Health care ‘improvement movement’ stymied by fear
February 28, 2013
Donald Berwick is a man on a mission.
After a brief stint as administrator of the Centers for Medicare and Medicaid Services (CMS) and, before that, president and CEO of the Institute for Healthcare Improvement (IHI), he's taking his plan for quality, affordable health care on the road, impressing upon his audiences the importance of confronting any and all obstacles to achieving true and lasting reform.
The good news, according to Berwick, is that what he refers to as the "improvement movement" in health care (e.g. an increase in patient-centered care and a decrease in hospital-acquired infections) is at a turning point.
The bad news is that the work's not done. Not even close.
During comments made before a packed house at The Commonwealth Club of San Francisco in December, Berwick asked, "What's in the way? What has us stuck? Why aren't we a nation on the move to better care at lower cost?"
"We're scared of the truth," he said.
Berwick spent most of his talk detailing what he sees as the primary sources of inertia that we're afraid to confront, including polarized politics, treatment based less on science and more on myth and habit, overtreatment, professional resistance, and a failure to focus on prevention instead of intervention as the preferred method of care.
Another source of inertia not mentioned by Berwick — another truth we have yet to confront fully and fearlessly — is the extent to which consciousness or the mind governs our physical wellbeing, even the effectiveness of the treatment being provided.
I brought this up at the end of his talk, asking him if we'd ever be able to achieve real health care reform without taking into consideration the mental aspects of disease, both in terms of its cause and potential cure.
Part of the problem, Berwick said, is that since dealing with a patient's mental state is not procedural, it's hard to get paid for it — and perhaps why it's not an integral part of most treatment plans. Even so, organizations that do address the patient's thoughts are seeing better results — not to mention lower costs.
"A depressed diabetic patient costs 240 percent more to care for a year than a nondepressed diabetic patient," he said. "What does your logic tell you?"
At the very least, it should tell us that there's more than meets the eye when it comes to treating disease, and that despite the politics, ignorance, resistance, and fear that can sometimes get in the way, the road to exploring different and potentially better ways of caring for our health should be kept clear.
Unfortunately there's a tendency to dismiss — or even discredit — those forms of thought-based health care (e.g. meditation and prayer) that are difficult if not impossible to evaluate using conventional scientific methodologies. This may lead us to believe that this type of treatment – despite considerable and mounting personal evidence to the contrary – is uncertain, ineffective, or unsafe.
It could be that by removing just this one obstacle – by confronting the assumption that drug- and surgery-based medicine is the only surefire approach to health care, and recognizing the indispensible role our thought plays in gaining and maintaining our physical wellbeing —‚ we could make a significant contribution to keeping the "improvement movement" forging ahead.
No doubt Dr. Berwick would be pleased.
Eric Nelson's articles on the link between consciousness and health appear weekly in a number of local, regional, and national online publications. He also serves as the media and legislative spokesperson for Christian Science in Northern California.