Is Capitation a Loss of Autonomy?

Galileo, Darwin and Einstein: three historical figures who changed the way we view the world. Galileo broke the myth that we’re the center of the universe. Darwin proved that humans evolved slowly, not through sudden divine action. Einstein’s theories of relativity led to new ways of looking at time, space, matter, energy and gravity.

Each of these critical thinkers helped humanity take massive leaps forward. But have some of their lessons been lost on the medical profession? In this episode of Fixing Healthcare, sans cohost Jeremy Corr who was out with illness, Dr. Robert Pearl joins ZDoggMD to probe the left and right brain for answers.

Are doctors convinced they’re *not* the center of the universe – or least the center of health and medicine? Borrowing from Darwin, if life is evolutionary and *not* divinely given, then how much of the end-of-life care doctors provide does more harm than good? And if time and space are *not* static or objective, should the scientific method be the final arbiter for medicine or should we follow a different master?

To find out, press play or peruse the transcript below.

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Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple Podcasts or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn.

UNFILTERED TRANSCRIPT

Robert Pearl:

Welcome to Unfiltered, our newest program on our weekly, Fixing Healthcare Podcast series. As usual, joining me today is Dr. Zubin Damania, known to many as ZDoggMD. Unfortunately, Jeremy has lost his voice, a terrible problem for a podcaster. As such, I’m going to have to do his part of today’s show as well as mine. For 25 minutes, Zubin and I will engage in unscripted, and I predict, hard-hitting conversation about art, politics, entertainment and much more. We’ll apply the lessons we extract to medical practice. I’ll then pose a question for the two of us to consider that Jeremy might have asked, to conclude the episode. Zubin, are you ready?

Zubin Damania:

Oh, I’m ready. It looks like all your years of being an understudy for Jeremy… Jeremy, they’re finally coming to fruition. You finally get to step up into the lead role.

Robert Pearl:

Excellent, excellent. So, let me start Zubin, by clarifying another of the many rumors about you that I see on social media. So, is it true that they asked you to be the king after the death of Queen Elizabeth, but you turned them down?

Zubin Damania:

I turned them down because honestly, I didn’t have a circular enough family tree to have the requisite recessive genes to be a monarch. I was too out bred, honestly, that was part of the problem.

Robert Pearl:

You could have had a poison ivy, poison oak kind of family tree, I think. Right?

Zubin Damania:

Exactly. I mean, all seriousness though. The loss of the queen was like the loss of a common mythology. We were talking about the hero’s journey the other week, and this idea that we have this shared identity. Most people in living memory do not remember not having Queen Elizabeth as the monarch of Great Britain. So, it actually is a grieving process for everybody in a way.

Robert Pearl:

Well, anyone under the age of 70 wasn’t alive, and probably they don’t have very many remembrances until at least age 10. So, anyone under the age of 80 can’t remember a time before that. Probably anyone over the age of 80 might have forgotten some of the things way back then, so we’re left with the fact that no one could remember a time without Queen Elizabeth.

Zubin Damania:

I think that math is correct. Yes. I believe it.

Robert Pearl:

So, anyways, we heard from lots of listeners that they enjoyed the conversation we had about Amazon’s acquisition of One Medical, and the implications it has for American medicine. Since then, as you know, CVS acquired a company called Signify, and the company employs 10,000 physicians to provide in-person and virtual at home care. United Health, which already employs over 50,000 doctors, signed a 10 year agreement with Walmart. In your opinion, Zubin, how nervous should physicians be and what do you recommend they do now?

Zubin Damania:

Well, I mean, I think this is clearly an epiphenomenon of how we’ve actually failed to do the job of healthcare that Americans actually want. So, private industry is stepping up, and with the probable some degree of hubris that they can do it better than physicians. But the truth is, they have the resources, the drive, the time horizon and the incentive because they’re paying, their footing the bill for their own employees. So, I would be concerned quite a bit if Amazon, if CVS, if these guys are all partnering to do this, that they’re going to at least have a shot at succeeding on some level. That’s going to put the pressure on regular physician groups and multi-specialty groups to step up as well. This is something that’s probably been a long time coming and probably overdue.

Robert Pearl:

I mean, I’d argue that we have refused to take the lead, and as long as there’s a vacuum and a void, someone else will come into it, so why not be one of the big businesses in the United States?

Zubin Damania:

Yeah. I mean I think that’s the bottom line. Especially with the Amazon thing, it’s interesting because again, Iora Health are partners at our clinic in Las Vegas, to see it go full circle back to Amazon, I’m just… Again, if they get it right, they really have a very powerful model in their hands. If they can scale it for chronic disease that the Iora model and for the consumer, the younger people, the One Medical model, I would be very nervous right now if I were in the traditional healthcare system. I think doctors can no longer just say, “Oh, you know what? I’m just going to keep my head down and hope it all settles out.” It’s like, we have to lead, because if we don’t, it really will be the technocracy that leads it, and it won’t be the best for, I think, the physician/patient relationship moving forward. So, we do have to start to lead, because we’ve really dropped the ball, like you said.

Robert Pearl:

This morning, Zubin, I published an article in Forbes on leadership, or at least what I see is its lack in healthcare today. So, the listeners should be aware, you probably haven’t had a chance to read it, but I’d like your thoughts on the following paradox. From my perspective, the challenges in healthcare are massive: lack of affordability, lagging quality burnout, healthcare disparities, we could go on for the entire show today, just listing the ones that are there. Yet most of the efforts I observe that people and companies inside healthcare are doing, they’re focused, Zubin, on a small opportunity often, an incremental improvement. Do you see the need for a massive change? If so, who should and who do you think will lead it?

Zubin Damania:

Well, what I think is happening is this is indicative of our societal shift in general towards this micro thinking, reductionism, left-brain scenario. There’s a lot of misunderstandings about left brain, right brain schism, by the way, Robbie. Like Iain McGilchrist, a psychiatrist, neuroscientist in Great Britain wrote a great book called Master and His Emissary, about the actual debunking some of that mythology. The mythology that the left brain is the rational clear thinker, sees strategically and so on, that’s not true. The left brain takes wholes and breaks it into parts. It always thinks it’s right. It has righteous anger, it’s a reductionist, and it is isolated from the whole, and that’s what it is. It’s a grasping tool.

Zubin Damania:

It’s the right brain that sees things holistically as a bigger picture, and sees parts in their context. In medicine, I think what we’ve done is we’ve tried to, oh, well we can improve this little thing, or we can build this little widget a little better, and we build this little widget, and you forget that this is a multidimensional interdependent organism that is healthcare. Who is going to lead that? It has to be the part of that organism that does the operating end of it, and that’s physicians and clinicians and people in that space. They really haven’t. What happens is now you have this technical reductionism, where you have people working on these different parts, and they talk about, “Oh, now I’m wearing a Fitbit, and here’s this data.” It’s like, how does that data plug into the bigger picture, and what are the hopes, dreams and fears of the patient that you’re getting that data from? How does this relate to outcomes that matter to them, and that also save money in the economic game and so on?

Zubin Damania:

It has to be, I think, physician leaders in partnership with business leaders, in partnership with economists, in partnership with businesses, because they have so much skin in the game. What is it? Half of all the spending in the country on healthcare is from our large employers, employers in general. We have to look at it more with a right brain, left brain collusion, more of a balance. We haven’t done that. It’s just like the rest of society, we reduce and reduce and reduce, and it becomes this technocracy.

Robert Pearl:

Are you saying that the right brain, and again, speaking really metaphorically not anatomically, but that the right brain is the more logical of the two hemispheres?

Zubin Damania:

No. It’s more that the right brain sees things more in context. It is actually more emotionally intelligent according to McGilchrist. He lays out in 1,000 pages why this is so. It actually was the master in the original relationship, and as societies and individuals evolve over time, the left brain, which was the servant, it actually evolved to help the right brain break things into parts and manage little tasks and things like that, it actually started to think it was the boss, and that by breaking things into parts, you could recreate wholes from the parts. It doesn’t work that way. It’s the emissary suddenly usurping the role of the master. This is metaphor, but it’s also based on studies off split brain patients, on people who’ve had strokes in different sides of the brain and seeing what happens.

Zubin Damania:

For example, people who’ve had right brain strokes, where parts of the right brain are knocked out, they tend to not see things contextually. They’re very concrete, they live in abstractions, they’re unable to function in society. Whereas left brain strokes, people tend to overcome them. Often you lose speech or language, and language is a very reductionist thing too because it breaks things into parts and subject and object. But you still function actually reasonably well. So, it’s really quite fascinating that… He points out to western civilization, as society evolves it shifts to a more left brain dominant space before it collapses. He goes to a lot of history and different big civilizations and what ends up happening. They become these huge bureaucracies. Bureaucracy is the domain of the left brain. What you really need is a corpus callosum that connects the two, that actually brings balance, where master and emissary are in harmony. We’re losing a little bit of that balance it feels like, definitely in healthcare, but in society in general.

Robert Pearl:

I love that analogy. Let me take it a step further. It seems to me that the context of medicine is the unaffordability for the patient. It’s the fact that we don’t do as good a job on prevention, avoids the complications from chronic disease, as we might. It’s looking at the technology that we value, like the operative robot and the technology that we tend to minimize, even now, like telemedicine. It seems to me that maybe what you’re saying is that as physicians, we are really trained in the left brain, multiple choice questions and four answers, and that we need to have a lot more of this sophisticated understanding of the right brain.

Zubin Damania:

That’s it exactly. I think you nailed it. I think in medicine we really are left brain oriented through our education. That right brain, that’s why we ought to be screening physicians, not so much on MCAT scores and these reductionist pieces, but on emotional intelligence, creativity, imagination, those pieces that are very right brain, left brain synergies. Like you said, I think taking a patient out of his or her context, is problematic. Their social determinants of health and all of that are a big piece of it, that’s their context. Their family, their community, their culture, all of that rolls in. Then it’s the same with medicine. If you take a piece of data out of context of the bigger picture, it doesn’t mean anything.

Zubin Damania:

In fact, it leads to more reductionist poking and iatrogenesis and cost from causing harm and those kind of things, where we’re doing things to people instead of for the larger person. So, I think it is a very good metaphor actually, a good model for where we might be going wrong. It’s not limited to medicine, but I think medicine is the best example of it, because it’s such a human enterprise. When you start to see it go out of balance, people know it. They may not be able to articulate it, but saying, well here’s a model that might actually put it in words, in some kind of structure, it might be helpful for people to go, okay. So, how can we overcome that?

Robert Pearl:

Do you have a view how it’s going to happen? Is it going to be an individual like yourself who started a program in Las Vegas? It had to close in the end. But today, might have been successful. Is it going to be a medical group led by some CEO? Is it going to be some type of medical society? How do you see this, I’ll call it massive change, disruption is what a business student would call it, happening, a transformation of how healthcare needs to be provided? How are you going to get ahead of the curve, rather than letting these other organizations like Amazon and CVS beat us to the punch?

Zubin Damania:

Yeah. That’s a great question. Disruption in the classical tech, say a tech company or something disruption, it really is a very… It’s almost like a single site mutation. You do this one thing better and you do it cheaper, and initially the quality isn’t as good. Then over time it gets better, and really suddenly that other big old school legacy company is out of business because you’ve disrupted their model. In healthcare that more reductionist left brain disruption can’t happen. It has to be a holistic, multifocal, almost like a caterpillar turning into a butterfly, every organ transforms. That means all the entities that you listed, I think, have to be a part of it. They all have to wake up a little bit to, okay. What’s the problem? Because a problem well defined is already half solved, as they say.

Zubin Damania:

Then each of us starting to work on solutions, but connecting with each other so that we never miss the big picture, because otherwise we’re just spinning our wheels in the dark. Like the old metaphor of the elephant, trying to figure out what is this creature, and blind people, these blind wise men, each touching a different part of the elephant and not understanding that it’s an elephant, until they actually talk to each other. So, that’s what we haven’t really done a lot of, is connecting across these different spectrum. Like you said, the medical societies and the big healthcare organizations and the small healthcare organizations, and the on the ground doctor and so on.

Robert Pearl:

Listening to you, Zubin, I’m reminded of something that I read about three historical figures who change the way we see the world, because I think what you’re describing is that doctors need to see things different, see them in context. These three people, pretty famous, Galileo, Darwin and Einstein, and how their discoveries contradicted how humans see the world and ourselves. Galileo broke the myth that we’re the center of the universe. Darwin proved that we became human through slow evolution, not a sudden divine action. Einstein demonstrated that everything is relative, and maybe we can apply this a little bit to medicine. As doctors, we see ourselves at the center of medical care delivery. We see our judgment as the best way to reach the optimal approach for a patient’s problem. But maybe, just what if it’s actually complex data analytics or even artificial intelligence? How will we know that we need to change and what do you think we’re going to do about it?

Zubin Damania:

Yeah. This is a great question, because as you’ve pointed out, Robbie, in your books, physicians in particular are the masters of denial. So, we can continue to drill down in our little piece of the world, thinking that we’re doing good and at least convincing ourselves of it, because we’re generally pretty good people. I think what happens though is we need to wake up that it’s not working. I think many of us intuitively feel it. Some people will say, well, this is a function of burnout and we don’t get enough resources and we don’t get enough tools and trust and teams and so on. To some extent that’s absolutely true. But to another extent it’s just that we are drilling down in the wrong direction. I think people who work in primary care feel this very acutely because they see what’s broken.

Zubin Damania:

They know intuitively what needs to happen with their patients, that it is a contextual thing. It’s a much more intricate web and they need the time to spend, but also the tools. Like you said, the AI and the data analytics to give them the best possible tools. Everything that can be mechanized is mechanized, and then apply it to that unique complex human entity that’s in front of you. That has spiritual components, it has scientific components, it has psychological components, everything is bio psychosocial at root. To some degree, it’s waking up from our own slumber on this, our own denial on this. I think people are waking up. So, it might be that we don’t even predict it, Robbie, that all of a sudden there’ll be this mass tidal wave, the culture will shift, we’ll all wake up and then it will just start to avalanche, the change. But that’s an optimists view and I tend to be an optimist, so I’m hoping that it’s right.

Robert Pearl:

When I look at it, I wrote a little bit about it in the piece today, it would seem that the people who would really be pushing for a move from Fee For Service to capitation would be primary care. I mean, in a Fee For Service world, the only way you can generate more revenue is seeing more patients. That’s what’s happening today. We’re seeing more and more patients all the time, which means that the amount of time per patient is going away, and all the things you just discussed, all of the contextual ways. We need to understand the individual in terms of the social world in which they exist. There’s no time to figure that out. Whereas in a capitated world, the way you are economically successful is by taking out the things that add little benefit for the patient, and by helping the individual avoid disease and avoid the complications from chronic disease. Yet outside of a few groups that are across the nation in primary care, I’m not hearing the big primary care societies pushing for it. Why not?

Zubin Damania:

I think they’ve been burned by the promise of capitation not actually panning out in their lives. So, if you’re capitated, and everything you said is absolutely correct, and that was our belief at Turntable and Iora, it’s like, give us a chunk of money to care for these patients, and we’ll do it right. Now, the question I think becomes, how much is that chunk of money? Because you can certainly spend more time and apply more levers and resources to those patients if you have a little more money per patient, per month. Then what your panel size is, what’s your support? What are the tools that you have and the teams, the human resources? Then are you given the trust to actually have those outcomes happen if your skin’s in the game somehow? You’re a part of the organization and you feel really invested in it, then you will do that.

Zubin Damania:

But we all know the stories of, there’s some people who… It’s almost like quiet quitting. They’ll phone it in because they know they’re getting this or that salary or whatever, and the patients are capitated so they’ll have a big panel, but they’ll do the minimal necessary and the organization suffers. So, I think it’s just getting the details right. It’s actually just figuring out those bits. Some of that is culture and leadership and those sort of things. But I’m curious what you think, since you led one of these large, very successful organizations for so many years.

Robert Pearl:

My sense is that capitation generates fear, because you’re now actually responsible. You can’t just do something and expect to get paid for it. If things go wrong, and you’re absolutely right, you’ve got to get the amount of capitation right, you have to have some protection against things like a transplant and other things that are just unexpected, COVID hitting this shore. So, you need to have it negotiated correctly. But it does require things that I think are not intrinsically built into doctors after their training. One is this willingness to take risk, that’s much more of an entrepreneurial piece. The second is it requires tremendous collaboration. Third, it requires that everyone agree on how they’re going to take care of a problem and having agreed, actually do it. We love autonomy. We like to be able to do whatever we want to do. I think that that is problematic, and ultimately all the things we learn as physicians are anti capitation. They favor Fee For Service. It’s just that in the current world, Fee For Service doesn’t work, from my perspective.

Zubin Damania:

I think that was really well put. I think that’s directly it. It’s our culture. I mean, there are many doctors even listening to this conversation, who’ll say, “Oh God. They’re talking about capitation, and they don’t understand that that’s a loss of autonomy, and it’s this and the other thing.” To that degree, they’re correct in the sense that you can’t just go and do anything you want. There is a collective shared agreement that you’re trying to coordinate, almost like an organism. If you’re a tissue in a body, you do coordinate with the other tissues and organs and systems, and there is a general ethos and telos and flow to where you’re going. I think we’ve not had that in health 1.0 and 2.0. 2.0 is more of a top down, okay, we’re just going to do this. And then there’s general rebellion or quiet quitting, just phoning it in.

Zubin Damania:

I think a 3.0 model is more, okay. Listen, no. Actually we need to change even our expectations, what it means to be a physician and what it means to work in a large organization, or even a smaller organization or as part of a defacto network of physicians. So, some people opt out and they go, I’m going to do direct primary care and I’ll get a capitated rate to take care of patients and I’ll do it my way. That’s wonderful, except that it doesn’t integrate with the larger system unless they generate structures to do that. So it is kind of one of the big challenges moving forward.

Robert Pearl:

Well, that model requires that people be able to pay a lot more to get the added convenience. There’s a segment that can do that, but it won’t solve the problem of the more general population. Again, I just see that I would much rather generate income by helping patients avoid heart attacks and strokes and cancer. When I became the CEO in Kaiser Permanente, our hypertension control rate, the number one cause of stroke, was similar to the rest of the nation, a little bit better. We were maybe at 60%, the nation was 55. We agreed that every doctor, not just primary care, would look at the blood pressure. Maybe the specialist couldn’t take care of it, but the specialist would know whether it was normal or not and could make sure the patient got taken care of. We got that over 90% diminishing strokes by 30%, the same when it came to heart disease with blood lipids, hypertension, smoking, et cetera.

Robert Pearl:

We dropped the rate of patients developing a heart attack by 40%, the chance of dying from heart disease by 50%. Same thing when it came to colon cancer. Every doctor can look on a chart and say, “Did you have your proper screening?” I don’t mean having some kind of colonoscopy. I’m talking about getting a FIT test, a fecal immunochemical test that you can do in your bathroom in five minutes at home without a bowel prep. How hard should it be? The nation is around 60%. We got up to 90%. Again, saving 40% of people from developing metastatic disease and cancer. These are the kinds of things I would think would drive doctors to say, I’d much rather do those things than add another patient and another patient and another patient. But somehow that passion isn’t there. Again, when you ask me why, I just think there’s this fear that somehow we’re going to give up what we have today. When I look at it, what we have today isn’t that great.

Zubin Damania:

Yeah. I think that’s it. The stuff you’re talking about isn’t sexy. It’s not sexy to prevent a colon cancer, or prevent a heart attack. It’s sexy to go in with a stent and dramatically open up, get Timmy three flow out of this thing that’s acutely occluded. That’s the cool autonomy, and that’s where you’re the Top Gun maverick, doing your thing. I think we’re very conditioned by that kind of glory, and not looking at the just sheer number of lives and suffering, and area under the curve of good we’re doing in the world, by what you’re pointing at. Again, that’s cultural conditioning from years. It’s almost like a karmic thing. How many millennia physicians have had this kind of autonomy and shamonic role in the community, and they feel that it’s being reduced? But I think there’s room for all of that. There is a holistic way of looking at this that actually incorporates all aspects of that. Again, some of it becomes a cultural shift. What gives us joy in medicine?

Robert Pearl:

So, I hate to think of a show when we’re not controversial, so let me look at that in the same context and move on to Darwin. If life is evolutionary and not divinely given, then might much of our end of life care be creating more harm than good? Or phrased differently, Zubin, is the idea to save a life at any cost an artificial construct? If it is an artificial construct, what should we doing? I mean, I think of patients I’ve taken care of with head and neck, cancer of the tongue, who’ve had a series of surgeries, they can’t speak, they can’t eat, they can’t breathe. Or I just read about a patient who spent 900 days intubated on a respirator in the ICU after COVID. When does medical care become torture?

Zubin Damania:

Oh. This, again, it gets back to this left brain, right brain thing. There is no part of a right brain approach to this issue that would do the 900 days COVID post ventilator thing. Because again, that’s doing things to people, it’s turning people into machines that are failing as a model. The left brain is a machine and the machine is working or not working. Humans are not… They can’t be reduced to mechanistics. They’re very dynamic, crazy, complex processes that include this element of spirituality. Even a non-religious spirituality where it’s like, no, there’s meaning, there’s purpose, there’s awareness. That’s what makes humans just absolutely beyond any mechanistic description of them, that could reduce anything to that. So, what we’re doing now is, from an evolutionary standpoint, it’s crazy, because it doesn’t make any sense. Of course, we’re a little beyond even standard evolution now because our technology is helping us.

Zubin Damania:

So, we’re evolving our technology as a proxy for our DNA. It doesn’t even make sense, I think, from any religious based, spiritual approach because it’s decidedly unnatural to draw things out in a way that is against what even the patient would want if they were able to speak. We haven’t had the conversations, we’re fear-based. Ultimately, Robbie, it’s our fear of death because we are in the dark as to what it is we actually are. So, we live in this dark hall of fear, and as doctors we suffer from it because we won’t even talk about it with our patients, because in some way it reflects back to us and our accomplishments and our conditioning and our culture.

Robert Pearl:

I wonder how you’re going to apply this left brain, right brain, right brain putting in context to the things we’ve learned from Albert Einstein. The idea that somehow everything is relative. Is that a question of putting into context, taking it out of context? Is the scientific method, the final arbiter for medicine, or should we follow a different master?

Zubin Damania:

Oh, man, you’re asking a good question. So, Einstein, fascinating guy, because what he would do, you would think, Einstein’s the epitome of the left brained scientist. Not at all. In fact, what McGilchrist argues in his book is that the idea of science and reason is not a left brain thing. Reason is a right brain scenario. It’s taking data from the world, taking information, and actually applying the filter of context and common sense. What Einstein used to do is he would bang away at a problem in a reductionist way as long as he could, and then he would stop and he would just give up and he would go to sleep. The inductive, intuitive processes that are much more right brain oriented, would speak. That’s how he would get these insights that were beyond.

Zubin Damania:

I mean, how would you derive the theory of relativity from first principles? You can’t. It’s almost an intuitive leap that he made. The fact that everything is relative, that time and space are plastic, was a transformative idea. Even Einstein would say things like, “We’re trying to probe the mind of God here. The more you look, the deeper the mystery, and you should celebrate the mystery.” So, again, I think it relates again to this idea that the mind is a mind divided into these realms. Increasingly one realm is becoming ascendant, and it may not be the realm that should be ascended. It’s the servant rather than the master.

Robert Pearl:

With Jeremy not being here today, I have to take a guess, Zubin, about a question he might ask. He’s an historian, so I’m going to ask you, given everything you’ve talked about for the past half hour, if you had to pick a president from the past to lead healthcare into the future, one who could understand this newer definition of left brain and right brain, who would it be and why?

Zubin Damania:

Wow, man. That’s putting me on the spot. Let me think of my history here. I think it would be a split between Teddy Roosevelt perhaps, FDR or JFK. The reason I picked these three is what they found, what they could do it seemed, was integrate very complex information like World War II with FDR. Teddy Roosevelt, more the general milieu of everything in the wars that were going on and so on. But in John F. Kennedy, with the moonshot, the Soviets, the Cuban Missile Crisis, integrate all this kind of reductionist data with deep understanding of the connections between humans, how to inspire them, how to move them through crisis, how to actually embody some of the values that we claim to have in America, and embody them and show them in a way that actually inspires others. I think I would vote for those guys. They were the perfect balance of right brain, left brain, and the transcendent quality that comes when those are in balance.

Robert Pearl:

I too think of three people. One person is Abraham Lincoln, who tackled probably the hardest question our nation has had, that of slavery. Which should be an easy question, but not in the context in which he lived. He had to balance the sides, he had to bring into his cabinet, as Doris Kearns Goodwin has pointed out, individuals from different backgrounds, often not from his own party. He was able to not do what most people would do, I will call it left brain, in quotes, logical approach. But to put everything into a context. I agree with you also about JFK. But to me, the big thing is, he was going to take the leap, put a man on the moon. I think for healthcare, that’s what we need.

Robert Pearl:

We need someone willing to take the risk, willing to make that commitment, not just sometime in the future, but he set a 10 year deadline and met that deadline. The third person I’d put is George Washington. I’d put him for two reasons. First of all, in the context of the immediate, he could see the difference between the United States being a free country, and being a country under Britain, he could see the opportunities through linking together with the French. Then, when he could have become a monarch and taken a third term and fourth term, he could see the problems that would create, and he put the nation in front of himself. I think that that’s going to be required for us to move healthcare into the future. We’ll see whether medicine can have the kinds of leaders that you and I both see and see what Jeremy says in the next program.

Robert Pearl:

For the listeners, we hope you enjoyed this podcast, and will tell your friends and colleagues about it. Please follow Fixing Healthcare on Spotify, Apple Podcasts, or whatever other podcast platform you use. If you like the show, please rate at five stars and leave a review. If you want more information on healthcare topics, you can visit my website, robertpearlmd.com, or our website @fixinghealthcarepodcast.com. You can follow us on LinkedIn, Facebook and Twitter, at Fixing HC Podcast. Thank you for listening to Fixing Healthcare’s newest series, Unfiltered, with Dr. Robert Pearl, Jeremy Corr, and Dr. Zubin Damania. Have a great day.

The post FHC #66: Right brain vs. left brain in medicine  appeared first on Fixing Healthcare.