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Exogenous Factors & Shifting Terrain: Time for Integrative Medicine and Health Leaders to Show up PDF Print E-mail
Written by John Weeks   

Exogenous Factors & Shifting Terrain: Time for Integrative Medicine and Health Leaders to Show up

The TEDMED franchise, owned by billionaire Priceline founder, Jay Walker, favors the kind of high-tech solutions that have attracted capital to medicine in such billions over the last 60 years.

One such presenter at the April 2013 TEDMED at the Lincoln Center was Jonathan Bush.  Bush, whose uncle is George W. Bush, is the founder and chair of fast-growing electronic health records company athenahealth. Bush's talk rhetorically asked: "Is it fair to profit from healthcare?"  He responded affirmatively.

In a follow-up Q&A with Walker, Bush chastised government for suppressing entrepreneurs. Walker: "Where does the revolution comes from? It doesn't come from within the medical community. It's got to come from the customers - call them patients."  Bush responded: "My sense is that all of this needs some exogenous factor to get the ball rolling."

Bush's comment, which I heard via a video clip from TEDMED, brought to mind a recent example of such exogenous input making a difference. This was, however, from an emerging part of the medical community that sees itself as exponents of a patient-centered movement. 

The scene was a workshop of the Institute of Medicine Global Forum on Innovation in Health Professional Education. Those gathered were entrepreneurs in academic practice - if that is not an oxymoron -- rather than entrepreneurs in business.  The 60 plus representatives of virtually all of U.S. health professional academic organizations - from medicine and nursing to social work and more - convened to identify potential characteristics of an era that one of their members has dubbed "transdisciplinary professionalism." 

What took place underscores the importance of leaders from the integrative health and medicine communities in revolutionizing the national debate over the future of medicine toward one that focuses squarely on health creation.

Mary Jo Kreitzer, PhD, RN: Carrying the health and wellbeing banner
The participants in the interprofessional gathering envisioned a coming era in which the power of guilds was reduced and the importance of collaborative teams elevated. (If the creativity needed to advance such transdisciplinary ends amidst the payment system's reinforcement of guilds does not count as entrepreneurial, I am not sure what does.) 

But notice the agenda. Imbedded in the middle of the 1.5 days was a breakout session called "Health and Wellbeing in Transdisciplinary Professionalism." Mary Jo Kreitzer, RN, PhD, FAAN, the director of the Center for Spirituality and Healing at the University of Minnesota and a past vice chair of the Consortium of Academic Health Centers for Integrative Medicine had the lead. She was teamed with Elizabeth Goldblatt, PhD, MPA/HA, chair of the Academic Consortium for Complementary and Alternative Health Care (ACCAHC), with which I am involved. Kreitzer is also a member of the Council of Advisers to Goldblatt's group. 

This was the one session that directly put health, as an outcome, on the table. 
At the conclusion of Kreitzer's report to the committee of the whole, the participants resoundingly agreed that, the topic is important. Using desktop clickers, they voted on a single query Kreitzer and Goldblatt formulated for the group: "Should all health professionals have an interprofessional course, together, that focuses on health, well-being and self care?" 

The response was overwhelming. Of the leaders present, 92% agreed.  Those who "strongly agreed" were a full 82%. The participants struck a resounding transdisciplinary chord for a focus on health and well-being. 

What this has to do with Bush's comment is clear from a look at how the theme of health and wellbeing came into the room. Goldblatt's consortium, ACCAHC, is the only organization from the integrative health and medicine disciplines that is a member of this Global Forum. Goldblatt was selected to serve on the planning committee. From there, she was able to suggest the theme - the core innovation in health professional education that ACCAHC's board charged her to carry. Goldblatt's colleagues on the planning committee agreed that the subject was of interest. They approved the session, and Kreitzer. 

Goldblatt: her organization stimulated the health-focus
Bingo: via such an exogenous factor, health and well-being explicitly become a component part of transdisciplinary professionalism. 

Because it came from health professionals, the work of Kreitzer and Goldblatt may not be the sort of external input Bush or Walker had in mind. Yet arguably, health and well-being should be at the disruptive center of any dialogues over the future of medicine, whether at TEDMED or at the IOM or elsewhere.  

The themes of health and wellbeing may unfortunately remain exogenous to the core discussion over the future of medicine in the U.S.  Yet the present landscape offers fertile ground. 

Other presenters at the IOM workshop, for instance, identified "balanced life," "emotional intelligence" and "self-reflection" as key characteristics of healthcare leaders for the coming era. And to Walker's credit, TEDMED includes among the healthcare's 20 Great Challenges the economic charge of Making Prevention Popular (and profitable). 

The terrain is increasingly, responsive. Wanted: additional exogenous influencers for heath.

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