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Philip Glass and Healthcare Reform (Part 1)

Guest Post from Deborah L. Benzil, MD, FACS, FAANS (left)
Member, AANS Board of Directors
4Chair, AANS/CNS Communications and Public Relations Committee
Columbia University Medical Center
Mt Kisco, New York
Daniel K. Resnick, MD (right)
Past President, Congress of Neurological Surgeons
Professor, Vice Chairman and Program Director
Department of Neurosurgery University of Wisconsin
Madison, WI

1Homily #1: “The Importance of Being “Tuned”

Philip Glass, a prolific musician and composer, was recently honored as the Michael L.J. Apuzzo Lecturer at the 2014 Annual Meeting of the Congress of Neurological Surgeons. Before he began his dialogue with CNS President, Daniel K. Resnick, MD, and Arun P. Amar, MD, he thrilled the audience with an evocative rendition of Metamorphosis 2. This selection proved highly thematic for the transformative impact of the stories he related and the lessons to be learned for many-and given today’s challenges, thoughts immediately turned to what they said to those of us embroiled in the maelstrom of healthcare reform. His homily is worth telling, the lessons worth exploring.

The Homily

3At one time, Mr. Glass found himself in a cross-fertilization project that required he establish a productive relationship with a group of Wixarika musicians in the mountains of Mexico. All involved were highly enthusiastic and motivated for success but there was a key roadblock. The first problem that all musicians must solve when they first come together is they have to play “in tune.” This provides the critical foundation for the language of music. “Tuning” allows the musicians to sit together at the same table and then the work can start. For Glass, in the mountains of Mexico this provided a particular problem as these musicians knew no European language and they built their instruments themselves with no tuning mechanisms found in Western instruments. But they all persevered and ultimately succeeded as the musical gift of “Concert of the Sixth Sun.” When asked what made this unusual “tuning” possible he gave the obvious answer: TRUST, but then clarified that trust is more than respect (which he feels is easy) because trust implies a greater level which leads to a willingness to accept something new.

So what lessons should be learned from this for the current crisis in healthcare delivery and healthcare reform? Universally, those involved in the healthcare system (physicians, hospitals, pharma, technology, and patients) appreciate that the system is not working optimally. Many might believe that the system is broken. And yet, the efforts to improve the system over the last 20 years have been abysmal failures in nearly every measureable way. Just a few examples are:

  • patient satisfaction and quality have not significantly improved
  • physician job satisfaction is at an all-time low
  • the cost of healthcare delivery continues to grow at rates far surpassing inflation and growth of the GDP

Philip Glass and the Wixarika musicians teach us that we may have failed because we violated the first rule: we failed to tune! This failure to find a common language, to find a symbiosis of purpose means we have yet to truly sit together at the table and thus cannot begin the work that is before us. Does his story give us any hints as to why this has been the case? Of course, it is the utter failure of TRUST. There may be a modicum of respect between some of the involved parties, but the trust has long been eroded. Every day, the participants work to preserve jus their part of the healthcare world, trying to bury the realization that ultimately, when the system fails, we all do. This is the great challenge of our time no less than conquering The Great Depression, The Great Wars, or the Cold War. It is time; somehow, the tuning must begin so the great institution that brought us polio vaccines, the cardiac pacemaker, and the artificial heart can continue to provide the best healthcare today and tomorrow.

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