Listen to the Whispers
I vividly recall meeting Congressman Patrick J. Kennedy in the Cannon House Office Building in Washington, DC. It was 2006, and Dr. Paul Grundy and I were together, working on the launch of the medical home crusade. We were preparing for an ambitious journey that crossed continents and would last a decade.
Later, I had the honor of sharing the stage with Patrick at the 2016 State of the Union address for Mental Health and Addiction. During my remarks, I quoted a Native American proverb attributed to both the Dakota and Cherokee nations. It brought to mind wisdom shared by elders. I imagined a gathering around the evening campfire, a time when such great wisdom is reverently passed from one generation to the next.
“Listen to the whispers, so we won’t have to hear the screams.”
I imagined campfire listeners nodding in agreement with the ranking elder in the warmth of a special moment. The fire snapped. Sparks flew upward. There was silence.
This powerful proverb resonated with our audience of mental health champions as well, because we are a nation that struggles with listening to whispers.
On her final regular television show on May 25, 2011, Oprah Winfrey talked about her greatest regrets.
“Whispers are always messages, and if you don’t hear the message, the message turns into a problem. And if you don’t handle the problem, the problem turns into a crisis. And if you don’t handle the crisis, disaster. Your life is speaking to you. What is it saying?”[i]
She’s right. Now we have the greatest public health crisis of our time with substance abuse, addiction, depression, and suicide. We’re paying the price for not listening to the whispers.
Of all the things broken in our healthcare system, perhaps mental health, and substance abuse are the most troubling because we as a culture have stigmatized these illnesses.
We hear the screams. This book is about listening to the whispers of the wise.
***
Every person’s healthcare could be described as a journey. We like using that metaphor.
So too, every nation’s healthcare could be depicted as a journey.
In developing Trusted Healers, co-author Bud Ramey and I traveled throughout the US and abroad to retrace the steps of Dr. Paul Grundy, who spent a decade crusading for better healthcare. In these pages, we observe several nations with innovative approaches to healthcare. We also acknowledge that America’s healthcare journey has been quite bumpy. By reminding ourselves of where we have been, we can see a better way forward.
We know that many of our healthcare sins have been self-inflicted either through ignorance or indulgence. Early Americans, for example, took a healthful dram for breakfast. Whiskey was a typical lunchtime tipple. Ale accompanied supper and the day ended with a nightcap. Continuous imbibing clearly built up a tolerance as most Americans in 1790 consumed an average 5.8 gallons of pure alcohol a year.[ii] In early America, alcoholism—also known as dipsomania—was starting to have a serious impact on communities. Women and children might be in physical danger if the man of the house began drinking. If he became ill or lost his job through drink, there was no social safety net to support or protect his family. In 1862, the US Navy abolished the traditional half-pint daily rum ration for sailors, and in the same period support for Prohibition, banning the manufacture and sale of alcohol, was overwhelming.
By the late 1800s, dipsomania, or alcoholism, was being treated as a disease.
The first arrest for driving under the influence of alcohol was in 1897.
On January 16, 1919, the Eighteenth Amendment, which set Prohibition into law, became part of the Constitution.
In 1955, the Breathalyzer was patented.
Today, Americans drink an average of 2.3 gallons of alcohol a year compared to 7.1 gallons in 1830.
And then there’s our history with tobacco.
Most Americans born into the generations following the post–WWII baby boom have gone their entire lives aware that smoking can cause lung cancer. But this fact was not always well known. The tobacco industry intentionally camouflaged smoking’s effects and even promoted it as stylish. Societal consequences of that charade were dire.
Prior to the 1900s, lung cancer was a rare disease. But by the turn-of-the-century, we faced rapidly increasing lung cancer rates. New technology allowed cigarettes to be produced on a large scale, and advertising glamorized smoking. Many movies featured lengthy cigarette smoking scenes. Smoking ads were everywhere.
“LSMFT. (Lucky Strike Means Fine Tobacco)”
“More doctors smoke Camels than any other cigarette”
“Chesterfield: smells lighter, smokes lighter”
“The Marlboro Man”
The military got in on it too, giving cigarettes to soldiers during World Wars I and II, and continued to do so until 1975 in field rations.
Cigarette smoking increased rapidly through the 1950s, becoming much more widespread. Per capita cigarette consumption soared from sixty-four per year in 1900, to 4,345 per year in 1963.
And, lung cancer went from rarity to more commonplace. By the early 1950s it became “the most common cancer diagnosed in American men,” wrote American Cancer Society Chief Medical Officer Dr. Otis Brawley in an article published November 2013 in CA: A Cancer Journal for Clinicians.[iii]
The creation of that landscape-altering report began with a letter sent to President John F. Kennedy in June 1961. Leaders from the American Cancer Society, the American Public Health Association, and the National Tuberculosis Association urged Kennedy to form a national commission on smoking to find “a solution to this health problem . . . ” Kennedy asked his surgeon general, Luther Terry, to tackle this.
These two behavioral crises provided a rhythm for healthcare all the way into the new millennium. What new health and behavioral crises lie ahead, challenging us?
***
Forty years seems like a long time. It’s a generation. Forty years was used by the ancient Hebrews figuratively to mean a long time. The number 40 is used in Scripture many times in various ways.
It was forty years from the tragic assassination of Martin Luther King, Jr. to the election of President Barack Obama.
It was forty years from the Academy Award for Best Picture to the silent movie Wings to the first steps on the moon of Astronauts Neil Armstrong and Buzz Aldrin.
It took forty years from the opening in 1830 of the Baltimore and Ohio, America’s first railroad, until the golden spike was driven to symbolize the opening of the Transcontinental Railroad.
And forty years passed from the development of the nation’s first electronic medical record in 1960 until the Modern Age of Healthcare Information arrived.
Consider taking a closer look and comparing the construction of the Transcontinental Railroad with America’s burgeoning healthcare information network.
Railroad track had to be laid over two thousand miles of often difficult terrain, including mountains of solid granite. Before the Transcontinental Railroad was completed, travel overland by stagecoach cost $1,000, took five or six months, and involved crossing rugged mountains and arid desert. ($1,000 in 1860 represents $30,265 in today’s dollars.)
The alternatives were to travel by sea around the tip of South America, a distance of 18,000 miles, or to cross the Isthmus of Panama, then travel north by ship to California. Each route took months and was dangerous and expensive.
The Transcontinental Railroad made it possible to complete the trip in five days at a cost of $150 for a first-class sleeper. It took six years to complete.
The first spikes were driven in 1863, during the Civil War, and on May 10, 1869, at Promontory Summit, Utah, a golden spike was hammered into the final tie. The ceremonial 17.6-karat gold final spike is now displayed in the Cantor Arts Center at Stanford University.[iv]
In healthcare, the first electronic medical record was developed in 1960. Forty years later, worldwide healthcare stood at the door of the millennium and at the threshold of the Age of Healthcare Information.
Some would argue that the global pace of change has now quickened.
That may be true in many areas. But even though medicine and healthcare leaped across large chasms at the turn of the millennium, even though technological advancements are as powerful and lasting as any the developed world has achieved, healthcare still clings to its own rhythm and pace to create cultural change.
Throughout the nineteenth and twentieth centuries, our culture had been immersed in unhealthy behaviors. Yet, life expectancy was creeping up. In 1900, it was in the forties. In 1950, life expectancy had risen to the sixties. By the millennium, expectancy was in the seventies. But it was a struggle. It took Prohibition to slow down our drinking pace. And cigarette makers were finally reeled in by a federal government that could no longer ignore cancer wards filled with patients suffering with lung diseases. Regular exercise was on the rise, but not for most.
Slowly, surely, citizens of the developed world embraced a different idea about taking care of themselves.
Healthcare information technology helped get us on the right course. Healthcare morphed and expanded into not only medical treatment for diseases, but preventative care and improving lifestyles with diet and exercise.
Information sparked this change. We learned how many of us were dying of cardiovascular disease and lung and other cancers. We saw it every day. We lost friends to an early death. This bad news was in the newspapers. On TV. On the radio. The screams were finally beginning to yield to the whispers as the health railway was being engineered.
We knew how to build it, but we did not know for sure how long it would take. We could not know the difficulties ahead. There would be obstacles, as the railroad faced rivers, mountains, and deserts. Like the builders of the Transcontinental Railroad, we would blast our way through.
With time, technology, and perseverance, we unleashed the full power of the Age of Healthcare Information into medicine.
Our doctors can now see our entire health record without opening a three-inch thick paper chart. We can keep track of what works and what does not work, what we have done and what we have not done.
Information flows, which leads to better healthcare decisions. The pace quickened, keeping up with rapid medical discoveries and advancements. These innovations profoundly impacted how caregivers are updated and educated.
Just as the Transcontinental Railroad united East and West, the movement from healthcare to healthy living unites caregivers and patients. Today, electronic medical records are now being used by 96 percent of providers in the US.
The word prevention has exploded into our medical lexicon. And we had data to buttress preventative care. Gifted physician communicators interpreted clinical research into compelling information on good health and prevention. Real-world research and convincing presentations drew millions to embrace wellness.
Anne Altman retired general manager of IBM US Federal Government and Industries, who worked with Paul at IBM for many of her thirty-five years there, made a keen observation.
“Throughout time, healthcare by healers changed. With the Age of Healthcare Information, we have access to untapped knowledge about ourselves.”
“At the outset, everybody wrestled with how to manage that information. Who would be responsible, who would be the keeper?
“The answer became obvious—the medical home. It is actionable. That’s where all this should reside, with the Trusted Healer,” Anne said.
Patient information and data empowers caregivers. Clinical protocols are at their fingertips. Diagnostic information could reach the doctor instantaneously instead of days or weeks later. Medical care advanced. Rural and suburban doctors suddenly had many of the tools and data previously available only in cities. Results were encouraging as patients became healthier. Medical interventions, now based on accumulated evidence, improved.
The acceleration of the speed and volume of information changed everything. Healthcare systems changed. Outcomes changed. People’s behavior changed.
We learned that maybe we had a say in how long we live, how we could best avoid disease. This new freedom helped us pause, relax, and ask ourselves some core questions about life:
How can I be most productive for my family and community? How can I live a healthier and happier life?
For the first time health became part of our culture’s definition of prosperity, and that cultural shift gives hope that we as a country and a world can achieve even more.
The movement from healthcare to healthy living has already changed the world.
Five powerful events happened almost simultaneously:
- Led by Patrick J. Kennedy, we committed to equal clinical attention for mental and behavioral health and opioid addiction. Brain illness is no longer relegated to the sidelines of medicine. Children will grow up with new tools to learn how to navigate society, relationships, disappointments, tragedies, and victories. Gradually, the stigma we created in the twentieth century will dissipate.
- Led by Dr. Paul Grundy, we decided that primary care must be the heartbeat of medicine. The medical home model of care would solve a crisis in cost, quality, and physician morale. It would also give us an opportunity to have a Trusted Healer of our own. No longer just a doctor, the medical home brought us the concept of team care. Everyone practices “at the top of their license,” which means assuming every responsibility they can within their credentials, and everyone benefits.
- Led by Dr. Glenn Steele and his team at Geisinger Health System, we discovered evidence-based medicine. The clinical world turned upside down. By highly disciplined evaluation of outcomes and care processes, we could select a best practices, an evidence-based way of delivering care that was proven to have much better results at lower costs.
- Michael Roizen and the Cleveland Clinic used the new wealth of information to demonstrate best health practices in diet, exercise, stress management, and life management. Dr. Roizen and Dr. Mehmet Oz shared these findings with the people on television and in best-selling books around the world. People began to awaken. Millions accepted responsibility for their own health.
- Escaping a culture boxed in by racism and bias, led by a series of powerful national leaders, a movement guided by the belief that everyone matters
***
The speed has become prodigious.
Now, we not only get immediate data, but we receive insights. Our car’s navigation system tells us how to get there, but now can advise us to take a different route to save twenty minutes. That’s insight.
Our phones are intuitive. The speed of innovation and change is mind-boggling. Everyone has access to a universe of information.
We are advancing the technology to deliver all of the information needed about the patient’s history at the point of care. By assembling, aggregating and presenting all this information, the more data that is available, the more we can learn about you—expressly for you. We can mine data as if prospecting for gold.
That is the promise in healthcare and the Trusted Healers approach. We can tap into the movement towards understanding our genetic make up. We can apply more knowledge to the foods we eat so we perform at our best in every way. We can now keep up with the worldwide information explosion in healthcare and digesting and offering usable, reliable information to the Trusted Healers at the point of care.
And there is so much more we can learn about ourselves. Uniquely you.
An end to the Age of Healthcare Information has been reached.
Mindful and appreciative of the past, we welcome the birth of a new Age of Healthcare Intelligence, one where there is a promise of personalized and precision medicine and care.
This is a really big deal.
The Transcontinental Railroad changed our notions of mobility and exploration.
The Age of Healthcare Intelligence changes the capabilities of our Trusted Healers. Never has so much been developed, so fast, by so many, that can affect every man woman and child on Earth.
This is the golden spike for healthcare.
***
So it is with shifting the way a society does things. Cultures move slowly, steadily, and over time to tackle issues that matter, issues of importance.
Trusted Healers offers a view of healthcare from the inside out. We embark upon a journey with a front row seat to societal change, to new principles of cultural leadership and to a new threshold in healthcare.
Societal shift starts with this crucial question: How does a culture change? That comes from sincere, trusted leadership, someone who falls in love with the question.
Leadership is the second major tenet of Trusted Healers. On our journey ahead, we will have front row seats to this process in several nations. And we will get to view the approach of leaders who have aspiration, who create inspiration and who have the discipline to run the long race.
We will see leadership in action, in diverse cultures. These leaders do not grapple for a handhold. They confront complexity and confusion. They lead, and they return to the citizens with simplicity and clarity.
We will enjoy leaders that make the issues come alive, championing causes that matter, and we will see the power of trust which results from a high level of integrity in thought and action.
The third tenet of Trusted Healers comes in the final chapters when powerful societal questions about healthcare are asked. To get to these questions, we will illuminate healthcare past and present.
We begin to see clearly the path ahead. It’s magnificent.
First, and foremost, we must enable access to healthcare. The citizens of developed nations that assure access to care get rewarded for that with significantly longer life spans and happier people.
By having access, we are able to gain and nurture information. Within that achievement is also the management of cost and quality, and the creation of actionable patient information.
That vital knowledge, innovatively developed with new technologies, provides intelligence, which drives personalized precision medicine, creates better care, a higher quality of life, and illuminates for that society that everyone matters.
A child born today in a developed nation (that has solved access to care) could expect to live to be 110, according to Dr. Mike Roizen.
So what will happen in the next 110 years? What will a child born today experience?
We have some predictions. We will take you on a tour of the continuum of care where the medical system will be a tool of the individual, enabling you to run the race of your life.
You will have the entire continuum of care under your control and the guidance available at the time of need, all in collaboration with your Trusted Healer. You will be empowered and guided rather than subjugated. The rails for this journey of healthcare liberation are already laid. The builders have joined the tracks together with the golden spike.
This is now our journey toward a much brighter healthcare future. All aboard. Let’s have some fun with this. Let’s explore it. Understand it. Not just watch the scenery go by. Be awed by where we have been. Be delighted with where we are going. Get ready for a ride that changes the way you look at your healthcare.
Let’s begin our journey.
This book is your ticket.