CENTURY MEDICINE STILL GROUNDED IN SCIENCE
BUT IN AN APPROACH THAT’S PERSONALIZED, PROACTIVE,
AND PATIENT-DRIVEN. IN THIS APPROACH, WE TRANSFORM
HEALTH CARE INTO A SYSTEM THAT NOT ONLY DELIVERS
EXCELLENT MEDICAL CARE, BUT PARTNERS WITH PEOPLE TO HELP
THEM FULLY LIVE THEIR LIVES. THAT’S A WHOLE DIFFERENT ERA
IN MEDICINE. SO IF YOU THINK ABOUT IT,
IN 1910, THE THEORY WAS EXPLAINED
FOR THAT FUTURE REVOLUTION IN HEALTH CARE
BY THE FLEXNER REPORT, AND THE PRACTICE
WAS DEMONSTRATED AT THE JOHNS HOPKINS
SCHOOL OF MEDICINE. NOW IN 2010, THE IOM PUBLISHED A REPORT,
AND THE OPPORTUNITY HERE IS FOR THE VETERANS
HEALTH ADMINISTRATION TO DEMONSTRATE, TO MODEL FOR
OUR VETERANS AND FOR THE COUNTRY THIS FUTURE STATE
OF HEALTH CARE. IT WAS DEFINED IN OUR NATIONAL
LEADERSHIP COUNCIL LIKE THIS– A SYSTEM THAT PRIORITIZES
THE VETERAN AND THEIR VALUES, AND PARTNERS WITH THEM TO CREATE
A PERSONALIZED, PROACTIVE STRATEGY TO OPTIMIZE
HEALTH AND WELL-BEING, AND WHEN NEEDED PROVIDE STATE-
OF-THE-ART DISEASE MANAGEMENT. THAT’S THE FUTURE. THE GOOD NEWS IS, WE HAVE
TREMENDOUS STRENGTH TO DO THIS. I THINK THERE IS NO OTHER SYSTEM THAT COULD DO THIS,
EVEN IF THEY WANTED TO. WE HAVE ONE INTEGRATED SYSTEM. WE HAVE AN ORGANIZATION FILLED
WITH TALENTED PEOPLE ALREADY INNOVATING THE FUTURE
OF HEALTH CARE COMMITTED TO THIS VISION. WE HAVE STRONG INITIATIVES
UNDERWAY ALREADY. WE HAVE PARTS OF THE TRAINING
AND THE TOOLS ALREADY IN PLACE AND THE CAPACITY TO BUILD AND
CREATE MORE OF WHAT WE NEED. WE HAVE THE CAPABILITY
AND COMMITMENT TO STUDY THE OUTCOMES, DIFFERENTIATE BETWEEN
SUCCESS AND FAILURE, AND ADAPT. WE HAVE A POPULATION
THAT IS INCREDIBLY DESERVING, AND THAT POPULATION HAS
CULTURES AND VALUES THAT ALREADY ALIGN
WITH THIS FUTURE APPROACH, AND LASTLY, WE HAVE A COUNTRY THAT TRULY NEEDS OUR LEADERSHIP
IN THIS WAY. IF WE GET THE CONTENT
OF HEALTH CARE RIGHT, WE WILL GET THE OUTCOMES
AND THE COST RIGHT. WHAT CAN YOU DO?
WHAT CAN EACH ONE OF US DO? EACH ONE OF US NEEDS TO HELP
LEAD THIS. WE NEED TO BE THE VOICE
OF THIS VISION WHEREVER WE ARE
IN THE ORGANIZATION. WE NEED TO DRIVE PAST
WHERE WE’RE COMFORTABLE. THAT’S WHAT LEADERS DO. WE NEED TO PROTECT THE INTEGRITY
OF THIS VISION OVER TIME BECAUSE IT’S HARD. IT’S HARD TO CHANGE. IT’S HARD TO CHANGE
A SYSTEM THIS BIG. IT WILL TAKE YEARS. WE NEED TO KEEP OUR FIELD
OF AWARENESS WIDE. WHAT DOES THAT MEAN? THAT MEANS WE’RE HEADED
IN THIS DIRECTION, BUT WE DON’T HAVE
ALL THE ANSWERS, AND THE MOST IMPORTANT FEEDBACK
IS GOING TO COME FROM THE PEOPLE DOING ALL THIS
HARD WORK ON THE FRONTLINE. NOTICE WHAT’S WORKING.
NOTICE WHAT’S NOT. WHAT DO YOU SEE
THAT WE HAVEN’T NOTICED YET? THAT’S PART OF LEADING,
AND LASTLY, BE FEARLESS. IT’S HARD TO CHANGE.
IT’S SCARY TO CHANGE. WE WILL ONLY SUCCEED
IF WE’RE FEARLESS. SECRETARY SHINSEKI
GAVE US A GREAT QUOTE WHEN HE PRESENTED TO
THE NATIONAL LEADERSHIP COUNCIL DURING OUR STRATEGIC
PLANNING RETREAT, AND IT’S A QUOTE FROM
MARIO ANDRETTI, AND IT’S THIS. “IF EVERYTHING
SEEMS UNDER CONTROL, YOU ARE NOT GOING FAST ENOUGH.” I LOVE THAT,
AND IT’S GREAT COUNSEL TO US. HERE’S WHAT I BELIEVE TO BE THE CASE. MODERN MEDICINE STARTS WITH THE BODY RATHER THAN THE SOUL, THE MIND RATHER THAN THE HEART, BUT THE SOUL AND THE HEART ARE ACTUALLY THE DOORWAYS TO HEALING AND THE HEALTH OF THE BODY AND THE MIND. THE SOUL AND THE HEART ARE THE DOORWAYS TO THE HEALING AND HEALTH OF THE BODY AND MIND. SO NOW WE HAVE THE OPPORTUNITY TO DESIGN FOR THIS APPROACH AND LEAD THE WAY. I WANT TO CONCLUDE BY
REMINDING US THAT OUR VETERANS COMMITTED THEIR LIVES,
THEIR HEALTH, AND THEIR WELL-BEING
TO MISSION SUCCESS IN DEFENSE OF OUR COUNTRY, AND NOW, NOW, WE CAN HELP THEM BE MISSION-READY
FOR THEIR LIVES, WHATEVER THAT MEANS TO THEM. WE CAN HELP THEM BE
MISSION-READY FOR THEIR LIVES IN SUPPORT
OF WHAT MATTERS TO THEM. AND SUCCESS?
WHAT DOES SUCCESS LOOK LIKE? SUCCESS LOOKS LIKE
THEY ACHIEVE THINGS THAT WHEN THEY WALKED
IN THE DOOR OR WE WALKED INTO THEIR DOOR, THEY NEVER EVEN DREAMED
WAS POSSIBLE. THAT’S SUCCESS. I WANT TO THANK YOU
FOR THE WORK YOU DO EACH AND EVERY DAY, AND I HAVE NEVER WORKED
FOR AN ORGANIZATION WITH SO MANY COMMITTED,
TALENTED PEOPLE. SO KEEP DOING WHAT YOU’RE DOING
AND PLEASE HELP US LEAD IN THIS MOST IMPORTANT
TRANSFORMATION FOR THE BENEFIT OF OUR VETERANS
AND FOR OUR COUNTRY. THANKS.

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