From Babel to Jericho



There was a doctor. The doctor had an office. In the office, he had a practice. The doctor worked hard, was honest, smart and compassionate. He took care of many patients, everyday, and helped many people. The people paid with cents, checks and chickens. He was solo, alone, by himself. It was good.

There was a hospital, near the doctor. It was an important hospital. It took care of many patients, everyday, and helped many people. The hospital was alone, by itself. It was good.

And, there was a nursing home.

And, there was a pharmacy.

And, there was an insurance company.

And, there was big pharma.

And, there was a medical school.

There were nurses, health planners, administrators, architects, system analysts and many other smart, compassionate, hardworking people. They all took care of patients, everyday, and tried to help many people. They were each all alone. In boxes. In silos.

Nonetheless, even though they did their best, even though they deeply cared, despite all their very hard work, it came to be that the people realized it was not good.

There was waste, mistakes, and confusion. There was duplication, anger and fear. There was pain, suffering and death. Patients got sick and the harder all the people in all their silos tried, they made everyone sicker.

So, the people said, we have to get together. We have to talk. We have to think and plan.

It was a good idea. A bright light. However, there was a terrible problem.

The people did not trust each other. The doctors thought everyone was out to get them. The nurses got no respect. The administrators could not get anyone to listen. The nursing facilities were an afterthought. The drug industry was “about profit.” The medical schools were not sure what to teach and could not get any patients for research. Financiers and industrialists believed the whole thing was expensive dysfunctional chaos. Politicians were a punch line. No matter what good works the insurance companies did, the people hated them more. Everyone was frightened of the lawyers, who though they tried very hard to connect, created obstructive bureaucracy.

Nevertheless, this was a crisis; something had to change. Therefore, the people sat down at a big table. It was a very big table. It was so big that the people at the each end of the table had their feet in the water of different oceans. The people started to talk.

They did not talk, at first, about sick patients, cost centers, information systems, certificates of need, personalized medicine, blueprints, bond ratings, staff ratios, Obamacare (oh, maybe a little) or critical research. They did not start to rebuild.

They talked about language. They talked about priorities. They shared their dreams. They learned about each other, and what each silo, each box, was trying to do.

Why did the lawyers love contracts? Why did the planners need metrics? How do computer designers write? Why does the CFO love EBITDA? What in the world is translational medicine? How do insurance companies work and what do, they really want? How does government and health policy happen? What does a doctor feel when it is 6:45pm and they are 90 minutes behind and they haven’t seen their family in a week and the patient in front of them takes out a long list and there is a scream in their waiting room and the EMR crashes?

A marvelous thing happened. As all the people in all their loneliness learned about each other and what each was trying to do for patients and the communities they loved, they learned that they had much in common. They could help each other. Team meant something broader, more universal and powerful, than just the one person in the next room. Together they had an incredible opportunity to take all the great things they had built alone and, as one, change the future.

Then, there were no more boxes. Everyone left their safe isolating destructive silos. They became one immense powerful caregiver with capacities, and energies never before dreamed. Colleagues, collaborators and compatriots. They spoke one language; the language of healing, and health. The language of balance, efficiency and empowerment. The language of exploration, research, and innovation. The language of hope.

And the walls came tumbling down.


  • Kathryn Zusmanis
    Very well spoken Dr. Salawitz. Do you think this age of immediate communications through social media, internet, eRecords etc is contributing to silo's crumbling walls? At least here at home, Is the patient population getting more involved in their personal well being? Patients seeking answers from the electronic universe of knowledge, not rubber stamped allogrithims to our own well-being? The age of "take this pill, call me in the morning" is being bulldozed over. When the dust settles, our children, will see what remains of the rubble. Imagine, I alone in my room, can speak directly with a great thinker, a warrior in the field, and you can guide me. In any language.
  • Liz
    And then there is reality LOL
  • And the reality is that, in the medical-industrial complex, there are many agendas. Many of these agendas originate and emanate from positions of power and political strength and find patients and those who care for them a nuisance. Perhaps a necessary nuisance, but a nuisance nonetheless.
  • Let's bring the walls down! Noise brought down the wall of Jericho - right (well, and God)? Doctors can make an impact and we hope all doctors will lend their voice to restoring the practice of medicine at a non-profit physician townhall:
  • It's a wonderful story. I hope it really is happening. But, Doctor, did I see any patients at any of these tables?
  • jillma
    Inside the box means different things..both positive and negative, relative to it's application. I went to a local urgent care doctors office, my former breast cancer surgical site..symptomatic of inflammatory breast cancer. I had just watched a video of training ballet dancers, Miami Ballet, and how certain steps on pointe stayed within a 'box' on the floor..indicative of perfect execution. Than, an office worker at this doctors office, corrected me when I used the term 'dim wit', ie: not to bright or witty. I did not fit in this individuals 'box'..I am not a Kindergartner and she is not a kindergarten teacher but...probably, she has a HS diploma and a certificate. I asked if she ever studied cultural anthropology. Another office worker came in to take my medical history. I wanted to say none of your business, I will talk to the doctor. She was condescending and patronizing..was vehement..what was the surgical procedure. I really doubt she she is a surgeon or surgical expert, and I had to explain that, the doctor admitted me for a hernia,..said they were not sure just before surgery, and, that he might have to make a full incision across my abdomen, but, they were going to make a local incision, left inguinal, The biopsy report, by the way, made little sense to me. A cyst. After years of trying to resolve the pain and problems I have with my head and neck, chronic breast pain at needle localization site, neurological difficulties, right after surgery and radiation, have been referred to a Breast Oncologist. Perhaps the lack of information I received from the surgeon about my diagnosis was purposefully to keep me ignorant of what was done and why. Perhaps the reports were deliberately misleading, not accurate..etc. Jericho. Has a long complex history. Babel.
  • D Someya Reed
    I so badly wanted to agree with Margaret but yet another dose of reality just today slapped me right back into agreement with Dr. Riley. Took a 90 yr old man to the hospital for cataract surgery this morning. We arrived 8am told to be there at 8:15am for a 9am surgery. First thing, we were greeted with... "You were supposed to be here at 7:30am!" "No one told us anything but 8:15," I replied. "Yeah, well it was 7:30" came the snappy retort "and they're waiting for you." Followed by, "Oh, you're an eye patient...they don't like us to call their patients." I guess that's the equivalent of an apology. Would have been nice had she checked whatever that information was...first. The supervisor came in interrupting the delightful conversation with... "If you get backed up you're to call across the street." "I am backed up and no one told me" came the quick reply. "Well" the supervisor said, "I was informed that you already knew this." I made a mental note...Then what was the point of the supervisor telling her this fact (that she knew was already known) in the first place? Couldn't she have called for additional help herself seeing the back up by, say, looking through the glass at the filled up waiting room? And why do this in front of patients? Probably too much logic on my part...I get in trouble for having that malady far too often. At this point our check-in staffer asks 'sweetly,' "And how are you doing today?" So if this is the treatment of patients at the most basic level, how can anyone hope that some worldwide enlightenment will occur, feet dangling in water or otherwise? None of these groups care about what any of the others are doing, how they do it or why they do it. To further illustrate...we were asked to sign an acknowledgement that all parties involved in the treatment will be sending billings separately. Whatever became of economies of scale and consolidation of effort and such? Centralization? Perhaps the e-medicine and robotic caregivers are the way to go after all. I suppose so unless they ask that they be programmed with "attitude." Oh, and the "they're waiting for you comment?" My friend was taken into surgery at 10:30am. That would be 2-1/2 hours after we arrived. A "material misrepresentation of fact," perhaps? No...I'm sure it's designed to make the patient feel at ease before having his eye sliced open. But we had to see six different people who asked the same questions six different times and entered the answers into the system likely in six different areas before we ever saw either the anesthesiologist or the surgeon. Nope, the walls are up, the walls are solid, the walls are NOT coming down.
  • Sounds like a marvelous imaginary scenario. Still, you're right in principle. The more people communicate and understand each other, the more smoothly things are likely to run. Who is promoting dialogue between the separate players in this often dysfunctional mega-system?

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