Archive for the ‘Books’ category

The Integrative Journey

March 28th, 2022

 

After having returned from the Ornish Coronary Artery Disease Reversal program in Sausalito, California, my life, my mental health, and my view of healthcare had been changed forever. Having previously been selected as the CEO of a traditional hospital that, like all hospitals, was all about sickness, I now realized I had new tools in my toolbox, new arrows in my quiver, and new eggs in my basket. . . you get the idea.

That workshop had taught me that there is no one right way to go through life, to achieve a better quality of life, to deal with health issues, and to survive this journey. I came home armed and informed that sickness could be stopped or reversed, and this concept did not just apply to heart disease. There was significant evidence that Type 2 diabetes, some autoimmune diseases, erectile dysfunction, some prostate cancers and other diseases could be positively impacted by diet, exercise, stress management and group support.

As Americans in one of only two developed countries that permits advertising of pharmaceutical products on our air waves, we had been carefully trained, pruned, mentally shaped and, if you will, brainwashed to believe in the “heal to the pill” method of care. We get sick, go to the doctor or hospital, are prescribed pills, and move on. Or we get a shot, or get the offending body part cut out, and life goes on, or not. Those were the options previously permitted on the proverbial healthcare menu.

It was only a few years later when the chief scientific officer of a major drug company explained his world to me like this, “You don’t understand the pharmaceutical industry. We’re like the movie business. We only want the blockbusters. We want to give you a pill that you’ll have to take from the time you’re five until you die at 75 or 80 that will never make you better. It will just help control the symptoms.”

In 1987, I was working toward another Masters Degree at Carnegie Mellon University, and our epidemiology professor challenged us to find something that would significantly alter the health, lives, or future of at risk people in our hospital’s catchment area. I decided to have our physicians give pneumococcal (pneumonia) vaccines to our at-risk senior population.

When I told my CEO of that plan, he suggested I present it to the primary care physicians at their monthly meeting. I boldly stood in front of a room full of internal medicine and family practice physicians and made my pitch. You would have thought I asked them to bring in their first born child to be assassinated. I was very nearly strung up. I heard cries like, “How are we supposed to pay or bills? How can we pay off our loans? What am I supposed to do, pull my kids out of college? Treating those patients is how we make our livings.”

Ironically, in 2017, I found myself in front of the leadership of a major health system with 125 cardiologists, and I informed them we were going to enter into the coronary artery disease reversal program. The spokesperson for the group put up his hand and said, “Let’s talk about the elephant in the room, do we really want these people to get better?”

Bottom line, we have created a medical industrial complex that is dependent upon sickness, and what I had learned in California was, “Yes, we’re all going to eventually die, but why not give your body a chance and live as healthy as you can for as long as you can?”

Interestingly, the Ornish program was not yet being offered in many places in the country, and when I asked if we could bring it to Western Pennsylvania, there was a long pause on the other end of the line, and Dr. Ornish asked,”What do you want?” He explained that he was working on a licensing project with our local Blue Cross, and I was not going to be able to bring it into my hospital, but that didn’t stop me.

We worked out a deal with some local churches to bring elements of the program that were available to the public just to test the water. Within weeks, we had heart disease participants in their 60’s, 70’s, and 80’s doing stretching exercises, meditation in whatever form they selected, nonjudgmental group support, and vegetarian covered dishes to church halls and basements.

The amazing thing about this program was that people who were suffering from angina pectoris (chest discomfort) found relief in sometimes less than a few weeks. They were no longer living in fear of dropping dead, and more importantly, they were taking control of their life without having to be afraid of the outcome. It was giving their bodies a chance to do what those bodies are so great a doing, healing.

Of course no good deed goes unpunished, and those non-believers, or those individuals who were potentially most negatively impacted by a health and wellness program began to identify me as a zealot, a fanatic, a vegetarian warrior. I was openly mocked at board and physician meetings when I ate my specially prepared vegetarian meals, and when I started holding meetings on the indoor track we had created with our new wellness center, those who would not benefit from my new found center for wellbeing went on a mission to discredit these ideas.

At one point the powerful head of a local Baptist Church began to take steps to have various conservative sects actually picket our hospital for teaching yoga and trying to take away the souls of our participants. (Their interpretation of yoga.) One of our powerful physicians sent emails on a regular basis to our staff with the intention of discrediting me and my programs for wellness and prevention. It was not unlike Salem, Massachusetts for a few years. Then something incredibly powerful occurred.

I was, for only the second time in my 30+ year career in hospital administration, invited to have dinner at a physician’s home. At that dinner, I was seated beside our local congressman, John P. (Jack) Murtha. The host’s wife did not know what to prepare for my meal so she gave me a large white plate with two egg whites on it. When the Congressman saw it, he asked, “What the heck is wrong with you?” I carefully explained my experiences in California with heart disease reversal, meeting patients who had successfully stopped and or reversed their disease, and how well they were living. He leaned back and said, “We’re spending a billion dollars a year on heart disease in the military. Maybe if you got to Bethesda or Walter Reed and find someone who would work with you, I might be able to help>”

We knew that his 25 plus years in Congress had given him some seniority, but what I didn’t realize was that he was in charge of the subcommittee on appropriations for the department of defense. His committee was responsible for well over $300B dollars of government spending. Well, my board chair was a former Navy airman and he flew me to Bethesda where we met with and were politely turned down by the Navy. A few months later when I was in D.C. for a meeting, I got in a cab and, without any knowledge of military life, command, or structure, I showed up at the front door of Walter Reed Army Military Hospital which became Walter Reed National Military Medical Center Bethesda several years later.

When I walked inside, I saw hundreds of soldiers, family members, and medical personnel, but I didn’t have an appointment. Consequently, I walked up to the first white coat I saw, explained who I was, where I was from, and who had suggested I come there. Serendipitously, he was the only physician who had ever received a federal earmark and it was about $75M from Senator Ted Stevens of Alaska to create a center for the study of prostate cancer. He looked at me, smiled, and said, “Follow me.”

After meeting with a Walter Reed cardiologist, I went home, wrote a white paper, and several months later we established two Ornish Centers, one at Walter Reed and one at Windber with a grant that was made possible through Congressman Murtha. The reason you need to understand this back story is that without these grants, there would have been no way a hospital our size could have supported a program featuring integrative medicine.

Share

$4.3 Trillion in U.S. Health Care Spending?

May 9th, 2008

“Money doesn’t make you happy.  I now have $50 million, but I was just as happy when I had $48 million.”
–Arnold Schwarzenegger

According to an article in Internal Medicine News by Mary Ellen Schneider, spending on health care in these United States is projected to reach 20% of the gross domestic product on the one hundredth anniversary of my father’s birth, 2017.  Of course that projection is only an estimate made by CMS, the Centers for Medicare and Medicaid Services.  That estimate is, of course, based upon a continued escalation of nearly 7% each year for the next nine years.  In lay terms, that escalation would mean that the total dollars spent on health care would hit $4.3 trillion…Whatever a trillion is? I still can’t fathom a billion of anything.)

Burdenicon2
We all should realize by now that this spending in the public sector, Medicare and Medicaid, will increase due to the first wave of Baby Boomers entering the Medicare system in 2011.  My 78 million peers, like the lemmings, are working their way toward the proverbial wall, and for those of you who will have to carry the load until we are wearing our wings, that is not a pretty financial picture.

The same economists from CMS are predicting a decrease in reimbursements to physicians over the next several years while Home Health will likely grow faster than most other sectors except perhaps prescription drugs.

What does it all mean?  We are spending more on health care in the United States than any industrialized country in the world and, truthfully, our overall age of death is significantly surpassed by many of those “spending less” countries.  How can that be?  Well, for one thing, we have 47 million uninsured citizens in this country and no one really knows how many illegal aliens. Why so many uninsured?  They don’t vote.  The vast majority are young, single mothers with small children, and this does not take into consideration the illegal aliens who are also not insured.

Back to the answer. . . prenatal care is inadequate and infant mortality in the United States is still an embarrassment. A few of the countries that do better than us in the world in infant deaths per thousand are:  Australia, Austria, Canada, Czech Republic, Denmark, Finland, France, Germany, Greece, Ireland, Japan, South Korea, New Zealand, Norway, Portugal, Spain, Sweden Switzerland and the United Kingdom.  Hmmmmmm?  Could it be because we spend 30% of our annual health care dollars on the last thirty days of life, and less than 4% of our monies on preventative and wellness care?

Of course, Hospice would be a tremendous help.  We could reduce expenditures on end of life care, properly care for our babies with the excess funds, and ensure that our uninsured are properly covered as well, but what politician is willing to touch that electric third rail of the electorial subway tracks?

We could begin by putting in a network of sidewalks, bike trails, and walking trails.  We could actually walk once in a while and treat our bodies like a true temple, not the “Temple of Doom.”

HospiceOne of the least often heard issues revolving around these expenditures is the continuation of our archaic hospital system.  It is based on the acute care model, and the vast majority of our diseases are chronic.  We rush the victim to the hospital, patch them up, send them home and then rush them back again without any commitment to behavioral modification.  I have seen individuals reverse their heart disease from diet, exercise, and stress management.  Why can’t we embrace this concept, reward these activities, and change our society?  The millions of bicycles in Europe are no accident.

So, as I’ve quoted in some other blogs, “Change or Die,” or just spend ourselves into oblivion as we attempt to prop up a system that should have gone out with the Industrial Revolution.  Good luck kids, your ole man needs you to keep working to cover my health insurance.

Share

Managers, Smanagers…It’s Over

April 17th, 2008

Kenneth Cloke and Joan Goldsmith wrote a very interesting book entitled The End of Management. In this book, they assert that managers are the dinosaurs of our modern organizational ecology. They go on to assert that the “‘Age of Management’ is finally coming to a close.”  Their treatise is that “the need for overseers, surrogate parents, scolds, monitors, functionaries, disciplinarians, bureaucrats, and lone implementers is over. . . ”

End_of_management_cover_2If, by now, you managers are wondering what comes next, our authors assert that the new need, the true need in modern day business is for “visionaries, leaders, coordinator coaches, mentors, facilitators, and conflict resolvers.”

In a recent conversation with an “old school” manager/friend, I reached out to explain to him why he was alienating his subordinate.  I explained very carefully that management as a self-contained system fails to open the heart or free the spirit.  This approach has truly taken our organization to new heights.  Of course, one can only work within one’s comfort zones, and many managers, especially, old school managers, only know one approach, and that is, the industrial revolution way.

Let me suggest that you analyze the quality of the individuals with whom you work.  Then, step back and realize just how amazing those individuals are with “butterfly” qualities.

Do not penalize your charges because of your insecurities.  Build a team that “has your back” by empowering them to be all that they can be.

The revolution quoted by Cloke and Goldsmith is one of “turning the inflexible, autocratic, static, coercive bureaucracies into agile, evolving, democratic, collaborative, self-managing webs of association.”  From our perspective, the object is to allow those butterflies the freedom to fly.

How do you manage a butterfly?  Work together on the goals and then get out of its way.  Provide it with just the very basic, fundamental needs and goals of your organization, and then trust it, love it, empower it, and encourage it.

If I could possibly find one example that would clearly embrace our success as an organization, it is that of doing everything possible to kill “parent to child management.”  It is not enough to move into the 21st century with our thinking; it is most important to identify those individuals who get it and then give them the space “to do it.”

Are they traditional?  Do they do everything the way you were taught in the “dark ages of the industrialized style of management?”  Nope.  Will it drive you crazy when you look for them, and discover that they are not on the flower where you expected to find them?  Sometimes.  Will they accomplish more than you have ever dreamed if you treat them with dignity, respect, love and freedom?  Oh, yeah.

You see, it is not about control.  Control is only necessary for those who are not trustworthy.  Better than trying to control a non trustworthy individual, simply help them find work somewhere else.  If they don’t get the mission, don’t understand the philosophy, and don’t work to their capacity, they shouldn’t be there.

On the other hand, if they are loyal, trustworthy, committed, and caring, back off and allow them to soar, and you will never see results of the kind they that they will deliver to you or your organization.

If they look at it as a job, if they are only comfortable with myriad rules, time clocks and books of policies, they are stuck in the past.

Leadership means trust.

The End of Management, Kenneth Cloke & Joan Goldsmith

Share