James Hansen, MD, is a gastroenterologist in private practice with more than 40 years' experience. He previously directed a free clinic and taught at the University of California. His new book, "Reinvent the Heal: A Philosophy for the Reform of the Medical Practice," shares his thoughts on the changes needed to reform and transform healthcare delivery in the United States and the need for a more holistic view of patient care.
Question: Your first chapter refers to the state of healthcare in the U.S. as a "catastrophe." Can you briefly summarize some of the reasons we've arrived at this state?
Dr. James Hanson: I believe the basic reason is the unbridled costs attributed to 'technophysicians.' I have used this pejorative to describe specialty physicians and surgeons whose motivation is something other than altruism. They have seen the color of money and replaced altruism with greed and avarice. When one glances at the rising healthcare expenditures, which are 2-3 percent higher than the GDP, and notes that this parallels the number of surgeries and advanced procedures done each year in the U.S., the issue becomes clearer.
Q: Your book refers to quality as "a job that physicians must do but are often not interested in doing." Do you think this is still the case? If so, how can we change that?
JH: Many physicians, most of whom are technophysicians, are not interested in the quality issue. My guess is that they know very little about continuous quality improvement, outcomes research, benchmarking and clinical guidelines. They are busy criticizing Obamacare, churning out procedures, gaming the system and enhancing their market share.
Q: At the same time, though, your book argues that only physicians can truly reform healthcare and solve America's healthcare quality and cost problems. What are some of the reasons you believe this to be true?
JH: Physician orders account for 70 percent of healthcare expenditures. Only physicians can write patient care orders. Healthcare engineers, which include politicians, academics and physicians who have traded in their stethoscopes for a pin-striped suit, cannot and will not be able to instill quality into the mix. The only individuals who can make substantial changes are those physicians who participate with the patient in healthcare's sentinel event, the doctor-patient moment.
Q: You argue that patients should be more involved in their care, pushing physicians and the industry as a whole to be more accountable. Why do you think patients are slow to do this, and how can that hesitancy be changed?
JH: Patients are usually intimidated. They continue to bond with their physicians, even when their recommendations are absurd. They are still imbued by a high regard for their physicians. There are many dedicated and trustworthy physicians, but technophysicians are suspect. The purpose of this book is to throw back the covers and make citizens aware.
Q: Your book ends with a call to arms of sorts for patients and physicians to come up with better standards for healthcare reform that allow for practicing "holistic medicine" with a concern for quality. What are some of your ideas for this? And, do you think this approach will also address the rising cost of healthcare?
JH: The challenge is to galvanize all of us who are past, present or future patients. There needs to be a partner. The American Medical Association is well situated. I would envision this organization making the rounds to every medical school and lobbying for inclusion of a spiritually oriented holism into the medical school curriculum. At some point, 130 seasoned, respected, holistically oriented physicians need to be identified overseeing the process at the 130 medical schools in the U.S. These individuals would probably meet often to develop the curriculum, standardize it and instill it. This needs to be a significant part of the medical school experience and post-graduate work. Physicians who are successful with this part of their education would be given special attestation so that future patients could find them. These physicians would not only be primary care physicians, but all specialists and sub-specialists. At some point, when a meaningful spiritual connection and holism is organic to the process of physician education, proper case selection will trump sloppy ethics, and healthcare will be well served. Costs will go down, value will go up, insurance premiums will ultimately go down and there will be money to take care of the under served amongst us.
Q: Anything else you'd like to discuss?
JH: The theme of this book is to contrast the present day linear, reductionist, cure-oriented approach with a holistic, spiritually instilled brand of healing. We are not simply a bundle of nerves, arteries and veins fashioned like a clock that only needs the repair of defective parts. We are spiritual and emotional beings with a need for alignment with a higher power. The holistic physician coordinates an approach to illness using appropriate allopathic medicine along with spiritually driven holism. The scientific method cannot promise us immortality or a disease-free existence. A spiritual dimension is needed to alleviate suffering, so readily apparent in chronic disease, but in all aspects of our life's journey.
Question: Your first chapter refers to the state of healthcare in the U.S. as a "catastrophe." Can you briefly summarize some of the reasons we've arrived at this state?
Dr. James Hanson: I believe the basic reason is the unbridled costs attributed to 'technophysicians.' I have used this pejorative to describe specialty physicians and surgeons whose motivation is something other than altruism. They have seen the color of money and replaced altruism with greed and avarice. When one glances at the rising healthcare expenditures, which are 2-3 percent higher than the GDP, and notes that this parallels the number of surgeries and advanced procedures done each year in the U.S., the issue becomes clearer.
Q: Your book refers to quality as "a job that physicians must do but are often not interested in doing." Do you think this is still the case? If so, how can we change that?
JH: Many physicians, most of whom are technophysicians, are not interested in the quality issue. My guess is that they know very little about continuous quality improvement, outcomes research, benchmarking and clinical guidelines. They are busy criticizing Obamacare, churning out procedures, gaming the system and enhancing their market share.
Q: At the same time, though, your book argues that only physicians can truly reform healthcare and solve America's healthcare quality and cost problems. What are some of the reasons you believe this to be true?
JH: Physician orders account for 70 percent of healthcare expenditures. Only physicians can write patient care orders. Healthcare engineers, which include politicians, academics and physicians who have traded in their stethoscopes for a pin-striped suit, cannot and will not be able to instill quality into the mix. The only individuals who can make substantial changes are those physicians who participate with the patient in healthcare's sentinel event, the doctor-patient moment.
Q: You argue that patients should be more involved in their care, pushing physicians and the industry as a whole to be more accountable. Why do you think patients are slow to do this, and how can that hesitancy be changed?
JH: Patients are usually intimidated. They continue to bond with their physicians, even when their recommendations are absurd. They are still imbued by a high regard for their physicians. There are many dedicated and trustworthy physicians, but technophysicians are suspect. The purpose of this book is to throw back the covers and make citizens aware.
Q: Your book ends with a call to arms of sorts for patients and physicians to come up with better standards for healthcare reform that allow for practicing "holistic medicine" with a concern for quality. What are some of your ideas for this? And, do you think this approach will also address the rising cost of healthcare?
JH: The challenge is to galvanize all of us who are past, present or future patients. There needs to be a partner. The American Medical Association is well situated. I would envision this organization making the rounds to every medical school and lobbying for inclusion of a spiritually oriented holism into the medical school curriculum. At some point, 130 seasoned, respected, holistically oriented physicians need to be identified overseeing the process at the 130 medical schools in the U.S. These individuals would probably meet often to develop the curriculum, standardize it and instill it. This needs to be a significant part of the medical school experience and post-graduate work. Physicians who are successful with this part of their education would be given special attestation so that future patients could find them. These physicians would not only be primary care physicians, but all specialists and sub-specialists. At some point, when a meaningful spiritual connection and holism is organic to the process of physician education, proper case selection will trump sloppy ethics, and healthcare will be well served. Costs will go down, value will go up, insurance premiums will ultimately go down and there will be money to take care of the under served amongst us.
Q: Anything else you'd like to discuss?
JH: The theme of this book is to contrast the present day linear, reductionist, cure-oriented approach with a holistic, spiritually instilled brand of healing. We are not simply a bundle of nerves, arteries and veins fashioned like a clock that only needs the repair of defective parts. We are spiritual and emotional beings with a need for alignment with a higher power. The holistic physician coordinates an approach to illness using appropriate allopathic medicine along with spiritually driven holism. The scientific method cannot promise us immortality or a disease-free existence. A spiritual dimension is needed to alleviate suffering, so readily apparent in chronic disease, but in all aspects of our life's journey.