Author: Deborah L. Benzil
Philip Glass, a prolific musician and composer, was honored as the 2014 CNS Michael L.J. Apuzzo Lecturer. Before he began his dialogue with CNS President Dr. Daniel Resnick and Dr. Arun P. Amar, 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.
At 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 that they have to play “in tune.” This provides the critical foundation for the language of music. “Tuning” enables the musicians to sit together at the same table so that the work can begin. For Glass, in the mountains of Mexico this provided a particular problem as these musicians knew no European languages, and they built their instruments themselves with no tuning mechanisms found in Western instruments. But they all persevered and ultimately succeeded with the musical gift of “Concert of the Sixth Sun.” When asked what made this unusual “tuning” possible, Glass gave the obvious answer: trust.
He then clarified that trust is more than respect (which he feels is easy), because trust implies a greater level that leads to a willingness to accept something new.
What lessons can be learned from his story for the current crisis in healthcare delivery and healthcare reform? Universally, those involved in the healthcare system (physicians, hospitals, pharma, technology, and patients) recognize that the system is not working optimally. Many may suggest 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 lack of trust. There may be a modicum of respect between some of the involved parties, but the trust has long been eroded. Everyday, the participants work to preserve just 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 that 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.