Obama: Addressing the Healing Crisis

James S. Gordon, MDMind-Body Medicine0 Comments

By James S. Gordon MD

Dear President Obama,

Before you even took office you asked us Americans to share our ideas about healthcare reform with your new Administration. Thousands of us, thrilled to be invited to participate, gathered in small groups and offered our vision to you. Now, tonight, as you address us, it’s time for you to give us back our vision, enhanced by your broader perspective, enriched by detail, unencumbered by fear.

I’m sure you and your advisors have seen the polls that have repeatedly shown that the vast majority of Americans (up to 85%) believe that our healthcare system needs to be “fundamentally changed and completely rebuilt,” and that almost equal numbers are concerned that “access to medical tests and treatment would be more limited” as a consequence of healthcare reform. The polls tell us that Americans know that our far more expensive healthcare system is significantly less effective and efficient than that of other developed countries, and that, in general, we like the doctors who care for us.

These apparent contradictions are best understood as Zen koans, paradoxes that work to boggle our minds prior to opening them to new ways of seeing and thinking. I hope tonight you will invite us to look at healthcare reform in such a new way;  help us to find, beyond the fears that have been evoked, and the mind-numbing horse-trading and compromise of the legislative process, the vision that continues to animate your commitment to the health and wellbeing of all Americans.

The vast majority of Americans-not just “Democrats” or “progressives,” but all of us – are decent, compassionate people who really want all our fellow citizens to have the healthcare they need. We know that change is necessary, but we don’t know yet what’s actually being proposed, and we fear that the change that comes may take away the surety of care and the security of our relationship with our doctors.

Fear is an enormously powerful emotion-deeply embedded in our evolutionary heritage and in our central nervous system. It signals danger, mobilizes the fight or flight response and all the psychobiological mechanisms of survival. Fear, as this summer’s town halls illustrate, overwhelms our capacity for nuanced observation or even rational thought. The very thought of going to the doctor makes many people tremble. The possibility of failing health, or of a vulnerable old age, or a change in access to those who are supposed to care for us makes us deeply uneasy. When opponents of healthcare reform have used evocative and provocative words to summon up these specters, the fear factor has obviously jumped off the chart.

To our agitated minds, “rationing” means that we will likely lose the diagnostic tests which we hope will clear away threatening uncertainties, the treatments that may restore us to health, and the doctors whom we have literally trusted with our lives. “Death panels” signify that anonymous others will, in the name of some impersonal, financially motivated calculus, shorten our lives.

Outrage, reassurance, and careful reference to the actual texts of proposed legislation-the principal defensive strategies of healthcare reform proponents to date-only take the edge off our collective apprehension. Relaxed, even meditative, clear-eyed assessment of healthcare realities, active engagement of each person in responding to them, and a call to transcendent and common purpose are what will ultimately make it possible for us-individually and collectively- to move through and beyond the fears that have been dominating the discussion. We are an energetic, inventive people and once we know it is possible and even necessary, we will want to be actively, effectively engaged in our care, and in determining our destiny.

Think of the “terminally ill” mother, who “somehow” lives to see her daughter’s wedding, the firefighter who enters a burning building to save an endangered child, the soldiers who brave bullets to protect one another. Think too, of people with life-threatening or life burdening illnesses (coronary heart disease, diabetes and cancer, clinical depression and post traumatic stress disorder), who, in the therapeutic programs many of us have created around the country, are healing themselves: sharing their fears and developing strategies for dealing with the threats to their lives; regarding illness more as a challenge than a disaster; eating and exercising in more healthy ways; learning from and supporting one another. William James coined the phrase, “The moral equivalent of war.” Caring for ourselves individually and collectively is such an equivalent.

I’m asking you, really, all of us are asking you, to mobilize and inspire us to participate actively in our own healthcare; to insist that those professionals who are supposed to help us treat us respectfully, even lovingly, as active partners, not passive patients.

We don’t, for the most part, need more drugs or procedures, but rather doctors and other healthcare professionals who will spend adequate time with each of us, listening and creating partnerships, as well as writing orders and prescriptions. The powerful therapeutic effects – and cost effectiveness – of such instruction in self-care, of what some are calling “lifestyle medicine,” on outcomes of chronic illness have been repeatedly documented.

If every older person were guaranteed a physician with time to talk about life and ways to live it more fully, as well as to discuss the best ways to deal with the inevitability of death, debates about “death panels” would wither from lack of fearful fuel. If doctors spent more time looking at the excess of often clashing and contraindicated medications that older people take, much of the unnecessary suffering and fear that accompanies care in old age would disappear. As we actually learn what combinations of self-care and physician-administered therapies are most effective, for which condition, most concerns about rationing-raised now almost entirely by drug companies, which fear that their products’ flaws will be revealed- will dissolve. We need to hear clearly from you that all those individuals and institutions that profit from our pain – hospitals, insurance and pharmaceutical companies, and those of us who are doctors too – can be justified and supported only as long as they serve all of us.

Finally, you must assure all of us, left, right and center, that you and your Administration will continue to give us and our health care the careful consideration we deserve, that this present effort is only the first stage of healthcare reform; the beginning of a process of national education; and a framework for the more profound and pervasive changes that we want but are not yet sure how to achieve. Tonight, we need you again to inspire us, to give us a vision not only of how we can all be safely and effectively treated, but how we can thoughtfully, lovingly, energetically, even joyously, learn to better care for ourselves and one another.

About the Author
James S. Gordon, MD

James S. Gordon, MD

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James S. Gordon, MD is Founder and Director of The Center for Mind-Body Medicine; Clinical Professor, Department of Psychiatry and Family Medicine; Georgetown University School of Medicine and author of Manifesto for a New Medicine, Comprehensive Cancer Care, and Unstuck: Your Guide to the Seven Stage Journey out of Depression.

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  • This was meaningful to me, and hopefully to Obama and his people:

    We need to hear clearly from you that all those individuals and institutions that profit from our pain – hospitals, insurance and pharmaceutical companies, and those of us who are doctors too – can be justified and supported only as long as they serve all of us.

    Am researching programs for group behavioral change to improve self-efficacy for persons with diabetes, and though they talk about lifestyle, food management, exercise and such, they seem very focused on medication compliance and how to utilize glucose monitoring devices.

    Jim, I sat at a diner with some lovely people last Sunday night, at a restaurant overlooking the ocean in Santa Cruz, and two women, unrelated but bonded through marriage, calmly took out their devices, took some measures, and gave themselves shots right at the table.
    They then proceeded to eat some fulsome meals, followed by drinks (kahlua) and dessert, pumpkin pie.

    I’ve shared meals with them before, and there’s always dessert. Now, it’s awful to begrudge anyone dessert, I guess, but if this means that we are all paying the cost of those monitors and shots, because there’s not a program like yours (or maybe ours) to support them to make changes they would like to achieve.

    So thank you for saying it like it is, and so well!

  • Lee McGinnis

    Gosh, both your post and the comment immediately above mine seem to be saying “Daddy, take care of me,” which I find to be in complete contrast to the first three chapters of Unstuck.
    People need to be responsible for themselves; no one is forcing that pumpkin pie on those women, but if their glucose slips and monitors are paid with Medicare dollars, they are using taxpayer money to support their bad choices.
    Don’t tell me it’s a lack of health care that is making them eat pie.
    Lifestyle choices are responsible for 70% of chronic disease; unless and until people–not their employers, most certainly not the government–have skin in the game of the cost of these decisions, they will continue to act like children.

    • Dear Lee (and I think Bett may be interested as well),

      The health care system has to move in a direction in which health professionals become teachers as well as ‘treaters.’ Our work is to “care for” people in every sense of those words. A significant portion involves teaching people how to take care of themselves. It’s not a matter of doing things for people (except in emergencies), it’s much more a question of teaching them to help themselves. This can be done in many settings, government-sponsored as well as private. My own experience is that if you give people this time and attention, many of them will take on more responsibility. Coercion and deprivation and even the proverbial “carrots” are not nearly so important as coming to a realization that your best help comes from within.

      Thanks for your good words. Let’s keep on looking at ourselves and working together.