Attempting to pick up a guitar and look at the fret board for the first time and trying to make sense of the notes is no small endeavor for a new student of music. The same applies to understanding the intricate fibers of the healthcare fabric. Where do threads cross, knots form, and patterns emerge?
A young physician reciting the symbolic ethical pledge known as the Hippocratic Oath is an Ancient Greek nod to exceptionalism and care. If only that was the Greek I am referring to.
In music, to unlock a fret board, you must first vision the fret board as the piano keys, black and white. White keys are “natural” notes, and the black keys are the “sharps” and “flats,” the augmented and the diminished, the intricate parts of the key for which a song is played. In any given key, we will take our 7 chosen notes and throw out the 5 others (maybe to use later as an accidental).
The key to unlocking the keys is to think in intervals of tones: full tones, half tones, or, in American English, full steps and half steps. Understanding the space between notes really accelerates and annotates melody, but I am getting ahead of myself.
To understand the keys, it is important to start on the easiest scale, C major (or the relative A minor). In the Sound of Music, this note “C” is the onset of our favorite rhapsody, “Do-Ray-Mi-Fah-So-La-Ti-Do.” In other words, this is the Ionian Scale (the classic major heptatonic scale) where the natural note “C” is the first note.. Now, I’ll transpose because the rest of these Greek heptatonic scales align respectively with the notes of C Major: (C) Ionian, (D), Dorian, (E) Phrygian, (F) Lydian, (G) Mixolydian, (A) Aeolian, (B) Locrian, and Ionian. To add a little more, think of these Roman Numerals indicating the tone of the scales as MAJOR or minor (I, ii, iii, IV, V, vi, vii*, I). That is one through seven with the seventh scale, Locrian, as getting an asterisk for being a little weird on how to identify it. However, do you see the translation?
Well, how about healthcare? How do you approach our modern healthcare system with the similar logic as we approach music? For starters, there are no boilerplates, templates, or one-size-fits-all. We are discussing purchasing groups who can buy the same medication on the same day and pay three different prices for the drug based on nothing other than location. Location, location, location. It’s the key to real estate, but also an interesting part of pharmacy purchasing.
Finance: the tail that wags the dog. The unfortunate reality of the power and the sheer size of the economic impact in the medical industry is that greed and profit have become entrenched deep inside the walls and stalls of hospital groups, administrators, and insurance providers alike. Money has ruled all but a physician’s decision on how to treat their patients from the time of Hippocrates. The physician will do what ever she or he will do to help an ailing patient indifferent of the cost. That is the true power and freedom of care delivery. However, when insurance companies and administrators prioritize profit over care the results are predetermined.
Physician leadership must be fully aware and transparent of their earnings, production, and overall financial contributions. Administrators, long left scratching heads on what to logically do with EBIDA profits other than build more square feet and line their own pocks, have now paid themselves into a corner. Look no farther than Candid’s (f/k/a Guidestar) non-profit report for the IRS form 990. How long can physicians, allied health providers, nurses, and the diversified care specialists view leadership who pay themselves exponentially more than the “Clogs on the ground?” The executive pay scale is why a Congressional Ways and Means Committee Chaiman, Jason Smith, just referred to hospital systems as “hedge funds with hospital beds.“
Integral Health is here to stay because the problems plaguing our health systems are not going to go away left alone. We, the people and as a people, need to stop allowing the lack of transparency to continue unfettered while the majority of us statistically hold some amount of medical debt on some hospital system’s general ledger.
We can learn Greek. We must learn Greek. And then we can continue the symbolic values of “doing no harm” and return health systems to a being truly a servant of the community, and not a lord. And we will accomplish this by doing a better job for less.