Fixing Healthcare Podcast

Dr. Ezekiel Emanuel has spent a lifetime challenging the establishment. He says that tendency is very much a part of his family’s heritage. “My mother, not infrequently, would have to be in school because her sons were opposing rules and speaking out when everyone else was silent.” Those other sons happen to be Rahm Emanuel, the former Chicago Mayor and current U.S. Ambassador to Japan, as well as Ari, an American businessman and CEO of the massive entertainment agency Endeavor. Zeke, himself, is an oncologist, medical ethicist and a major contributor to the Affordable Care Act legislation. In this interview, hosts Jeremy Corr and Dr. Robert Pearl ask him about the rules of medicine that deserve to be broken and who among us can lead the charge for change. Interview Highlights   On the Emanuel Family “We are rulebreakers. My partner is always saying, ‘You think a rule is a good suggestion and not as a rule in the sense that most people think about it.’ I would say that it comes from our parents.. My mother, very early on, and I mean very early on, when she was a teenager, was very dedicated to Civil Rights well before white people and white women were heavily involved in Civil Rights … And then in 1965, right after the election, when Medicare was being debated and legislation was moving and the AMA opposed it, (my dad) quit the AMA.” On his reluctant path to medicine “I would report myself as a reluctant physician … I really was not very fond of medical school, mainly because I didn’t like the hierarchy of medicine that everyone deferred to whoever was the most senior person around as opposed to, let’s have a discussion about this. And I also did not like all the memorization of medicine and what really appeared to me during medical school to be a lot of irrelevancy that I couldn’t imagine would be really related to treating patients and making advances like relearning the Krebs cycle, like the Startling law and things like that. On regrets with the AFFORDABLE CARE ACT “There are a lot of things I wish I had pushed harder on, and a lot of things I wish I had thought more deeply about. I would say top of that list of things that I wish I had thought more deeply about and emphasized more is more simplicity in our system. One of the things I think that the Affordable Care Act unfortunately did is to actually make the system much more complicated, and I think that is a problem. I think it’s one of the major problems of the American healthcare system. It’s so damn complicated to use. It’s really, really hard for people who aren’t focused on health. And even if you are focused, we had to invent the whole new category of employment called Navigators because it’s become so mind-numbingly complex. On dealing with death as doctors “I do think that medicine has moved on since the time that you and I trained in the sense that when we were training almost every patient who died in the hospital got resuscitated. DNR orders were still controversial. Withdrawing treatment was still controversial. We didn’t talk to patients about it, and the majority of patients were dying in the hospital. Well, I spent a lot of time in the end-of-life care field, first of all trying to understand what really motivated patients and then trying to change our norms about it. And I think the norms have changed … I think that this notion of do everything no matter what has evolved, and I think that’s super important.” On ‘Why I hope to die at 75’ (his 2014 column in The Atlantic) “Human beings are on a spectrum or a bell-shaped curve or some kind of curve, where some people are cognitively intact, are physically intact well after 75. Most of us are not outliers like that. Most of us are solidly in the middle. And what you see is in the middle, the rate of Alzheimer’s goes up at 75 … People retire, they end up being less creative. They’re just not producing and contributing in the same way, and that’s not the way I see my life. I don’t want my children or other people to remember me in a particular way. I want to go out being very active, totally intellectually engaged, physically fit. And so that’s 75. And, again, it’s just playing the numbers.” READ: Full transcript with Zeke Emanuel * * * Dr. Robert Pearl is the author of a book about medicine’s invisible yet highly influential physician culture. Check out “Uncaring: How Physician Culture Is Killing Doctors & Patients.” All profits from the book go to Doctors Without Borders. Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Spotify, Stitcher or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn. The post FHC #67: Dr. Zeke Emanuel on the virtues of rule breaking appeared first on Fixing Healthcare.

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. * * * 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.

This Fixing Healthcare podcast series, “Diving Deep,” probes some of healthcare’s most complex topics and deep-seated problems. On today’s episode, Dr. Robert Pearl and Jeremy Corr talk about two of the world’s biggest tech companies and their potential impact on American healthcare. Later in the episode, the hosts revisit the three biggest threats facing healthcare and discuss solutions that can and must be implemented in the next two years. For more information on these topics, check out Dr. Pearl’s latest healthcare columns on Forbes and LinkedIn. For listeners interested in show notes, here’s a time-stamped discussion guide: AMAZON VS APPLE [01:08] How much of an impact has technology had on medical practice in the 21st century? [01:55] Don’t doctors want to be at the cutting edge of technology? [03:38] How are tech companies trying to penetrate healthcare’s $4.1 trillion market? [04:18] What is the unwritten rule of health technology? [05:32] Is Apple breaking or following this unwritten rule? [07:45] Can Apple make a meaningful difference on human health? [08:50] Can Apple profit in healthcare without fundamentally improving health? [11:21] What could Apple do differently? [12:35] What would be the impact of a medical device created by Apple? [15:14] Why hasn’t it happened yet? [16:00] How is Amazon’s healthcare strategy different? [17:03] What’s Amazon’s long-term goal? [17:44] Hasn’t Amazon failed twice before in this space? [18:39] What happened with Haven and Amazon’s telehealth platform? [19:42] What’s the biggest hurdle Amazon will need to overcome?   HEALTHCARE’S 3 BIGGEST THREATS [23:20] What is healthcare’s “perfect storm” and is it heading our way? [24:39] Where will the impact be the greatest from the three “mega forces”? [25:42] What options do hospital leaders have to temper the storm? [27:34] What’s the first action needed? [28:25] How, exactly, could hospital leaders quickly to reduce cost, increase access and improve professional satisfaction? [30:24] Could the right hire actually decrease the cost of care? [32:05] What’s the second action needed? [33:25] How might this concept be applied to the work that doctors do? [34:42] What’s the third action needed? [36:44] Why haven’t these changes been made yet and what’s next? * * * Dr. Robert Pearl is the author of a book about medicine’s invisible yet highly influential physician culture. Check out “Uncaring: How Physician Culture Is Killing Doctors & Patients.” All profits from the book go to Doctors Without Borders. Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Spotify, Stitcher or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn. The post FHC #65: Diving deep into Amazon and Apple’s healthcare ambitions appeared first on Fixing Healthcare.

In this episode of Coronavirus: The Truth, Jeremy Corr and Dr. Robert Pearl discuss the battle between the current Covid-19 vaccine manufacturers, the next generation of mRNA vaccines, and the latest on America’s monkey pox fears. You’ll find these topics and others discussed during this show here: Each show begins with the most recent and relevant facts concerning the Covid-19 pandemic and its impact on American life. What’s happening and what does it mean? How are future Covid-19 vaccine shots being positioned by the federal government? Listener question: “Why did the government decide to stop paying for everything Covid-19 related and leave that to private insurers?” Will this apply to this next generation vaccine?” Why aren’t Moderna and Pfizer playing nice with each other? How profitable have the vaccines and treatments been for these two companies? Are employers still requiring vaccines? What has happened to those that did? Have Americans changed their approach to COVID and vaccine requirements since last we spoke? Listener question: “Is there any data that Paxlovid actually saves lives?” What’s the latest science relative to Covid-19 and kids? What is the current science on monkey pox and the people who contract it? Listener question: “Has anyone died so far from Monkey Pox?” How have healthcare professionals administered monkey pox vaccines? How has Covid-19 impacted life expectancy? Listener question: “I couldn’t tell from your last episode, are the drug coupons that manufacturers give out is positive or problematic?” What’s new beyond Covid-19? How would consumers feel about getting medical care through Amazon, CVS or Walgreens? This episode is available on Apple Podcasts, Google Play, Spotify and other podcast platforms. If you have coronavirus questions for the hosts, please visit the contact page or send us a message on Twitter or LinkedIn. *To ensure the credibility of this program, Coronavirus: The Truth refuses to accept sponsorship, outside funding sources or guests with any financial or personal conflicts of interest. The post CTT #65: Why are Moderna and Pfizer going to war? appeared first on Fixing Healthcare.

American writer Joseph Campbell famously studied and diagramed the hero’s journey in folklore and literature. That journey begins with a call to adventure, prompting the hero’s reluctance—often due to a fear of failure. Along the way, mentors lends guidance and help, but it is ultimately the hero, alone, who must summon the courage to win the day. In this episode of Fixing Healthcare, hosts Jeremy Corr and Dr. Robert Pearl join ZDoggMD to discuss the hero’s journey in healthcare. In every medical professional’s career, there is a calling, a fear of failure and people along the way who provide support (or pose additional challenges). Who are healthcare’s heroes these days? What are the dragons that need slaying? How do we overcome our fears of failure in medicine? What journeys lie ahead for the future of American healthcare? The show concludes with a question posed in our last episode. We asked listeners on social media: “What medical hero or moment in history deserves its own Hollywood adaptation?” The answers may surprise you. For more, press play or peruse the transcript below. * * * 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 Jeremy Corr: Welcome to Unfiltered, our newest program in our weekly Fixing Healthcare podcast series. Joining us each month is Dr. Zubin Damania, known to many as ZDoggMD. For 25 minutes, he and Robbie will engage in unscripted and hard-hitting conversation about art, politics, entertainment, and much more. As nationally recognized physicians and healthcare policy experts, they’ll apply the lessons they extract to medical practice. Then I’ll pose a question for the two of them as a patient based on what I’ve heard. Robbie, why don’t you kick it off? Robert Pearl: Good morning, Zubin. How are you doing? Zubin Damania: Top of the morning, Robbie. Robert Pearl: Excellent. I’ve heard from dozens of listeners, who have said they can’t wait to hear us talk about the hero’s journey that you mentioned in our last Unfiltered episode, and I promised that we would explore it today. So let’s dive in. Can you tell listeners a brief summary of Joseph Campbell’s ideas and his model? Zubin Damania: Yeah, so Joseph Campbell studied mythology and what he called the monomyth, the single myth that crosses almost every human culture that he studied, is this idea of the hero’s journey. The idea that the hero, all of us, really, starts out in one place, and then there’s a call to adventure, because there’s something not quite right there. There’s a call to adventure, and then there’s a whole series of things that happens. There’s a mentor that comes and takes them, helps them leave the shackles of inertia and fear, go out into the world and fight the dragons and do the trials and suffer the ordeals, all to gain some sort of atonement or knowledge or elixir that then they return with, for the benefit of all people. And this is such an archetype throughout human history, in a spiritual sense, in a actual, absolute sense, and looking at all our pop culture too, the hero’s journey is woven into much of our most popular movies and books and stories and ideas. Robert Pearl: As I remember Joseph Campbell’s work, there’s also early in the path, a mentor, a gnome or a dwarf, someone else who gives the hero the encouragement or the ideas or breaks through a thought process that the hero is stuck on, so that the battles with the dragons can begin. How do you see all of this happening inside of medicine? Who are the heroes? What’s the arc? Where should we be looking? What should we be teaching medical students? Tell me how you apply this inside the medical realm. Zubin Damania: I think every single person who works in healthcare undertakes the hero’s journey, in some sense. They start out as having not the knowledge and the skills and the ability to do what we do, which is very difficult, and then they embark on this journey. And the mentor can be anybody, anything. Nowadays it can be a podcast that opens people’s eyes, that suddenly expands their circle of understanding or their circle of compassion. What they thought was one way is actually seemed to be not true. It’s actually a bigger way or a more inclusive way. And sometimes the mentor is very specific. For me, it was Tony Hsieh, who was the CEO of Zappos, who snapped me out of my inertia and my fear and said, “It’s clear you want to do these things and change these things. Why don’t you do it?” And helped me quite a bit. Zubin Damania: For others, it may be a teacher. It may be a family member. It may be a physician assistant. For me, it was the person who taught me that procedures aren’t something to be afraid of. I was always so afraid of being a klutz and screwing stuff up. And they’re like, no, no, no, no, no, here, here’s how you need to look at this. And so it can be anything. And the idea then ,there’s the personal heroes journey, but there’s also the systems journey. Our system has gone from what I call health 1.0, and then the hero’s journey through 2.0 and the trials and the tribulations and the struggles of our technocracy, the administrative technocracy of 2.0, to the 3.0 return of the hero. So it actually has ramifications throughout medicine, both individually and from a systems stand point. Robert Pearl: Are the dragons the diseases, the system or the people? Zubin Damania: Sometimes the dragon is us. I really think that the more I introspect on this, the more our dragons are all self-created, because you can say, “Oh, it’s cost and it’s insurance, and it’s corporate medicine and private equity,” and it’s this and this and this. And those are all projections. We haven’t really addressed the internal dragons. The fact that we are very highly conditioned, fear bound creatures, and we get the system that manifests who we are. So maybe the dragon is us. And that’s a difficult journey, but that’s the classic Joseph Campbell spiritual hero’s journey. Zubin Damania: The idea of atonement with the father is a part of what he describes in the hero’s journey. And the father can be God. The father can be this idea of oneness and how we feel so separate, and the idea of our own ego, and how do we square that with this sense, this deep intuition, that we’re much more than we think we are. Yeah, it gets spooky and weird, but honestly this is the heart of the matter. And I think the hero’s journey is such a good framework for looking at that for all of us. Robert Pearl: So you described your hero’s journey, becoming a doctor, mastering procedures. How about your journey to becoming a transformational leader? Zubin Damania: And I’m still uncomfortable even with that term transformational leader, because I still have such an impostor syndrome around this, but I would say that there are all concurrent lines and levels of development in the hero’s journey. So for me, it’s funny, my story, Robbie, it’s weird. It falls classically into this hero’s journey kind of archetype. And I’m not saying I’m a hero or anything. I’m saying it pencils out. Here I am at Stanford for 10 years as a hospitalist and I feel very dissatisfied with how medicine is done. Zubin Damania: I feel we don’t prevent disease. We’re reactionary. We’re spending all this money and I feel disconnected from my patients, from myself, from my family. Then comes the mentor, Tony, who is like, “Are you happy doing what you’re doing? Here’s a book you could read,” The Happiness Hypothesis by Jonathan Haidt. My mind is it blown by that. I get very depressed. And then I overcome the fear. I get this offer to go to Las Vegas and then go on the journey there. Zubin Damania: And at this point, I have to learn everything about how does healthcare actually work? What does leadership even mean? How do humans even function? How does the mind even work? Because that’s not something we technically learn in medicine. And so the heroes journey for me was battling all this misunderstanding, misconception of how things are, and then battling my own ego, through meditation and that, the spiritual journey, and then doing the work of building a clinic and doing the business stuff and learning operations and fighting that battle, and the mentor helping you, but stepping away quite a bit. And failing, and then feeling what that’s like, the hero setback, but you learn so much from that. And then trying to return with this knowledge, with this show that we do, going, “Okay, now, how can I actualize this in myself and others the best I can while still feeling like a complete impostor?” And so it’s still a journey that continues to unfold. Robert Pearl: You’ve mentioned impostor syndrome now twice. One of the books I really enjoyed reading was by Angela Duckworth, the book Grit. And she talks about how perseverance counts twice as much as talent. First, perseverance allows you to build ability, and then it allows you to apply it. And yet so many physicians feel like they’re an impostor, and I believe that it happens because we think that the successful physicians are just brilliant, and we’re not as brilliant as they are. Or they’re articulate. We’re not as articulate as they are. What they don’t see is how much perseverance and hard work goes in there. Anyone who does really well works hard and they hide that often. I think the impostor syndrome is really problematic because it so undermines the confidence and the willingness of people to step forward, and I believe that the whole idea that we are impostors is an illusion. What are your thoughts? Zubin Damania: Oh, I think everything we believe is an illusion, honestly, but I think you’re onto something here, Robbie, and I think impostor syndrome has to be reframed internally as, oh, I’m feeling a little uncomfortable with my abilities in this space, for some reason. That’s great. That means I’m pushing the boundaries and that means more diligence or more doing it, more pushing, is probably a good thing. Within parameters. Sometimes doctors feel like they can work their way out of any problem, and that’s also a bit of a misunderstanding. Zubin Damania: But absolutely. They don’t realize what your friend Malcolm Gladwell says, it’s these 10,000 hours of diligence. You can have no talent. You can have a bunch of talent, but if you don’t put in the energy, you’re not going to do it. So public speaking’s a great example. You can feel like a complete impostor and you just keep going and doing it, keep doing it, keep pushing. And then it just starts to click and at some point you go on stage and you’re like, wow, what a gift to be able to be here and connect with this audience. And that sense of impostorness is almost like that egoic reflection of me against the world, me separate, dissolves into the absolute oneness of being present with other beings in this mutually reinforcing way. And so yeah, I’m with you, man. I’m with you. That’s a long way of saying, I’m with you. Robert Pearl: You say that for some reason we feel uncomfortable. The reason is, everyone feels uncomfortable when they first learn to put a knife into a human being, I guess, unless you’re some type of sociopath, or stick a catheter blindly into a blood vessel and hope it hits the right place, knowing you may penetrate the lung. There are all these things that we do that are designed by nature to be unusual, because no animal can do them. And so we have to gain those skills. So from my perspective, it’s just an inevitability that all of us will have this discomfort. The question I want to pose to you is that, for a hundred people set off on this hero’s journey, how many of them get to the end? Zubin Damania: Well, this is the thing. Is there an end to the hero’s journey? It’s almost like if you’re looking for a purpose of life, which I think is a difficult proposition because life doesn’t need a purpose. It’s just beautifully radiant in the present moment. But if you’re looking for a purpose, it is this perpetual hero’s journey of unfoldment. So you may get to the end of one particular aspect of the hero’s journey and then a new journey begins. You’re called again. I can’t tell you how many times it’s been a reawakened, oh, wait, what? No, there’s so much more to do, and so much more to learn. And there’s a different mentor now, and there’s a different set of challenges. And there’s a different elixir of knowledge that you bring back. Zubin Damania: And at each stage, one thing Campbell talks about, is there’s the resistance. So the call to adventure, which is when Luke Skywalker is, he’s there on Tatooine. He’s been moisture farming and Ben Kenobi comes to him and he is like, look, dude, your dad was a Jedi. Come with me, let’s fight the Empire. And Luke’s like, no way, man. I still got crops to harvest. My uncle needs me. That resistance to the call is the first challenge. And in medicine, oh my gosh. If you’re going to call the troops to adventure right now to change medicine or to wake up a little from our own conditioning, oh, the resistance is going to be all over the place. There’s a million excuses the mind makes. Zubin Damania: So you’ve got to overcome that. And then when you do get the knowledge, there’s a resistance to coming back with it. You want to stay in this transcendent state. You want to go out and just pontificate about it. So, no, no, no, no, no. You have to come back and embody what you’ve learned. And so that means teaching others. It means maybe going and putting it in practice. And there’s a resistance to that. So at each stage, the mentor can help nudge you, or you can nudge yourself, or circumstances nudge you back. Robert Pearl: I don’t know about you, but one of the hardest journeys that I believe that doctors are going to have to go down is going to be confronting the end of life and dealing with the realities that death is an inevitability, no matter how long we can prolong it, particularly as our ability to prolong life becomes that much greater. How do you envision this hero’s journey progressing? Zubin Damania: And so many of the classic heroes journeys involve a trip to the underworld, to actually address the face of our biggest fear, which is mortality. The fear of loss of control, of helplessness, of all these issues that are so central to the human, we think are so central to the human condition. And of course, in medicine, we’re on the front lines of that. And so if we don’t heed the call to actually address those things, to look at those dragons in our own psyche, then how can we address them for our patients, and what ends up happening is we obfuscate them with our own projections. So, no, no, no, you know what? One more procedure is what your loved one needs, not talking about comfort, not talking about palliative care or whatever it is, or even having the conversation that you know what, life is not infinite. And it’s not a failure to focus on comfort. Zubin Damania: Those are crucial things. And then the economic ramifications, the emotional ramifications of the survivors, all those things. When I do talks, I often perform a song that I did a while ago called Ain’t The Way To Die, which is a parody of an Eminem and Rihanna song about end of life. And I do it for people that [inaudible] why would you do it for this audience? Because every single person in the audience has had a loved one or has interacted with someone who’s been in that position where they haven’t had the conversation, they haven’t talked about end of life. There’s all this resistance. And it illustrates that resistance and how we might actually overcome it by making people feel something, like, oh my gosh, it’s always too soon until it’s too late to have the conversation. Robert Pearl: I don’t know if you’ve ever watched a particular YouTube video, but I’ve watched it, I don’t know, many dozens of times. And it’s the Susan Boyle Britain Got Talent tryout. Have you ever seen that one? Zubin Damania: Oh, it’s amazing. Robert Pearl: Yeah, for people who may not know it, it’s been seen by 260 million people. So most of us have seen it at some point. Susan Boyle comes on stage and she’s dressed frumpier than any other contestant. Simon Cowell asks her how old she is and she replies 47. The audience snickers. She can’t remember the word village when Simon ask her to describe where she’s from. And then all contestants, he asks, who do you want to be? And she says, Elaine Paige and the cameras pan to the audience. They’re rolling their eyes with smirks on their face. And they communicated with their body language, she’s a nobody, she’s a failure. The look of pity, it’s everywhere. And then she says, what song will she sing. And she says, “I have a dream, from Les Miserables.” And the music comes on, first three notes that come out of her voice, beautiful. Robert Pearl: A golden voice, shocking people. And then she sings the classic line, “I had a dream so different from this hell I’m living.” And the audience is on its feet. The place goes crazy, but it’s just the start of her journey. Simon becomes her mentor, gives her a record contract, new wardrobe, hairstyle, makeup. She confronts her Asperger’s. She goes through a mental breakdown, maybe from coming in second on the show. She goes on to make eight albums, sell 20 million records, nominated for three Grammys. She comes back at her, she continues to entertain. I watch that to tell myself how wrong we are as doctors when we judge patients and the massive mistakes we make when we dismiss people. Robert Pearl: Our mental models of healthy and unhealthy are so strong that even when our brain tells us we’re wrong, we struggle to change them. And I bring that up because again, having watched this dozens of times, you would think that I would now be an expert at not doing these things, but I still have this tendency to make these judgements on externalities and to not take people as seriously as I should. I’m not sure that that hero’s journey, as you say, is ever able to be fully completed. Zubin Damania: Wow. And that’s beautifully put. And here here’s a couple thoughts I have just hearing you talk about that. And that Susan Boyle thing is amazing. Every single one of our patients is on a hero’s journey, and once we see that, and once we figure that, hey, maybe we’re partially a mentor on this hero’s journey, in a certain way, on a certain aspect of their journey, that changes everything. And maybe we’re on the hero’s journey, and this patient is our mentor and that changes everything. And maybe when you talk about our judgments, Robbie, that is part of the thinking mind. The mind is a judging mind. It’s a comparing mind. It’s a thought generating mind. It’s a secreter of thought and the thoughts aren’t us. They speak in our voice. They use the word I when a voice in our head talks to make us believe that it’s us, but it’s not us. Zubin Damania: We’re actually the space those thoughts arrive in, we’re the awareness of that space those thoughts arrive in. So self-forgiveness when we do judge, when do get caught in that, I think is the order of the day, that then allows us to be better. And sometimes a hero’s journey is not this, Susan Boyle was a great dramatic example of that, but maybe it’s just being a little self, little less reactive with your kids, or a little more present. Maybe that’s your hero’s journey, that one arc and that’s enough. It doesn’t have to be so grand, although those grand heroes arcs are what make it so resonant, the Star Wars arc that George Lucas actually used Campbell’s work to design the first star wars series and that’s why it was so good. That’s why the prequels were such trash, and the sequels, weren’t very good, because the monomyth that we all resonate with deeply is right there. But yeah, self forgiveness, really, really powerful. Robert Pearl: Speaking about mentors, what’s the best advice you’ve ever received along one of your hero’s journeys? Zubin Damania: It was really, it was Tony Hsieh again. And he said, “You’re so afraid of what people think and how you’re going to be received and you’re always making jokes to try to put yourself, distance yourself from any vulnerability and to make yourself feel safe, it seems like, because anytime there’s two people in the room and I’m with you, you’re joking the whole time. And you’re a pretty, actually serious, reasonably thoughtful guy. Why don’t you just be yourself? Why don’t you just be authentic and don’t worry about the fear of what people are going to think and that sort of thing. It’s something that I’ve just noticed.” And of course, initially I was so defensive. I was like, what do you mean I’m making jokes? And then the more I felt into it, the more I realized, oh my God, he’s absolutely right. Zubin Damania: So it was such amazing advice because it allows this huge burden of trying to be somebody that you’re not to protect this seeming self from others, when that relaxes, then you’re truly just authentic. And that’s what Susan Boyle did when she sang that song. She’s like, this is me. How scary must that have been for her, seeing the audience rolling their eyes and Simon Cowell who’s notorious for being a butthole, it’s like, oh my gosh, it’ll make you cry just thinking about it. Robert Pearl: Absolutely. Someone once said that courage is not the lack of fear, but the ability to move forward, despite the fear. Has your fear disappeared and you’ve just learned to go past it or have you somehow been able to conquer some of your fears? Zubin Damania: The fear is always there. And actually on this last silent meditation retreat I was on for eight days, fear was the main theme, it felt like. It was this fear of helplessness, fear of vulnerability, fear of losing control when you realize that your thoughts aren’t you and your identity is very, it’s a construction, that there’s a deep fear. And I think that the trick is letting that fear be there, but acting anyways, like you said, that’s courage. And understanding that fear is just the mind trying to keep you safe, but it’s not often correct. Zubin Damania: It’s just like a car alarm that goes off when it was bumped. It doesn’t mean that someone’s breaking into your car. So you can feel it that’s okay. Let it pass through you, but don’t let it rule you. And it’s easy to say, but very hard to do, and you need support. You need people, again, to help and mentor and be there. And a lot of people, unfortunately don’t have those folks. So again, in medicine, I think it’s incumbent on us to try to be that person for our patients whenever we can. Robert Pearl: It’s interesting as you talk about it. I’d never put it into this context. When I think about two of the best pieces of advice I’ve ever gotten, I think now, that there were about fear. I wouldn’t have thought that before this conversation. One was from my mom. I was in 11th grade and I was wanting to become a class officer. And I knew that I could run for vice president and win overwhelmingly, but there was a very difficult candidate who wanted to be president. That’s really what I wanted to do. My mother said, “Never aim lower than you really want to go.” And I was able to run for that and win that particular race and enjoy that opportunity that I never would’ve had, had I yielded to that fear. Robert Pearl: And then the same thing actually happened when I was had the opportunity to become the CEO. I’m not even quite sure it’s fear. Although, as you know, at the time, Kaiser Permanente was down to two days of cash and had to borrow cash to stay viable. It was not a great job, but it was just not something that I necessarily thought that I wanted. And I went to one of my mentors, a physician, one of my teachers in residency named Lars Vistus. And I told him this story. And he said to me, “Robbie, windows open and close. And when they open, you better jump through them.” Robert Pearl: And so in both cases, whatever the resistance exactly was, whether you want to call it fear or you want to call it wisdom. I’m not sure which it might have been. I think that having that opportunity and it goes along with something that I’ve said learned from other people. We tend to regret the things we don’t do, rather than the things that we do do. And certainly, both of those chances that I had turned out, well, maybe that’s why I have such fond thoughts about them. But I think that the idea of taking action when you have that opportunity for something that you think is valuable, is probably a pretty good lesson for all of us going forward, even when we are afraid. Zubin Damania: That’s beautifully put. And I think that idea of, we regret the things we didn’t do rather than the things we did, I look back on my own past, and there’s a lot of stuff that, oh, you could have done it differently. Could have done it that way. Honestly, I wouldn’t have done anything differently. It just landed me right in this present moment where there’s so much still to do and it’s all unfolding perfectly and beautifully. So yeah, be fearless as much as you… Fearless meaning, let that fear be, but don’t let it change what you’re doing. I love your mother’s advice and your mentor’s advice. It’s beautiful. Robert Pearl: The last program we had, where we talked about the movies, the one that led to the question about the hero’s journey, I received so many individuals sending ideas from movies they would like to see made about medicine, the conversation that we had. There were people talking about Virginia Apgar who in 1952 developed a 10 point scale associated with her name and it saved tens of thousands of lives of children. Galen, living in the second century, who founded the scientific method in medicine that continues as the foundation of research and discovery today. Robert Pearl: The Blackwell sisters in the middle of the 19th century became the first women to become physicians in America. And of course, Marie Curie, who developed the theory of radioactivity, won two Nobel prizes, and ultimately died, as you know, from aplastic anemia, from the research that she did with radioactivity. But as I thanked people for their ideas, and I have to say, probably I had 20 different films, all of which would’ve been great. I was struck. No one mentioned anyone from the 21st century or even from the end of the 20th century. Are there no heroes today, or is it that there’s no problems that’s large enough to require heroes or no way to recognize heroism until after people’s careers are over and complete and maybe until they’re dead? What’s going on? Why does there seem to be so few heroes today? Zubin Damania: What a great observation. And I think, it’s all those things you said, but I think there’s also this component that mankind is actually evolving into a complexity level where the single hero, the Steve Jobs, for example. That’s a good example of he was maybe a partially 21st century hero to some and villain to others. But this idea that the single human is no longer so essential as this network of humans. So for example, that NASA and the European Space Agency were able to put an incredibly complex scientific instrument where it’s basically human consciousness peering back into the universe, basically the universe looking at itself, in a way that’s so incredibly beautiful and complex, could never have been the work of one person or one hero. Zubin Damania: So instead it’s the transcendent work, often, of a group of humans working in concert together over decades with all the resources of government and industry and private sector together. That’s heroism now. And so pointing to one person is so difficult, but pointing to, wow, look what this group of people were able to do, it’s transcendent, I think that’s maybe where we’re shifting and maybe that’s why it’s a little harder. So it’s less of a cynical, where are the heroes and more of a, oh, we’re all heroes, especially when we work together. Robert Pearl: You remind me of a conversation that Jeremy had on one of our other Fixing Healthcare shows. We talked at that time that this is the 15th anniversary of the iPhone, the Steve Jobs reference you made. It’s the 10th anniversary of CRISPR, the technology that can be used to alter genes. And it’s the start of the post-Roe Supreme court. Which of these three factors do you think will be most important a decade or two from now? Zubin Damania: I really think it’s that iPhone piece because this is where the existential promise and threat comes in because the iPhone has changed a generation of children. It has really exponentially actualized social media, for better or for worse, and I actually worry about it for worse. And it’s given us the universe’s knowledge in the palm of our hand in a way that, the classic saying is Bill Clinton had less access to information than a tribesman in Africa with a smartphone has now. And that is going to continue to transform society and the human mind in a way that CRISPR, okay, we’re hacking our DNA and that kind of thing, that’s cool. That’s going to have ramifications. Post-Roe world means that’s politics and policy and medicine. That’s all important, but man, that smartphone, the change that that’s wreaking on us that we don’t truly understand yet, I think that’s going to have the biggest impact existentially for us. Robert Pearl: Amazing answer. Jeremy, your question for us. Jeremy Corr: I know so many people, myself included, who’ve had the situation of either a boss that doesn’t believe in them and says, “Hey, you’re never going to make it further than this,” or, “You’re never going to amount to this,” or a parent or some person in their life who doubts them or pushes them down. And I know a lot of people get inspiration from this. Many of the big famous CEOs and successful people in the country have had someone like that in their life who either is, it gives that said person a chip on their shoulder to either work harder or maybe it gives them the understanding that, “Hey, I’m not in the right line of work. Maybe I need to shift what I’m doing or think differently about some things.” Have either of you had some sort of antagonist like that in your life who’s doubted you or told you you couldn’t amount to what you have amounted to, and how did you deal with that, learn from that, grow from that? Zubin Damania: Yeah, this is one of those things where you wonder whether these antagonists are actually really meant to be there, and think they are. They’re really essential. And it’s how you respond, it’s a test of the hero’s journey. It’s one of the big trials and tribulations. For me, it’s funny, part of the hero’s journey in the classic Campbell sense, is the father, this atonement with the father, and it can be the literal father. For me, I think it actually is the literal father. So my dad, internist, immigrant physician, private practice, central valley of California. He was always the voice narrating my decisions through life and even though, because I swore I’d never be a doctor because he was one. Then I went into medicine because I felt the call to it. And then his influence was constantly there. Zubin Damania: And it was always a, he began coming from India with nothing in his pocket, seeing that you could be homeless and on the street in a second, conditioned him a lot. So it was a lot of fear based decision making and caution and don’t take risk and that sort of thing. And so for me, it was this atonement with, he’s got a point. You should build up a safe base, but at the same time, use that safe base to go out in the world and do what you’re really trying and meant to do and that means taking risks and making yourself uncomfortable and really going out there where the ice is thin. And what’s funny is it comes full journey. Zubin Damania: So the hero’s journey comes back and the father in his eighties now recognizes, wow, oh wow, you did something that I wish I had done. You went out and did what you really loved to do and took risk and so on. And he loved doing what he was doing, but again, he had a different upbringing and a different set of circumstances. I was blessed to have his base to launch my own risk taking from. And so for me it was that antagonist was also one of the loved ones in my life, very important person. Robert Pearl: I was fortunate, Jeremy, I had a very supportive family, wonderful parents. And along the way, really at every stage, I had mentors who propelled me. I can think back even to elementary school teachers who were so encouraging, to high school, to college, to medical school, residency. So I would say I’ve not had that experience, not to say I didn’t face complex personal situations, but I could overcome them, and I had enough support to be able to overcome them. But I’d say the one time that I would point out, and I’d say it’s maybe the darkest time when I was CEO, was a vicious attack from the press and the state regulators, and the two coming to together in a way to want to be able to be critical. It was very specific to a transplant program. Robert Pearl: 150 kidney transplant plants had been done. Not a single patient had died. 149 of them were successful, but it came up against the national transplant body that didn’t like the fact that Kaiser Permanente, not a university, was doing transplants with these kinds of results and the reporter came after us for a variety of small things. There was a whistle blower who had been penalized for bringing alcohol to work and fired. And he was the one who fed the information, and there was a state regulator who wanted to have the support and look for… Everything was aligned in the wrong way. Robert Pearl: And the problem is that when you are the leader and you’re watching your people get beaten up, it’s like watching your child get struck by bullies on the other side of fence. And no matter how hard you shake it, the barbed wire at the top stops you from getting over the top. And I think at some point, and that’s why I asked the question to ZDogg earlier, to Zubin earlier, we can’t all complete our hero’s journeys. And I actually think that some of the hero’s journey is not being able to find that elixir at the end, because maybe those elixir’s are not really what life is about, but it’s being able to move on and come back despite not having them and the success that we had from a quality perspective, from a growth perspective and the respect of the nation around the quality that was provided and excellence of the physicians, that became the reward in the end. Robert Pearl: But the pain of that moment I felt, and I feel bad for anyone, as you say, who has that boss, who has the power and you can’t do anything about it, or the person who stands in your way, when you know that you should be able to get past that door. It’s just incredibly painful. And maybe the hero is being able to get past that and to be able to resume the wonderful life and productive life that you had prior to that. And to recognize that it’s not about you, it’s about them and be able to move on, but it’s certainly not easy. Zubin, another great show. So much fun. Can’t wait for the next time. Thank you for coming today. Zubin Damania: Oh, thank you. It’s like therapy for me. It’s beautiful. Thank you. Jeremy Corr: We hope you enjoyed this podcast and will tell your friends and colleagues about it. Please follow Fixing Healthcare on Apple podcast, Spotify, your favorite podcast platform. If you liked the show, please rate it five stars and leave a review. If you want more information on it… If you want more information on healthcare topics, you can visit Robbie’s website robertpearlmd.com and visit our website fixinghealthcarepodcast.com. Follow us on LinkedIn, Twitter and Facebook 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 #64: The hero’s journey in healthcare appeared first on Fixing Healthcare.

Tom Lee, founder of Epocrates and One Medical, discusses the dissonance he observed in healthcare norms and his motivation for entering the business world. He explores the need to reevaluate medical training and evaluation methods, reshaping primary care through One Medical, and the creation of Galileo, a data-oriented healthcare organization. The interview also touches on Amazon's potential disruption of healthcare and the future of the American healthcare system.

New data from the Annenberg Public Policy Center found that 4 in 10 Americans have returned to their normal, pre-pandemic lives. Over half of respondents say they rarely or never wear masks indoors while in public. This, despite 54% of Americans indicating they personally know someone who has died from Covid-19. A third say they know someone with “Long Covid.” How will these perceptions – alongside the continued loosening of public safety restrictions – affect the future health of Americans? In this episode of Coronavirus: The Truth, Jeremy Corr and Dr. Robert Pearl examine both the science and public opinion of Covid-19. You’ll find this topic, and all the [time stamped] topics discussed during this show, here: [00:50] Each show begins with the most recent and relevant facts concerning the Covid-19 pandemic and its impact on American life. What’s happening and what does it mean? [03:38] Listener question: “Is there is any explanation besides bad luck for both Dr. Fauci and President Biden getting ‘rebound COVID’ after taking Paxlovid?” [05:31] Covid-19 is now an endemic virus: What does that mean and what happens now? [08:21] What’s new with the monkey pox outbreak? [12:55] What are the current treatments options for monkey pox? [17:55] Is monkey pox a major concern for most Americans? [18:59] How might we “break” of some of healthcare’s most illogical rules? [24:45] Are Americans putting Covid-19 in the rearview? [25:59] What’s up with CDC? Is the agency changing course? [28:42] Kids and Covid-19: any news? [30:38] What do we know about the Inflation Reduction Act’s impact on healthcare? [33:09] And what about Amazon’s acquisition of One Medical? This episode is available on Apple Podcasts, Google, Spotify and other podcast platforms. If you have coronavirus questions for the hosts, please visit the contact page or send us a message on Twitter or LinkedIn. *To ensure the credibility of this program, Coronavirus: The Truth refuses to accept sponsorship, outside funding sources or guests with any financial or personal conflicts of interest. The post CTT #64: Are Americans putting Covid-19 behind them? appeared first on Fixing Healthcare.

This Fixing Healthcare podcast series, “Diving Deep,” probes into some of healthcare’s most complex topics and deep-seated problems. On today’s episode, hosts Dr. Robert Pearl and Jeremy Corr discuss the three biggest threats facing U.S. healthcare: Untamed inflation The nurse shortage A burnout / moral injury crisis These threats will require urgent and radical action. In addition, the hosts discuss another pressing topic: The threat of Covid-19. How dangerous is the virus today? For more information on these topics, check out Dr. Pearl’s latest healthcare columns on Forbes and LinkedIn. For listeners interested in show notes, here’s a time-stamped discussion guide: HOW DANGEROUS IS COVID-19 NOW? [00:59] Cohost Dr. Pearl had an eye-opening Covid-19 conversation with his ophthalmologist recently. What was discussed? [01:48] Who should get a second Covid-19 vaccine booster? [02:41] What are the most common Covid-19 questions Dr. Pearl hears? [05:40] How likely are people to die from Omicron? [07:44] Why are Covid-19 cases going way up but deaths aren’t? [11:22] How much should people worry about “Long Covid”? [15:12] Should people wait for the Omicron-specific booster coming this fall (or sooner)? [18:38] Is it safe to have a social life now? THREE HEALTHCARE THREATS WORSE THAN COVID [21:40] Dr. Pearl’s recent article “These 3 healthcare threats will do more damage than Covid-19” went viral. Why? [24:56] What’s causing the most concern in healthcare right now? [28:03] What’s concerning about inflation in healthcare? [30:41] How does the nursing shortage affect patient care? [31:48] What can be done to keep patients safe amid this shortage? [33:43] With cost and quality under siege, is there any hope for respite? [34:49] How will we unclog surgical backlogs in hospitals? [35:13] What about physician burnout? [36:34] Why are doctors dissatisfied and what can be done about it? [38:08] What happens when these three forces collide at the same time? [40:22] What does Dr. Pearl recommend as an “urgent and radical” solution? * * * Dr. Robert Pearl is the author of a book about medicine’s invisible yet highly influential physician culture. Check out “Uncaring: How Physician Culture Is Killing Doctors & Patients.” All profits from the book go to Doctors Without Borders. Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Spotify, Stitcher or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn. The post FHC #62: Diving deep into 3 urgent threats facing U.S. healthcare appeared first on Fixing Healthcare.

Did you catch the episode of Malcolm Gladwell’s Revisionist History about triplicates—those state-issued prescription pads that produced three copies of every painkiller script written? Many in medicine remember triplicates as a classic example of government overreach. But in 1990s New York, a city beset by a major drug problem, these triplicate pads had an amazing effect: opioid overdoses plummeted when doctors were forced to use them. In this episode of Fixing Healthcare, hosts Jeremy Corr and Dr. Robert Pearl join ZDoggMD to take an unfiltered look at the impact of triplicates (and regulations in general) on healthcare. The group also debates Amazon’s $3.9 billion purchase of One Medical and explores the untold lessons of Sesame Street (including: did the Count have an undiagnosed mental health disorder?), and much more. Welcome to Unfiltered, a show within the Fixing Healthcare family of podcasts that brings together iconic voices in healthcare for an unscripted, hard-hitting half hour (plus) of talk. For more, press play or peruse the transcript below. * * * 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 Jeremy Corr: Hello, and welcome to Unfiltered, our newest program and our weekly Fixing Healthcare Podcast series. Joining us each month is Dr. Zubin Damania, known to many as ZDoggMD. For 25 minutes, he and Robbie will engage in unscripted and hard-hitting conversation about art, politics, entertainment, and much more. As nationally recognized physicians and healthcare policy experts, they’ll apply the lessons they extract to medical practice. Then I’ll pose a question for the two of them as the patient based on what I’ve heard. Robbie, why don’t you kick it off? Robert Pearl: Good morning, Zubin. Zubin Damania: Hey, top of the morning, Robbie. Robert Pearl: You know, for a whole week before we do this show, it feels like I’m about to go to a Michelin starred restaurant and the chef’s going to cook me some new dishes. I don’t know what they’re going to be, but I’m certain they’ll be tasty and well seasoned and I can’t wait for today’s tasting menu. So if it’s okay with you, I’d like to revisit the conversation we had in the last episode, about the value of eliminating regulations and restrictions to address problems, rather than adding new ones to deal with the rules and regulations and restrictions that aren’t working. Like you, I agree, we have far too many. But I had an a-ha moment this week, when I listen to an episode from a different podcast, this one, Malcolm Gladwell’s Revisionist History. And he talked about the impact of triplicates, a topic I had never considered. So let’s start by, for listeners who may not know what a triplicate is, could you describe it for them? Zubin Damania: So are we talking about the old school DEA triplicates, where whenever you wrote a narcotic, it was copied three times with carbon paper and you had to send one copy to somebody and it was just this onerous process? Robert Pearl: Exactly the one I’m talking about. That’s exactly the one or the one he talked about. And he described some research that came, as you say, it’s the old way, so this was research coming out of, I’ll say 1990s. New York, Massachusetts, and New Jersey have similar populations and in the past they had similar incidents of deaths from overdoses. Then New York puts in place the triplicate process, but the other two states don’t. And suddenly deaths from overdoses come crashing down. This is like a natural experiment. It’s what economists love to find. And I want to know if our goal as doctors is to minimize deaths, how can we figure out which bureaucratic tasks are valuable? Which ones are waste of time? Which one will save lives and which will result in harm to doctors and patients? Zubin Damania: Man, this is a wonderful thought experiment because you have the regulation, which was designed to make it more difficult, presumably, to give out narcotics and so it adds a little activation energy to the physician’s workflow. So in a way, what you’ve done, is you’ve made it a little less easy for a physician to give a narcotic. And I remember when I trained in the ’90s, if someone needed a narcotic, I would just have to let out this heavy sigh, because now I got to go back to the little office, grab this thick old pad with the triplicates, do all this whole rigamarole, keep the records safe somewhere where they aren’t going to be stolen for a decade or whatever the requirement was. So any way I could get out of having to do that, you’re kind of looking, “Well, does this patient really need narcotics?” Et cetera. Zubin Damania: So in a way, what it was, was in my mind, it was saying, “Okay, did the doctors really need to do this?” Now, so it turns out they probably didn’t. Now the question is you didn’t really study how much excess pain was there, how much suffering was there, et cetera. We don’t know the answer to that, but we do know that overdose deaths plummeted. So the question is, was the regulation a good idea in the sense that, oh, we need that kind of regulation. Or was it a more of a test that says, “Hey, maybe we ought to retrain physicians.” Because at that time the pharmaceutical companies were telling us, you know what, a pain is the fifth or sixth vital and we need to treat it aggressively with narcotics and people don’t get addicted if they have real pain and so on. All of which has been proven to be nonsense and or less sensical than they were saying. And there we are. So it’s a matter of teasing out, do we need that bureaucracy or do we just need more awake medicine that looks at the externalities of everything we do? Robert Pearl: What do you think? Zubin Damania: I think it’s actually, we need more awake medicine that looks at the externalities of everything we do. And it just happened to take a bureaucratic intrusion at that time to teach us that guess what? This is probably not a good idea, how much opioids we’re giving out. Now the thing is, again, you and I are both also I think, although I may be putting words in your mouth, advocates of good system design, like smart system that, to use Jonathan Hyatt’s metaphor of the elephant and the rider. Our sort of unconscious mind that kind of runs the show in many ways. And the conscious little guy riding on top that really often is more the servant to the elephant. How do you shape the path that they’re walking on to make the default actions more beneficial? And to that degree, systems design is good. So would it be great to make it really easy to prescribe narcotics in the setting of a pharmaceutical industry that’s promoting them? No, probably not. So you would need that kind of systems designed. So it’s always a balance. Robert Pearl: I think that’s the argument that people make when they put in place restrictions and regulations, which is that if you shape the path in the direction that either will maximize good or minimize harm, that that’s going to lead to a good outcome, but as you and I both know, often that’s not what occurs. And what occurs is you inflict pain on both the doctor and the patients. Zubin Damania: So I, yeah. And the way I think about that increasingly is the way we think about any sort of, even if you study existential risk, like nuclear war or environmental catastrophe or these kind of things, you’re always looking at, okay, here’s an intervention that we do, like say social media with tech algorithms that try to draw our attention. Okay, that’s great. It has this outcome that the companies make a lot of money and we get this experience of social media. What are the externalities, the second, the third, the fourth order effects of that technology? And it’s the same with regulation in the healthcare space. We don’t know what those externalities are until you put it into place. And at that point it may be out of the bag, very hard to unwind and you’ve caused a lot of damage. So we need to get better at predicting externalities or considering them. Factoring them into the cost of any intervention. And it just gets tricky, but it’s not impossible. We ought to make it a priority. Robert Pearl: I heard interesting, I’ll say study, I don’t know if it was really a study or just an observation, that Sesame Street, the show for little kids, you think is designed to teach them the alphabet and mathematics. You know what it teaches them? Television is about entertainment. It’s not about learning. So although it is introduced at that point, it becomes an addiction for entertainment rather than for growing one’s mind and confronting difficult questions and challenges. Zubin Damania: Now that’s really interesting. So I actually revised my history of Sesame Street years later when I went through medical school, because I realized each of the characters had distinctive psychopathology and physical pathology, like the Count. Do you remember him? He would teach kids purportedly how to count, but really he had a severe case of obsessive compulsive disorder. I mean, he was counting everything. He couldn’t stop. One, two, three, ah, ah, ah. Poor Count. He’s suffering. But yeah, I hear you. Robert Pearl: Let me ask you about an associated issue that you and I both think about a lot, which is burnout. And one of the first step in addressing any problem, is always to figure out what’s going on and we know that bureaucratic tasks and the prior authorization imposed by insurers and all the rules and restrictions by hospital administrators. We know that this is making the lives of doctors and patients worse. But now I want to ask you the next step, which is recognizing the problem doesn’t, from my perspective, solve it. What you actually do is have to get someone else to take action. In your mind, how can doctors and nurses force the insurers and hospital administrators, to do the things that we know will reduce burnout without creating secondary problems as a consequence? Zubin Damania: Mm, I think in this case, it’s one of those situations where we have this adversarial zero sum relationship. It’s kind of like this game A dynamics, where somebody wins and somebody loses. So the administrators win, the doctors lose. The doctors win, the administrators lose. The insurance companies lose. We really have to align the incentives across the spectrum of that, which means maybe it’s more integration. Maybe it’s the integration of the payers and the caregivers together, that allows the incentives to align. And even then, of course, we’re going to have the politics that go back and forth and the different dynamics, but it would be much better. So I don’t know that anybody’s going to be able to force anybody to do anything. Zubin Damania: But even like something like a prior auth. Why are prior auths in place? Because a lot of times physicians will do things that are not evidence based, that are costly, that have second order iatrogenic effects, meaning they cause harm because of over-testing, over diagnosis, overtreatment. And the insurance companies say, “Well, okay, it’s also increasing cost. So let’s put a prior auth, let’s throw that triplicate, the barrier to entry here. Make it higher.” And then what happens is the doctors escalate and say, “Well, now my autonomy is threatened. Now my clinical judgment is questioned and my time is affected.” And that creates this injury that leads to burnout. So how about we actually powwow and say, “Okay, so what are the practices that actually do work? And when can we have the clinical autonomy to override those practices?” Because that’s what doctors do best is that deep intuition to say, “This is where the algorithm actually doesn’t apply or where we can actually make an exception.” And that trust then leads to more alignment, less need for these weird negative incentives to be put in place, I think. Robert Pearl: I agree with you completely. It’s a lot of why I think we have to move from a fee-for-service volume based mentality to one that’s capitated. The tremendous work you did when you were in Las Vegas, demonstrating how you can improve quality and lower costs, if you all have the incentives that align with each other, but still the progress to that goal seems to be incredibly slow. Zubin Damania: It does. Now, what’s interesting is our partners in that effort in Las Vegas, they merged with One Medical last year and One Medical just got bought by Amazon. So it’ll be interesting to see how that sort of intensive primary care model evolves in that space. It’s going to be interesting. And there’s a lot of headwinds to change, because the payment models haven’t changed. You’re still working in this kind of either fee-for-service or capitated without sort of revenue share or positive externalities when you do really well piece. And so we really need to look at how those payment models affect care models. And it’s tough because there’s so many legacy players. So many people with so much to lose and they’re all oligopolies. So how do you even start to crack that? It’s going to be multifactorial. Robert Pearl: Let’s follow up on what you just raised, which was the Amazon purchase of One Medical. For listeners who may not know, One Medical is a primary care first organization, Began in San Francisco. It’s now in 180 offices and 24 different cities. It was just purchased by Amazon for 3.8, I believe, billion dollars. Amazon entered into healthcare very slowly. A couple of years ago, they bought PillPack, which is a pharmacy delivery, that was really important because you have to have licenses in every state and they inherited the 50 licenses needed to distribute pharmaceuticals. Then they built some clinics for their own employees. Then they started online telemedicine. And now with One Medical, particularly because One Medical has acquired a company called Iora, about a year ago, which is in the Medicare space. You’re looking at this massive opportunity for Amazon to come into medicine, the way that it went into retail. Robert Pearl: It’s began in the book era. And when everyone was worried about the bookstores, they were already thinking about all of retail and then people were worried about the retail. Now they’re thinking about medicine and on and on in that process. How do you see this acquisition? How big a threat do you think it is? Where’s it going to go? When’s it going to happen? How should doctors think about it? How should they behave differently at this point? Zubin Damania: So this is an interesting response to the clear market dynamics with big self-funded employers, like Amazon, that prices keep going up. Care, quality and outcomes are not good. And it’s unsustainable, economically and morally actually, because people go bankrupt because of these medical bills and so on. And it’s a drag on the economy. So Amazon said, “Okay, well now we’ve disrupted these other spaces. Let’s see if we can do medicine.” Now, of course, they failed to do that with their enterprise Haven, with Berkshire Hathaway and JPMorgan Chase. So they know already how difficult this space is and they purchased One Medical. Now what’s interesting about One Medical relative to Iora, like you said, Iora’s focused more in the Medicare space because we use the same Turntable Health model that we used in Vegas at Iora, this sort of team based primary care, health coaches, intensive management of at-risk patients. Zubin Damania: Now One Medical actually just charges a yearly membership fee for access. So you get easier access. You have this high touch app and so on that you can schedule easily, but they still charge commercial insurance. And so as a result, they were losing money prior to the acquisition. So in order to make this work, Amazon’s going to have to figure out how to actualize really good preventative team based, relationship driven, primary care, that prevents downstream spending that allows some curation of a network of specialists that are actually doing the right thing, which is very tough in the self-funded space, because then that means employees have restricted choice. And they have to do it in a way that they’re going to have to subsidize, because it’s not going to be profitable initially. Zubin Damania: Now, if they can do that, they have the power, the money, the scale, the drive to do it. They could actually produce a kind of care that patients are so compelled by and physicians are so compelled to work in, that it does create that disruption and then the payment models start to change and you have true transformation. So that’s the potential outcome there. The more likely outcome is it’ll all fail, but that’s how I think about it. Robert Pearl: I would beg to disagree. Zubin Damania: Awesome. Robert Pearl: I predict that this will be a major transformation of American medicine. I think Haven failed because the other two CEOs really wanted it to be a not-for-profit for their own employees. And Jeff Bezos wanted it to be a sixth of a $4 trillion industry. He already got what he could get in retail, and now he wanted it to do it in medicine. I think that he will. I think that the word, choice, that we use has two meanings. Choice is, I want Dr. Smith. Choice is, I want my problem taken care of next Thursday. And he’ll be able to offer you the convenience. He will design healthcare the way he designed Amazon, which is to make it so convenient to give you lots of choices. And the fee you described for One Medical, I think that sounds like a Amazon Prime subscription model of which he only has 110 million people paying him for exactly what One Medical does. Robert Pearl: I think the big problem that One Medical, Iora and everyone else has had is scale. And what is Amazon really good at? Scaling. And I said back at Haven, is there anyone who thought that Bezos was in this as a not-for-profit for his own employees, probably also thought that all Amazon did, was sell books. I think the same thing here. This is not about improving the American healthcare system. This is about making money for Amazon, but his strategy would be to do in healthcare, what he did in retail, which is to make it very patient focused. Robert Pearl: And I believe that unless physicians start to change now, they’re going to get left behind, because I guarantee you, he’s not going to pick the best insurance company. He’s going to be his own insurance company. And he’s not going to pick every doctor in every hospital, but he’s not going to pick them because they’re cheap. He’s going to pick them because he provides high quality, good service in an efficient kind of way. And so I’m betting on them. And it’d be a great one to come back in about five years and see whose prediction ended up being more accurate. Zubin Damania: So, listen, I hope to God you’re right Robbie, because this is part of… Look, if they can pull that off, it will truly be the kind of American style healthcare transformation that I’ve been advocating. Rather than just straight single payer and paying for our broken system currently, why don’t we actually try real innovation? And if Bezos can do it’d be wonderful. What’s fascinating is don’t forget Zappos, who’s CEO actually funded our clinic, Turntable Health, is a fully owned subsidiary of Amazon. And they actually worked with us and saw our model at Turntable through Zappos. And so that was their sort of first exposure to this sort of intensive primary care. Zubin Damania: If they can bring what we were trying to do to scale, it would be absolutely transformative. And so I’m rooting for them. What I am Robbie is, I’m a little superstitious. If I’m too optimistic, what I find is, it’s like what my mom taught me. She never bragged about her kids, things would go wrong. So I’m hoping you’re absolutely right, but publicly I’m going to be very a circumspect because there’s a hubris in tech too, that often leads to failure. Robert Pearl: Now, on the other hand, I am worried about the success they’re going to have, because I can predict what it’s going to mean for doctors and nurses. And I’m not sure that they’re going to be happier under, I’ll say under the thumb or under the employment, I don’t know which way it’s going to go, of Amazon. We certainly know there are a lot of issues with the people who work inside Amazon today. Zubin Damania: So that was another point. And when I talk about it with my audience, they express the same concern. They’re a healthcare audience. What I’ll say is this, the hope there is that when Amazon acquired Zappos, Zappos was considered one of the best places to work. It would win these awards every year because of Tony Hsieh’s leadership and the general focus on happiness and work/life balance and so on. If Amazon does the same thing with Iora, One Medical, then we’re in good shape. If they try to turn them into Amazon employees, we should be very concerned, because they will create this attempt at cost, quality and convenience on the backs of overworked and underpaid and under automatized employees. But hopefully that’s not the case. And in fact, I don’t think it’s possible, because without engaged, trusted, and resourced healthcare providers, you can’t have quality, cost and outcomes that work. Robert Pearl: Yeah. I don’t think it’s going to be a question of not paying them. They’re going to pay them adequately. I think it’s going to be a question of expectations and that the expectations that Amazon will have, which is going to be a customer first notion, will clash with the culture of medicine, where physicians have, as you said earlier, focused on autonomy, focused on their own office, focused on the freedom to do whatever they wanted. And now there will be expectations about how quickly patients need to get care and how broadly they need to be available. And the types of things you could see coming out of Amazon. I think, again, I’ll flip back the other way, like yourself, the idea that somehow you could order shoes and just return them back and all the other conveniences that Zappos did, made no sense, except that it was so successful, because it was so desired by the customer. And I think that that’s the biggest shift. That I think Amazon will make medicine be customer, patient focused rather than provider focused. Zubin Damania: I think you’re right. And so the caregivers better get ready for that. But the other thing is, hey, if they just give them the 25% Amazon employee discount, I think everyone will be perfectly happy don’t you? Robert Pearl: Yep. I think it will be true. Zubin Damania: Just solve burnout. Just solve burnout. Just order a hand massager from Amazon at 25% off. Robert Pearl: So Zubin, I love our listeners and our audience is massive and several of them said they really liked our conversation last time about movies. And they wanted me to ask you, what is your favorite movie of all times? Zubin Damania: Oh, it’s really a difficult answer because there’s a few, but I’d say one is The Matrix. And the reason I love The Matrix is because it really encapsulates the deepest sort of Buddhist philosophy or any spiritual philosophy, which is you feel like you’re one thing and it turns out that’s an illusion. And at some point you wake up and then you do battle with your demons and then you transcend. You almost die and are reborn as a much more awake being. And that’s why I love The Matrix. Plus it was just amazing effects and action and all of that, but every single frame of that movie, points to this sort of deeper truth. So I love that. And then one of my other favorite movies is The Big Lebowski. Just because it’s The Big Lebowski. The dude abides. Zubin Damania: How about you? Robert Pearl: I’ll throw you two in return. A movie that probably 1% of listeners may ever have heard of, but I love, was a movie called Burn. It was Marlon Brando. And it’s the story of Marlon Brando, Sir William Walker in the movie, who’s sent to a Portuguese island in the Caribbean, to incite a revolution, because the British wanted to take over this very high revenue, highly profitable, sugar cane growing island. And he finds a dock worker, Jose Dolores. And he teaches him how to be a rebel and how to incite a revolution and it’s successful. And he leaves. And then in the second part of the movie, he returns seven years later, because now the island is in revolution against the British government. And he’s sent there to shut down the revolution. And the only way he can do that is by burning the entire island, because once the revolution begins, it can’t be stopped. So that is one of the best movies I’ve ever seen that I think of often. Zubin Damania: I don’t know how to parse that Robbie. It kind of feels like the hospital, like the clinical administrator’s paradox. You come from that space, you’re like, “Okay, I’m going to fix things.” You go become a leader and then you realize how trapped you are. But that’s great. I’d never heard of that movie. I’ll have to check it out. What’s the other one? Oh, go ahead sir. Robert Pearl: I just think the revolutionary spirit to make change is why this whole season I’m focusing on, this idea of rule breakers. And I think rule breakers have to understand that once you break the rules, you don’t control the rules, but they need to be broken and basically the entire model of the colony, which is really what it was, whether it was under Portuguese or British control, just was not appropriate. And ultimately the human spirit would survive. Although I guess in the end, the island was burned down, but you can’t stop it once it starts. Zubin Damania: Sometimes you have to start fresh. That’s you know. Robert Pearl: The other movie and to me, it’s the three part movie, is The Godfather. What I love about movies is when I learn things and what I loved about the three… The first one is one of the best movies ever made, but it’s beyond that. It’s the triple movie where you have the immigrant coming to the United States, starting with nothing, working his way up. And by the third movie, now you’re on the third generation and the last thing they want is to be in any way associated with the past. Robert Pearl: This is just the classic three generation story. It was in my family. It’s probably in your family. We see it all over the place. And it’s just so well shown. Without telling people, you just watch it. Everyone moves in the direction that you can understand. And by the end, you’re in a totally different place than you start and The Godfather is all over. So the other thing I loved about that movie is that my dad, near the end of his life, we had a little thing where for three weeks in a row, every Sunday night, we’d watch one of the three. And I still remember being with him in those last days. And it was a very emotional time for me. Zubin Damania: Mm that’s beautiful. Yeah. The immigrant story and the fact that everyone can get something from that. That’s beautiful. Zubin Damania: Movies, oh, sorry, one last thing. I mean, movies are so powerful, I think for us, because when we’re watching a movie, if we’re truly absorbed, the sense of self evaporates, it’s just the movie. And we lose ourselves in that. And I think that’s why it’s such a powerful archetype for us that going to the movies, especially going to the movies with others. There’s this weird collective thing that happens. It’s really wonderful. I recently saw a movie, Everything Everywhere All at Once, which is about this sort of multiversal Asian immigrant tale that throws in a multiverse. And some sci-fi and some action, but it’s really about a family story. And you could just feel the energy of the audience, many of whom were Asian American and is a very powerful experience. Robert Pearl: Wow. I haven’t heard of that movie. I’ll check that out too. Zubin Damania: You might enjoy it. Robert Pearl: Is it currently playing? Zubin Damania: It might be rereleased. It came out a few months ago, but you can get it on the usual rental channels online. Robert Pearl: One last topic coming out of what you mentioned earlier, you mentioned Buddhism and I’m always fascinated by your understanding of it, your practice of it, you’re going towards it. A book that I read at least twice a year is Victor Frankl’s Man’s Search for Meaning. And in this podcast, we’ve covered the gamut already. Issues around suffering and happiness. You’ve pointed out many times about Buddhism and the idea that suffering is, it’s integral part of life. Last episode we talked about on the other hand, that we’ve both had great fortune in our lives to have had pretty good lives and excellent upbringing. Victor Frankl talks about the fact that we can’t control the world around us, but we can control our response to that world. I want to ask you about this whole notion about our attitudes, about happiness and what we should do about that in the context of healthcare today. How do we separate what’s real, which is our ability to gain happiness out of purpose and at a function from what is simply Pollyanna deception. Zubin Damania: So, this is interesting and I actually don’t consider myself a Buddhist. I actually look at all these different approaches to self-awareness or awakening or however you want to call it. But I think what many of us in healthcare suffer from and I saw this at the retreat we did, I’m actually tomorrow, I’m leaving for another eight day silent meditation retreat, actually with a anesthesiologist, Angelo DiLulo, who’s been on my show a few times at his home. It’s just a small group of people. And it’s interesting, because a lot of these guys are healthcare people at the last retreat. Zubin Damania: And what we find is we are so self-referential, we’re so up in our head, we’re so identified with our thoughts and our emotions and our bodies and we feel like we’re the small thing against the world. And so we’re trying to find happiness as a separate self battling against a world that is opposed to us. And the real revelation starts to come when you realize, that’s just not the case. When you can actually examine your experience in the current moment and find no distinction between self and other and in a sense, it’s all happening and it’s happening perfectly. And that automatically realigns attitude, because attitude is a kind of a thought pattern. Zubin Damania: And we then interact with the world in a very different way. The energy we put out is different and our responses are different. And it’s all the cliches you hear, everything is love and this and that and all that. Those are just dumbed down ways of saying the experience that’s available in the present moment is beyond words. And people will reduce it to a Hallmark card, but it’s actually experienceable. So instead of thinking about it, talking about it, theorizing about it, just pay attention to the present moment and see what happens. And often the attitudinal changes and all that can just emerge from that, but it takes persistence, awareness and sometimes a teacher and sometimes some striving, which is paradoxical, but that’s been my experience so far on this sort of journey. Robert Pearl: How do you stop that from making the individual, the victim and the source of the problem, when it’s really the context around him or her? Zubin Damania: Yeah, it’s a paradox because you’re telling somebody, “Listen, this is really in your control. Meaning there’s no control, but you can wake up to that and you have to look.” And so in a way, you’re giving them this sense of agency and responsibility for themselves, which can create this kind of victim mentality. But in reality, that’s to wake up to the fact that they’re really, this is just this beautiful present moment happening. There’s no past and future. It’s really just this. Zubin Damania: And that means that when you actually, it’s not even a knowing, it’s an actualized realization. You embody this understanding. The way that you show up in the world actually is better. It’s better for you in the story sense. It’s better for you in the emotional sense and it’s better for others. And so it’s because so many of us are trapped in the kind of, I’m a victim mentality, or it’s all my circumstance, that’s the problem. And the truth is, there is no problem in the present moment, but that again, and that gets back to The Matrix. He says, “There is no spoon,” to Neo. In the end, when you realize that, then you have all the power paradoxically. Robert Pearl: To be continued in the next episode. Let me turn it back to Jeremy to pose the question to you and me. Jeremy Corr: I’m curious if there is a person or topic or something that happened in medical history, that if each of you had to choose, that you would make a movie out of that you would feel that would be inspiring to not just medical professionals, but to a mainstream audience as well? Zubin Damania: Boy, there are a lot of beautiful evolvements in medicine. I think Osler’s story, some people call him the father of modern medicine would be a great kind of biopic to tell, to kind of show what medicine is at its heart. I think the story of Maurice Hilleman who pioneered and discovered and invented some of the first commercial vaccines is a beautiful story. I think Paul Offit actually was involved in a documentary about him, but doing a fictionalized version would be a beautiful piece. There’s so many of these things that would inspire us to reconnect to the kind of sacred heart of medicine, which is that deep connection with other humans. That then you fold in the science and the technology and the innovation, but really it’s about other people. So I’ll turn it over to you, Robbie. But those are my top of the head thoughts. Robert Pearl: I love, whether it’s a novel, whether it’s a movie, the vision of an arc. I think every story has to have an arc of one sort. There are lots of different arcs, but it has to have a connection coming up to either a peak or going down to a valley and coming back up afterwards. And the story that I’m obviously focused a lot on right now, I just did a TED Talk on, was the story of Ignaz Semmelweis and the discovery of how doctors were carrying the bacterium, they didn’t know as a bacterium at the time, from the autopsy room into the delivery room and killing large numbers of women. I could imagine the movie opening with the suffering of women who were coming in for, what should have been a glorious event, delivering a child and dying in the hospital and leaving the new baby and the children back at home without a mother. Semmelweis’s fortuitous experience where a colleague nick’s finger, develops a local infection, goes on to a clinical course, identical to these women who develop the technical term’s puerperal fever. Robert Pearl: And he goes on to die. Semmelweis comes up with an idea. He’s a scientist. He tests it. He finds that the mortality drops from 18% to under 2%. We expect, as the audience, oh my gosh, this is terrific. People are going to embrace it. Doctors are going to love it. It’s going to spread rapidly. Only to find out that no, they actually hate it, because it lowers their status. It lowers their prestige. And Semmelweis ultimately gets submitted to a psychiatric mental health facility where he goes on to die a couple of years later. Robert Pearl: And it’s the pathos of both the experience, the suffering of the women and the families and the arrogance of the physician at the time. And of course, in the end, the pathos of Semmelweis himself, who won’t get a chance 50 years later, to see Pasteur define infection and be able to identify the bacteria that is responsible for this disease. And therefore allow us to then go on to treat the bacterium. And now that’s a relatively rare complication following delivery. So that’s the arc that I would follow in the story. And I think it would make a far, even a far more beautiful movie, than either book or article. Zubin Damania: So basically what I’m hearing is, you’re nixing my inventor of the DaVinci prostate robot story. Is that what you’re saying for Semmelweis? Because I think that story is completely boring and uncompelling. Zubin Damania: No, it’s beautiful. The Semmelweis story, because it points right back at us, at the culture of medicine. It’s so uncomfortable to think that we could be complicit in harming and creating, suffering in women. And yet there it is, the culture trumps everything else. And Semmelweis, when you talk about the arc, the hero’s journey, what Joseph Campbell, famous mythology professor talked about this hero’s journey. And by the way, a great thing to listen to if you haven’t, Robbie is The Power of Myth. It’s an audio series with Joseph Campbell and Bill Moyers from, I think it was the ’80s. And they talk about this stuff, the hero’s journey, it’s really, really powerful. Robert Pearl: I’ve read Joseph Campbell’s book. I love it. And I’m going to make sure we talk about it as the first thing we discuss in the next episode of Unfiltered. So Zubin, it’s been terrific. Thank you so much. And I can’t wait till we get back online a month from today. Zubin Damania: Thank you, Robbie. It’s always a blast. Jeremy Corr: We hope you enjoyed this episode and we’ll tell your friends and colleagues about it. Please follow Fixing Healthcare and Apple Podcast, Spotify or your favorite podcast app. If you like the show, please rate it five stars and leave a review. If you want more information on healthcare topics, you can go to Robbie’s website, robertpearlmd.com or visit our website at fixinghealthcarepodcast.com. 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 #61: An unfiltered look at Rx triplicates & Amazon’s healthcare expansion appeared first on Fixing Healthcare.

Returning to the podcast this week is a household name in medicine, Dr. Don Berwick, who made his first appearance on the show in season one. Back then, Don said something that would turn out to be highly relevant to this: the seventh season of Fixing Healthcare. “We have made so many stupid rules [in healthcare],” Don said, “and those stupid rules have to be stopped. They have to be taken down. Many of them are rules that make no sense.” He was referring to some of medicine’s written rules—particularly, the endless performance metrics that so many doctors despise. In this interview, hosts Jeremy Corr and Dr. Robert Pearl ask Don to discuss some of medicine’s unwritten rules. These are, as listeners know, the norms and behaviors that dictate the way doctors think and behave. Quick bio: Don is the former president and CEO of the Institute for Healthcare Improvement (IHI) and led the organization’s 100,000 Lives Campaign. He’s the former administrator of the Centers for Medicare & Medicaid Services (CMS) and has served on the faculty for Harvard Medical School and Harvard School of Public Health. Interview Highlights On fixing healthcare with help from colleagues “I’ve never done anything alone. It’s with a group of people like you, Robbie, who understand that we’ve got to make changes, our oath needs to be honored, and that’s only going to be done if we change the way we deliver care. I think that the lesson I learned early on is that the receptivity in the workforce is enormous, once offered the opportunity to improve the work they do to get really involved in all the dimensions of excellence. The vast majority of people in healthcare, doctors, patients, nurses, pharmacists, they really want to make changes. And if you can drill down to that energy, you can have success.” On the ‘100,000 Lives’ campaign “One of the most dramatically positive experiences in my career, I think, was the 100,000 Lives campaign back in 2004. The architect was my colleague still, Joe McCannon. We developed the idea of trying to mobilize energy throughout the nation in hospitals to adopt a relatively simple set of changes that would save lives by improving processes by standardizing and spreading practices that worked. Well within, oh, barely six months, we had over 3,000 American hospitals enrolled in that project. I think there’s a will in the workforce to work on making things better systemically that can be unleashed through proper leadership.” On changing the system of care “The trick is to learn to think systemically, for clinicians to understand that they are citizens in complex environments, much bigger than themselves. And only when we get involved in, buoyantly, happily, joyfully get involved in celebrating and working in those interdependencies with the support of leaders can we make progress. It’s really frustrating to try to be a hero all the time. It doesn’t work.” On preventive care “Prevention is always hard. You don’t actually know what doesn’t happen, but once you bring a scientific lens to this problem of excellence and get honest about the data, you can see it, you can see the harm.” On breaking hammerlock of healthcare financing “We’re in a hammerlock right now. The incumbent financial system is so deeply invested in the technologies and processes of acute care, some of which are miraculous, lives are saved every day by organ transplants and heart surgery and advanced chemotherapy that we should never give up, never ever give up. But in order to support that technocracy, we’ve developed a financial architecture that is confiscatory. It takes everybody’s money and talk about breaking rules. The rules for payment, the rules for profit, for greed that allow greed to enter the system are costing us dearly. And I think the incumbent system doesn’t want to change it. It doesn’t want to see that money shift.” On thinking globally to change healthcare “We really need to become globalists in our thinking. It’s not un-American to ask how other nations and other communities deal with health and wellbeing and at what price, it’s instructive. And we need to have a humility to do that searching.” READ: Full transcript with Don Berwick * * * Dr. Robert Pearl is the author of a book about medicine’s invisible yet highly influential physician culture. Check out “Uncaring: How Physician Culture Is Killing Doctors & Patients.” All profits from the book go to Doctors Without Borders. Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Spotify, Stitcher or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn. The post FHC #60: Don Berwick on ‘breaking the rules for better patient care’ appeared first on Fixing Healthcare.