Getting the Language Right
My present home in Puerto Rico has made news lately with its significant debt problems. The island’s leaders are trying to find solutions. One hears them talking on the radio or TV news or sees them editorializing about the solutions for nuestro pais—“our country.”
Puerto Rico, however, is not a nation. Nor do its leaders have the freedom to form any alliance, agreement, or policy that might benefit its people. Nuestro pais messages independence. Yet leaders are imprisoned in direct and indirect ways because the island, technically a “territory,” is—for the practical purposes of governing—a colony of the United States.
As the songwriter and performance artist Laurie Anderson sings, “Language is a virus.” The words we use lock in ideas and send reverberations of meaning. Nuestro pais is a wrong message. It sets a false stage for the tremendously tough political-economic issues on the island.
This damaging abuse of language came to mind recently while listening to a presentation by Steven Woolf, MD, MPH. Woolf was lead author of a 2013 report from the Institute of the Medicine of the National Academy of Science called Shorter Lives, Poorer Health. On virtually every measure, the US ranks worst when measured against 15 other highly developed industrial countries. And this is so despite the fact that the US spends—at $2.8 trillion—nearly twice as much per capita on medical-related costs than any other country.
“Healthcare system” is a comforting fiction
Compare the US with Puerto Rico, and we have a problem of similar dimensions due to our medical costs. These expenditures steal from our country’s ability to invest in social goods such as education, food, housing, parks, and the arts. They make our businesses less competitive.
Like Puerto Rico, we have a language problem that is a virus affecting the terms of the debate.
How often do we hear commentators, billboards, prestigious journals, and respected talking heads speak of our healthcare system? Lately, commentators sometimes catch themselves: Well, actually what we have is not focused on health and it’s not much of a system.
“Healthcare system” is our “nuestro pais.” It’s a comfortable fiction that protects us from a disquieting truth.
Those in the integrative health and medicine movement—patients and practitioners alike—have been correcting this language for years. The whole person, health-focused philosophy of practitioners such as holistic nurses and naturopathic and integrative doctors runs contrary to the reactive, disease-centered practices that dominate US medical decision-making. Integrative health people will say that what we have is a “disease care system.”
What we have is a “medical industry”
That term is also kind. Systematically managing disease is a positive and necessary undertaking. But if $1 trillion of the $2.8 trillion spent each year is waste, and an estimated 250,000 people are killed annually through medical errors, can this be a system for managing disease?
No. What we have—our version of the harsh term of “colony” for Puerto Rico—is a medical industry. We have an extremely efficient “system,” a medical industrial complex, for creating wealth. The less healthy we are, the more the industry makes. Each of those $2.8 trillion per year falls into someone’s happy pocket.
The whole debate becomes much clearer, if more harsh, with this grounding in honest language.
The good news is that some top leaders in US medicine are beginning to actively raise consciousness about a new language for a new, systematic way to control this disease-focused industry.
Douglas Wood, MD, the director of strategy and policy at the Mayo Center for Innovation, stated last April in an American Hospital Association publication that “we need to change the focus of the healthcare industry to creating health, not just producing health care.”
Change our focus to “creating health”
Wood is still caught in his residual language even as he is asserting a new paradigm. He refers to the “industry,” which is correct, but still suggests its focus is on “healthcare” and on “producing health.” Better that he would have said “we need to change the focus of the medical industry to creating health, not just producing medical procedures and services.”
Don Berwick, MD, subsequently landed on this “health creation” theme in what may well have been the tipping point in the US medical industry’s conceptual redirection. Berwick is arguably the most influential player in US medicine over the last 20 years. His audience was a room of leaders of hospitals and medical groups. Early on Berwick references how it is “fortunately commonplace now to say that we would be better off to redirect some of our healthcare enterprise from fighting illness to pursuing health, going from health care to health creation.”
Again, think how much clearer this communication would have been had he said, “Redirect some of our disease management enterprise from fighting illness to pursuing health, going from disease treatment to health creation.”
This correction of language to align with Berwick’s thesis projects the distance across a great chasm that we must travel; this goes further than “from health care to health creation.”
Berwick spends the rest of his talk respecting the depths of that chasm. He speaks to the need for systems: “The more commonplace claim that we don’t now have systems to create health is also correct.” He references progressive medical leaders who are trying to implant the so-called Triple Aim values (better patient experience, enhance population health, lower cost) for merely producing more medical procedures and purchases. Berwick calls these reform efforts a “sort of expedition now to find those systems” for creating health.
The redesign is more radical than previously imagined
Berwick then pushes his industry audience further: “The pursuit of health, the creation of health, may require something even bolder. The redesign we need may be even more radical than we have imagined.”
Berwick explores the elements of this “radical” shift. He guides his audience through his own awakening and names his mentors. Most, interestingly enough, are pioneers in the integrative health and medicine movement like Jon Kabat-Zinn, PhD; Dean Ornish, MD; and Wayne Jonas, MD.
The identification of a system for creating health as the bright star to guide us is an exciting sign of new clarity in what we must reshape to transform our medical industry.
To help the cause, I have taken a pledge. I invite you to take it with me. Let us never say healthcare system when what we mean is medical industry. Let us correct others when they do. Let us only use the term to honor those efforts that are part of this necessary radical shift.
If enough of us take the pledge, we might build upon this conceptual glasnost and have a chance to see our way across the chasm to health creation.
John Weeks is the editor of “The Integrator Blog News and Reports” (theintegratorblog.com), a leadership- oriented news, networking, and organizing journal for the integrative medicine community, and a columnist for Integrative Medicine: A Clinician’s Journal.