Health and Wellness Articles

Lifestyles: Rediscovering Medicine's Sacred Mission

2007-01-08T19:25:00.000-08:00

Are you burning out? You're not alone. It's clear that today's doctors just aren't as happy as they could be — or should be.

By Barbara A. Gabriel, MA
Physicians Practice spoke with a physician renowned for his sound advice and calm demeanor about how you can do the job you love and still remain sane.
An author, speaker, and Yale-trained psychiatrist, Carl Hammerschlag is a self-described proponent of "mind-body-spirit" medicine. He has authored three books ("The Dancing Healers," "The Theft of the Spirit," and "Healing Ceremonies") that chronicle his more than 20 years living with and caring for American Indians, cultivating his expertise on how to survive within rapidly changing cultures. He is highly sought after as a gifted speaker and storyteller who has addressed innumerable audiences across the globe. Between speaking engagements, Hammerschlag maintains a small practice near his home in Phoenix, and he is a faculty member at the University of Arizona Medical School.
Physicians Practice: What originally attracted you to the practice of medicine?
Carl Hammerschlag: I suppose I was programmed to become a physician from the time I was small. My mother had great respect for our family doctor and viewed him with a kind of awe usually reserved for theological figures. ... I was always interested in somehow working with people because I felt an obligation to make a difference.
PP: How did you come to practice psychiatry?
CH: I served in the Indian Health Services as an alternative to going to Vietnam, and I was seeing sometimes a hundred patients a day in clinics on reservations. I was like the proverbial shoemaker whose children had no shoes. I was working so hard I couldn't even take care of my own business. It was exhausting. My wife was saying, "Hey, we need some time here as well."
I was always interested in the workings of the human mind and thought maybe I could study psychiatry and learn something about why people behave the way they do.
I went into private practice in 1986. I still have a smaller private practice and I still see patients. It's an unusual practice. I am different from most of my colleagues. For example, I do not carry malpractice insurance, so I do not have hospital privileges. But I feel it's a very important statement that I choose to make to my patients. I tell them I don't carry malpractice insurance, and I ask them to sign a form acknowledging that. I'm sure it's not legally enforceable, but I want to make a statement about how I see the world, especially in contemporary life when the practice of medicine and the relationships between doctors and patients have become more adversarial than communal. It is my strong feeling about healing that doctors and patients need to be in it together. It's a shared partnership — people themselves must become the principal agents in their own healing.
PP: What do you think are the chief causes of physician burnout?
CH: The prime cause for burnout among physicians is that there are enormous demands on the profession but little support or reward. Those are the elements that are the predicates of burnout. We live in a situation now in which the demands placed on physicians are intense. We have to see patients quickly in order to be cost-effective. There are payers that don't renew contracts with doctors because they are seeing patients for six minutes instead of the four minutes the rest of the practitioners in their specialty average.
There is always an urgency to do more in less time — especially within the fixed-cost, managed-care setting. And so the expectations placed upon physicians are enormous. Yet we've always prided ourselves on relationships — that we have to make connections with people to heal them. The current atmosphere precludes making those types of connections.
Combine that scenario with an environment that dramatically over-emphasizes procedures and pills for anything that ails you. It's further complicated by direct marketing to consumers by pharmaceutical companies that suggest that anything you feel has a pill that could cure you. ... This has created the current atmosphere in which patients come and demand the drugs they see on TV. ... If you want to sit and talk to your patients about what's really ailing them, you don't have the time. All of this colludes to lead to burnout. A lot of demand in the absence of any reward or support.
PP: Those problems are endemic to modern medicine, aren't they? What can physicians do, given those realities, to avoid feeling alienated?
CH: I think they have to establish relationships with their patients, and I think you can do that by looking at them face-to-face. ... Today, when many doctors interview their patients, they are simultaneously typing on a keyboard, so we're losing that eye-to-eye contact. I think we can learn more talking to patients in five minutes face-to-face, eye-to-eye, than we can by having them fill out all sorts of questionnaires or entering their information into a computer while they are in our examining rooms. The critical issue is you have to reach out and touch patients in a way that touches their hearts.
The critical area of medicine in the future is not more pills and procedures, but preventive medicine. To do that, you have to spend some time with patients. Most chronic diseases are not better treated by pills and procedures, but by patients changing their behavior. From heart disease to diabetes to mental illness, to get well, patients need to shed stress, eat better, exercise more, drink less, smoke less — you get the idea. And in order to get people to change their behavior, you have to touch their hearts. That doesn't mean you have to spend 20 minutes with them, but you do have to make a connection. I think you can do that in five minutes. I also believe it's antithetical to good healthcare to tell people when they come into offices ... [that they] can't ask more than three questions ... That interferes with relationships.
PP: But physicians are doing that because of the current realities of billing payers ...
CH: Exactly right, and I think every practice has to make some decisions about what they can and can't deal with. So I think that instead of an organizational principle that says at the outset, "If you have more than three questions, you have to make another appointment," I think it's much better for the doctor, looking at the patient face-to-face, to say, "You have a lot of questions, and I would like very much to be able to address them, and we need more time to do that. So I would like you to come back so that we can talk."
Sometimes you need to take more time with patients. ... I want physicians to feel good about that. Make patients feel that you care about them in a real way. In the current atmosphere, our patients are not sure whether we're making decisions based solely on what it is that their carriers will provide or what's in their best interest. And that is demoralizing to all of us in the practice of medicine — that our patients are no longer sure that we are making decisions based on their needs or on what's covered and reimbursable. That distrust essentially distorts the most important element of healing — the doctor/patient relationship.
PP: Is there anything specific the average physician can do to maintain good relationships with their patients and still make a comfortable, relatively stress-free living?
CH: They have to ask themselves the question, "Is this what I want to continue to do, or can I find another way to practice?" If it doesn't feel good, you can't be doing the work effectively, and it will kill you. That's the bottom line. If you're working in an atmosphere that regularly steals your joy, it's going to set you up to get sick. You've got to find a way to come to work every day with joy. ... You have to find a way to feel good about your practice, and if that means you're going to see patients for six minutes instead of four, then you have to find a way to charge them accordingly and see fewer patients, or you have to be willing to make less money.
And when you're not working, you have to find some way to replenish your sense of joy. I don't care how you do that, but it's generally something that fills you with a sense of appreciation and awe. It doesn't make any difference to me if you play with your kids, your grandkids, whether you go mountain biking, fly fishing, or just spend time alone reading, but you have to find some way to recharge your proverbial battery.
And practice in a community in which your ethics and values are shared. You've got to find a group that values what you value — or you'll always feel like the odd man or woman out.
PP: How can physicians guard against their employees burning out?
CH: I think that if physicians feel better themselves, the people who work for them are going to feel better, too. Mahatma Ghandi had what I think is the greatest line when he said something like, "You want to be the change you're trying to create in others." If your employees can see in you what reminds them of what they like best about themselves and why they are doing this work, they will stay. People are desperate to do work that has meaning — to make a difference — especially in this culture. ... People want to believe that the organizations in which they work and the leadership in those organizations operate from a position of some ethic of morality.
The work of medicine, the work of healing, is holy work. It's a sacred profession, and the current atmosphere is stealing the sacred, because we're always running scared.
PP: What keeps you enjoying medical practice after all these years?
CH: I love what I do, and I like to think I do it well. I see fewer patients because I can spend time with them. I'm a psychiatrist. I see people for an hour. I just don't dispense pills. ... But I had to supplement my practice by speaking, which is how I can afford to stay in business.
PP: You now practice part-time, while you also write and speak. Why did you make that transition?
CH: I knew that I was not going to be able to continue to enjoy doing my work prescribing pills and seeing eight hours of patients a day. ... I kept that pace from 1986 to about 1990. And I was hospitalizing patients then as well. And then I found I was getting seduced into the ease of hospitalizing them because then I didn't have to see them for 15 minutes; I could see them for shorter periods of time and it was still reimbursable under the standard rate. It's so easy to get sucked in, and I could feel myself become seduced by it. This is not something that fills me with pride.
I didn't want to do that. I wanted to give my patients the best I had, and I knew that if I could see four hours of patients a day, I would be much better. But to do that and keep my kids in school, I had to find some other way. So I did, and lots of doctors are also finding other ways. I would hope that they can do it in medicine instead of having to leave it completely and become entrepreneurs, because I think as a profession, everyone who enters medicine does so basically for wonderful reasons. We are a remarkable group of people who go into healthcare delivery, and we want to remind ourselves of that. And if we can feel that, then the people who work for us will feel it, too. We ought to work in a system in which we honor the sacredness of our profession. That's how we can prevent burnout and turnover.
PP: Do you run a cash-only practice?
CH: I don't take any insurance. My patients may or may not be covered, but that's between them and their carriers. They pay me directly.
PP: Do you have a sliding scale?
CH: I do. If I see a teacher who is divorced and raising three children and making what teachers make, which is a sin in this country, she'll pay me the same that she pays what it takes to get her nails done. So my scale slides enormously.
I also barter and trade. Somebody made the front door to my house out of stained glass — he happened to be a stained glass artist. There are people who send me cedar and sage; there are potters who have made pottery. ... I had a patient who once painted the walls of my house in exchange for their psychotherapy.
I speak, and my fees are high. So I can do it, but you have to find a way to balance your own life. It's critically important to find some balance. To achieve it, you have to pay attention to what you're feeling inside. This is what I talk about. If you're not feeling good, it will destroy you. The entire medical establishment gives scientific credence to what I'm telling you anecdotally. If you don't feel good, stress hormones will break down your immune system and ultimately make you sick. It's too big a price.
Barbara Gabriel, MA, is the managing editor of Physicians Practice. She can be reached at bgabriel@physicianspractice.com. To learn more about Carl Hammerschlag, visit his Web site at www.healingdoc.com.

The Healer

2006-11-26T21:09:00.000-08:00

Carl Hammerschlag, M.D., Paradise Valley
Author, physician, psychiatrist, speaker

In Dr. Carl Hammerschlag, the spirits of New Mexico Native Americans still roam after more than four decades.

They transformed the son of German Holocaust survivors into a heralded psychiatrist, accomplished author, speaker and bona fide character. “Something happened in Indian Country that changed my life,” Hammerschlag says. He’s talking about when, in 1965, he left behind a New York upbringing for the big, blue sky of New Mexico. He landed a two-year stint at the U.S. Public Health Service Indian Hospital in Santa Fe, where he took up the agency mission of helping otherwise underserved Native Americans.

He came to the Valley in 1970 and went on to spend 16 years as chief of psychiatry at the Phoenix Indian Medical Center before going into private practice. In that work to better others, the Yale University-educated Hammerschlag found self-improvement and a personal mission: promoting mind-body-spirit medicine, known as psychoneuroimmunology—ostensibly bridging the gap between science, spirit and culture. Now 67 and living in Paradise Valley, he has authored several books, including The Dancing Healers; The Theft of the Spirit; and Healing Ceremonies; plus children’s books The Go-Away Doll and Sika and the Raven.

“Just think about what we have to learn from Native people,” he says. “If we only believed that those people that we conquered had some information to share.” In an undulating and admitted ramble, Hammerschlag derides the modern-day disconnect of health care, humankind, incessantly ringing phones, video games and other technological trappings. We no longer value conversation and, perhaps, never truly reveled in life lessons handed down through the ages, he says. Through mesmerizing monologues, Hammerschlag marries the wit and wisdom of Garrison Keillor and Carl Sagan. He has a mission and a message that, when delivered, opens a window to his soul, says Phoenix physician Howard Silverman.

“He’s unconventional, but he comes from a very authentic place,” says Silverman, who co-authored a book with Hammerschlag. “I think his message is that as medicine gets increasingly accelerated and hightech, let’s remember also to include issues related to the heart and related to spirit. I think that’s an important message.”

Mind-Body-Spirit

2006-11-26T20:58:00.000-08:00

Carl A. Hammerschlag is a master storyteller and internationally recognized author, physician, and speaker. A Yale-trained psychiatrist; he has spent more than twenty years working with Native Americans. Now one of the worlds leading proponents of psychoneuroimmunology ( m i n d - b o d y - s p i r i t medicine), he is a faculty member at the University of Arizona Medical School. He is an expert on how to survive in rapidly changing cultures.

Dr. Hammerschlag's life work has been chronicled in three critically acclaimed books: The Dancing Healers, The Theft of the Spirit, Healing Ceremonies, and two children's books. In his presentations, Dr. Carl Hammerschlag brings his gift of storytelling, and unique insights which bridge the worlds of science, spirit, and culture. With poignancy and humor, he leads his audiences on a joyful journey that will stimulate and renew their creative and healing potential. The following are responses to an interview about his work and his book The Dancing Healers.

What is psychoneuroimmunolgy?

Psychoneuroimmunolgy is the science of medicine that deals with the interaction of the mind, body and spirit. It is the connection between the nervous system, the endocrine system and the immune system. But it is the science of mind, body, and spirit medicine.

Is this considered a new science?

Well, it is clearly an old science; we have simply given it a new name. We always knew that mind, body and spirit were interconnected — but now we have ways of measuring it, and studying it in the laboratory, which now gives scientific credence to all of the anecdotal tales that our grandparents once told us and that traditional healers have known since the beginning of time. And that is that what you feel in your heart, what you believe in your spirit, is as least as important as what it is you know in your mind.

Why do you believe that rituals are an important part of the spirit?

Rituals and ceremonies provide us with a structure by which we can get in touch with our feelings. And what it is we feel is crucially important in dealing with what it is we are facing. Rituals and ceremonies help us get in touch with the intangible aspects of ourselves. They connect us with our feelings which is where the spirit lives. The spiritual part of ourselves has nothing to do with coming from a place of certainty, which is really what the mind is about. The mind is about certainty and knowledge that can be proven. The spirit resides in the heart and soul, that part of ourselves where hope and dreams live and have a profound influence in the healing process. Rituals and ceremonies help us get in touch with a part of ourselves, the intangible, unprovable but still profoundly and impactful part to help us deal with whatever we face.

Define Spirit.

Spirit, well it is not so easy to define. I think spirit is the light within that propels us forward during the hard times. Spirit is a quality inside that allows us to face the ups and downs of our lives. The human spirit is that part, the light, the fire inside that reminds us we are not alone and we can get through. And then there is the spirit outside of self, which is another matter. But in this particular instance you're speaking more of the spirit within us.

Yes, the ineffable quality within, the thing that can't be defined but somehow we know when it is not there, like depression for example. Depression is when we cover the light inside with all kinds of lampshades of fear and doubt until we are no longer sure the light even burns. And the task of psychotherapy as well as antidepressants is to remove those lampshades so you can catch a flicker of the light which reminds you that you can get through it.

You had indicated in one portion of your book: If we are comfortable only with answers that can be proven, we'll never really get comfortable. — Have we been taught this or have we just learned it?

Yes, we have been taught it. Part of the unfortunate side effect of the scientific and industrial revolution of the last 200 hundred years is we have been taught to pay more attention to what it is we know rather than what it is we feel. According to the process of science, the really important answers are those that can be proven. Answers lend themselves to some test retest reliability, some scientific equation which somehow provides all of the answers for us. And we have tended to reduce those things that we know because we intuit it, because we feel it, as having a less important status. As a result, we have reduced most of the human experience to a single sensory dimension — knowledge of certainty. And, we have tended to subordinate those things we know because we feel them, we intuit them as having less credence and that is one of the unfortunate side effects of our growing technology. I am suggesting the things we know from the heart, from the unconscious are important. Those things we know because we intuit them not because they can be proven or because they have easy answers. And, certainly when it comes to the important existential questions (what is the meaning and purpose of our lives) it is my belief that there could be many explanations so no one way of answering those questions is better than any other way. For example, why, while you are at an airport and somebody comes in and fires a gun and all the people around you are hit but you are not wounded? If you can't answer these questions as to why; why it happened to you or why you were saved then there are many ways to explain it and one is not any better than another. And I think we live in a culture nowadays, in which we tend not to pay attention to the feeling parts that have answers for us. Like if we can't explain it then somehow it's not real. I believe we have reduced science to what I call scientism because we don't believe anything unless it has a scientific explanation. As a result, we reduce the richness of the human experience.

Hammerschlag adds, If you anticipate that you are going to have pain, the likelihood is actually that you will increase your pain. There is recent research in psychoneuroimmunolgy; there are areas of the brain that are called “dread zones”. If you believe you are going to get pain it actually increases the likelihood that when you get the pain that it's going to be severe. If you don't anticipate, you actually experience less pain, even if you should have it.

In the book, you also specify that "If you only see what seems to make you comfortable, then you are always destined to relive the old experiences and remain closed to discovering new levels of your own being." How do you get to the uncomfortable part?

You have to take risks! Most of us only want to look at what we already know so we keep doing what we have always done. This is not the journey of hero's. Sooner or later all of us are going to face something that we don't know anything about. We're all going to get older and we're all going to die. It is part of the nature of our biology. So you want to prepare yourself the best way you know how to seek out experiences that prepare you for the unknown. The secret in living an effective life is not only paying attention to what you know and what you have already seen. lllumine those areas of your mind that have not yet seen the light. The most important things for us to look at are those areas that have not yet been illuminated. Those areas that make us afraid, those areas that give us doubt. Generally it's those things that we don't want to look at that are probably the most important for us to examine.

How do you deal directly with the transition of death and mourning, so you can get back to the business of living?

Now death is the ultimate unknowable. None of us are experts in that. All we know is that we leave this level of corporeal existence and that in the biological sense our life here stops, but we don't know what else happens. We have to deal with the process of mourning for those of us who are left. How are you going to give up the attachment to what was the actual embodiment? I think rituals and ceremonies are ways that help us and every culture has its own defined death rituals and these are ways that help us get through. But then you got to get up and out, because the tribute to death is living a good life, freer, you remember that person everyday, and then you get on with it. If you stay stuck and you hold on to it then you haven't done the work of mourning. A lot of people don't want to do the work, they want to hang on only to the loss and misery because they are afraid to continue to living, but that's not what it is that liberates us. You want to honor the people who have gone by honoring the spirit of their lives. You love somebody deeply you want to use their love to love again. Instead of suggesting, you know I loved somebody I am never going to love somebody again. That is not a gift you give to the person who died. The gift you give to the person who died, whom you loved tremendously is to choose to experience that kind of love again and again. That is the gift of love.

In your book, you state that "We are here for such a short period of time. The important thing is to play the hand you've been dealt." What about the burdened, sick, poor etc?

Clearly there are some who are born into cultures in which they are impoverished and enslaved. They haven't chosen that, they have been dealt that. But the important thing is you have to learn how to play the hand you are dealt. If you don’t like your cards you can’t call for a misdeal and do it over. Meaning that if you have cancer, you have to find some way to come to it instead of wishing somehow it wasn't you. If you have an amputation you can't keep wishing that it isn’t true, because that just makes it impossible for you to be where you are. You have to find some way to be where you are; you can't always want to be someplace other because it makes it impossible to deal with what you got. And you have some power about how you come to that, how you play the hand. You can give up and give up the spirit of your life or you can find some way to deal with it. You can be poor and still enjoy your family and commit yourself to your kids. If you are always wishing that you were someplace else, and miserable about your fate you can’t win.

Why do most of us minimize our choices by accepting somebody else's definition of what's possible or probable?

Because we are afraid to dream, to make leaps of faith, then somebody elses sense of what’s likely to happen becomes your reality. So let's say you have a cancer of the lung and they tell you, you have a 1 in 10 chance of staying alive for five years. I am suggesting you come to it with the expectation that you might be one of that 10 percent, and choose to find ways to strengthen yourself for the struggle.

In your book you say that responding with "I know it" means that we no longer want to struggle with other ways of seeing it. But the way we once saw it may not be the way it is now. Why do you think we are limited and not be open to re-examination?

Because as a species we tend to hang on to the way we know and do things. We spend so much time learning to see it one way that we figure even if it's not the best way we have become comfortable with it. And, we don't want to have to learn it another way because then we're afraid that the way we once knew it may not be the only way it is. So most of us tend to hang around with other people who know it the same way we do, which convinces us that the way we know it is the only way it is.

I think that unlearning always has a positive affect. I think most people don't want to unlearn it because it makes them vulnerable. And they think vulnerability is bad. I think vulnerability is good. It simply is an opportunity for new growth. You can't grow if you're not going to be vulnerable. That's the truth all over the animal kingdom — deer shed their antlers, snakes loose their skin, birds molt their feathers, etc. This is always a great vulnerability, but it is the only way the animal grows. The same is true for us as a species. The only way we grow is to give up some stuff — yet growth has nothing to do with adding things on — it has to do with letting things go. You got to make room for new material. If you only want to know what you have already learned you will only do what you have always done. So you only become what you once were, that’s not a paradigm for growth.

Dr. Hammerschlag's final comment: I think that we can become what it is we dare to imagine. We can actually become the hero's of our own journey. Stuff is going to happen to us all. I want people not to give up. I want them to know that they are not in it alone. I want them to connect to their truth within, and also to connect to something outside themselves. I don’t care what that is, this is not a plea for eccliasticisn. It doesn’t matter what you connect with, (whales, dolphins, spotted owls, or old growth forests, they may all be names for the great spirit), but is has to be something that you beleive in other than yourself. That's what sustains us in the hard times. I want people to marinate their minds in what's possible rather than to marinate their minds in daily newspaper reminders that escalate only in fear, cynicism and despair. I want us to make the changes in our lives and our own families that we would like to see people make in the world and by doing it ourselves demonstrates what is possible in the world.?

For information regarding Dr. Hammerschlag’s presentations, workshops and products, please visit his Web site at www.healingdoc.com

Speaking With Soul

2006-11-26T20:35:00.000-08:00

By Carl A. Hammerschlag M.D., CPAE

(Dr. Hammerschlag is an internationally recognized psychiatrist, author and healer. He is the only physician to hold the CPAE, Speakers Hall of Fame Award. He can be reached at www.healingdoc.com)

Our job as speakers is to get people’s attention and touch them in a way that leaves them enriched for having heard us. Depending on our orientations, we teach, inspire, motivate, and sometimes change behaviors. Our greatest joy is when an audience member tells us we made a difference in his or her life. To magnify that kind of impact, we have to speak with soul.

What is soul? The soul lives in the worlds of feeling, faith and intuition; it’s synonymous with the human spirit and is what sustains us even through hard times. Soul is what makes you a “mensch,” a person with principle who cares for others and inspires by example.

I have been a physician for 40 years, but I didn’t learn about soul or spirit in medical school. It was only after I came to work with Native Americans that I learned to appreciate the power of the human spirit in keeping us healthy. For 16 years, I was Chief of Psychiatry for the Phoenix Indian Medical Center, an experience that exposed me to traditional healers who found ways to kindle a person’s spirit and help them move beyond their limitations.

In the Navajo language, the word for soul is the same as the word for health, truth, beauty, harmony, and the Great Spirit. The word is “Hozho.” When we speak from that soul place, people hear us differently because they feel our truth. In this age of slick commercialism and salesmanship, there is desperation for that kind of honesty. As speakers, we are not only experts with practiced precision, but passionate people willing to take the risk of being spontaneous. To make such a leap means we also have to be willing to be vulnerable. Don’t be frightened by it. Embrace the vulnerability; it makes you real and soulful. When you come from that place, your audience will embrace you not because of your perfection, but your authenticity. People will remember what you say when you speak the truth of what you feel not just what you know.

My wife Elaine clarified this principle for me one evening, when we were giving our two daughters the requisite sex education lecture. I prepared for this and put together a 20-minute presentation of what I thought was uncompromising brilliance. I wasn’t two minutes into it when my two daughters began to nod off. I would not be denied my time, however, and blathered on for another 15 minutes. When I was finished, I turned to my wife (more as a courtesy then believing she was going to add anything of substance) and asked her if she’d like to say something. Elaine paused for several moments and finally said, “What I know about sex education I can tell you in one sentence.” The girls popped up from their lethargy and, with their hands folded across the chest said, “Oh yeah, what is it?” Elaine said, “If it doesn’t feel good you’re not doing it right.”

Those girls have forgotten everything I ever said that night, but they have never forgotten their mother’s line. That line is actually a metaphor for living a healthy, productive soulful life . . . “If it doesn’t feel good, you’re not doing it right.” If you come only from your head, you will only speak to people’s minds; when you speak from the heart with soul, you can change lives.

Let me give you an example from my own profession. There are 2 million heart patients in the United States who have bypass surgery or angioplasty every year, at a cost of around $30 billion. All these heart patients are told by their doctors that if they don’t change their lifestyles, (i.e., eat healthier foods, smoke and drink less, and exercise more), they’ll be back for surgery in five to seven years, if they make it that long. You would think those facts alone would change their behaviors, but 9 out of 10 of those patients do not change their lifestyles. The fear of death alone is insufficient to change people’s behaviors. The only thing the facts do is remind people of the inevitability of their mortality.

Compare this to the results of Dr. Dean Ornish, the distinguished physician whose program for cardiac patients teaches them what to eat, how to exercise, meditate, build community and connect with others on their healing journey. After a month at his facility, 85% of those patients change their behaviors and do not require repeat surgery.

To impact people’s behavior, you have to speak to hearts not just heads, and this principle is not limited heart patients. Consider the story of Jack Murphy who was the subject of the 1974 feature film Murph the Surf, starring Robert Conrad. Murphy was a legendary surfer, concert violinist, National surfing champion, tennis pro, movie stuntman, circus high tower diver, notorious thief and a convicted murderer. In 1968, he was charged with first-degree murder which he denied committing but was, nevertheless, convicted and sentenced to life in prison.

After 19 years, the Florida parole board voted unanimously to parole him because of his exemplary behavior. Bill Glass, the former football star with the Cleveland Browns, founded a prison ministry 35 years ago. Murphy listened to Glass and Hall-of-Famer Roger Staubach talk to inmates about finding God and how it changed their lives. Listening to them, Murphy considered for the first time, the possibility of faith as a way to change his life.

The same man who once sparked one of the biggest riots at Florida State Prison is now, at the age of 68, International Director of Champions for Life. The job takes Murphy into more than 200 prisons a year, where he preaches, consoles, laughs and cries with inmates. Of course, it’s Murphy the con the prisoners want to see, and he gives them a great show. He tells them about the grandest jewel heist in American history. On the night of October 29, 1964, he and accomplices broke into New York’s American Museum of Natural History and stole the J.P. Morgan collection, including the Eagle diamond, the Midnight Sapphire, the DeLong Ruby, and the world’s biggest sapphire, the Star of India, a 563 carat jewel about the size of a racquetball. Murphy was arrested within 48 hours at a hotel where he and his two colleagues had been throwing lavish all-night parties.

Jack Murphy visits the world’s most violent prisons to spread the gospel. Murphy says, education and employment aren’t enough to rehabilitate a criminal. He says, “If you don’t deal with a person’s heart and soul . . . all you’re doing is passing out Band-Aids.” It doesn’t matter how you share your soul — it certainly doesn’t have to be a religious experience — but it has to be your truth. If you are going to change behaviors, you have to let your audiences see in you what they dare to imagine is possible for themselves. You have to be willing to reach deep down inside and share your truth and the passion of your heart, if you expect people to reach down inside themselves and believe that they can move beyond their limitations. Be the change you are trying to create in others, speak with soul.

Erickson as Healer

2005-11-20T06:36:00.000-08:00

(B.A. Erickson and B. Keeney, Milton Erickson: An American Healer, April, 2006, pp.270-275)

Milton Erickson was the last great psychiatric hypnotist. In an unbroken line from Mesmer to Freud, he taught the critical importance of trance states: those states in which learning and openness to change are most likely to occur. Daydreams, meditations, prayers, being “in-the zone,” or hypnotic inductions are all states in which we see things from beyond our ordinary consciousness. It is in trance states that people intuitively understand the meaning of dreams, symbols and archetypes.

Erickson was a well-known psychiatrist by the 1960s. He was the founding editor of the American Society of Clinical Hypnosis; he hypnotized Aldous Huxley in the 50’s and collaborated with him. Margaret Mead, the distinguished cultural anthropologist, studied with him for more than 40 years. But I never heard a word about him when I was in medical school at the Upstate Medical Center in Syracuse, or in my residency at Yale in New Haven, Connecticut. Psychiatry was beginning to move toward neuro-chemical explanations for the gamut of the human experience. Hypnosis and trance states were relegated to romantic myths of an archaic age.

I discovered Erickson only after joining the Indian Health Service in the mid-1960’s. I spent twenty years in Indian country, most of them as Chief of Psychiatry at the Phoenix Indian Medical Center. Working with Native American medicine men, I saw things for which my training had not prepared me. Traditional healers could cure patients in varying states of psychological disintegration, in ways I’d never been taught in medical school.

Using ceremonies, myths and sacred objects, I saw Shaman cure the disabled and the psychotic. The hypnotic fires of all-night meetings, with drumbeat and prayer songs, the weaving of ritual, myth and symbols into ceremonies of awesome healing power — I didn’t understand a word of the spoken language, but I could feel its impact. The symbolic world clearly opened up channels to the unconscious mind. Their dramatic power changed people faster than I could with drugs and psychotherapy.

This process was difficult to explain in the traditional language of psychiatry (projection, incorporation, identification). It was only when I met Erickson that I began to understand and ultimately learn to speak this nontraditional language. I discovered Erickson through the writings of Jay Haley. When I learned he lived in Phoenix, I sought him out. Here was a psychiatrist who understood my experiences with clarity and translated what I was seeing into a profound awakening that had enormous practical application in my work.

Erickson revealed to me these guiding principles of healing:

1. A healer will see beyond a patient’s pathology, illuminate and mobilize his strengths, and help him move beyond his limitations;

2. Find ways to open up a channel into the unconscious mind and get patients to see their reality differently. Using stories, symbols, shared myths, and prescribing rituals, ceremonies, even ordeals, healers get people to look at the familiar in new ways.

3. Uniquely craft a healing experience for each individual in which both the patient and the healer are totally involved in the experience. There is no dispassionate, distant, unavailable transferential object to work through one’s neurosis.

Erickson was proud of the factor that he had Indian blood. He sponsored a scholarship at Phoenix College for Native American students who retain the practices and language of their tribal traditions. He was the keeper of a Navajo medicine bundle (ji’ ish) which contained the medicine man’s most sacred healing totems. In all my years in Indian country, I had never seen the contents of an entire one. I asked Erickson if he had ever looked inside it, and he said with a twinkle, “You get to see everything, when it’s time.”

A healer is more than a good doctor. A good doctor can make the diagnosis and prescribe the appropriate treatment; a great doctor can make the diagnosis, treat the patient and also add a preventative component that teaches the patient how to avoid exposure to trauma and pathogens. A healer can do all of that and, in addition, make a personal connection with the patient in such a way that touches them at a soul level.

How did Erickson get initiated into the shamanic journey? He got polio at age 18 and suddenly found himself paralyzed. Unable to move, it gave him time to observe people and learn to understand and speak the language of nonverbal communication. It was the beginning of his appreciation of the principle of utilization. It didn’t matter what happened to you, only that you learned something from it, which was its own reward.
Playing the hand you’d been dealt meant that what was once a curse could become a blessing. Erickson never stopped learning. At 57 he was stricken with post-polio syndrome and learned to face the world with slurred speech and weakened muscles.

All healers have the capacity to see things from beyond an ordinary perspective. When
healers look at patients, they see not only their pathology (Western medicine’s forte), but also look inside and identify their strengths. They use whatever symbols and language the patient speaks, in order to mobilize those strengths and move them beyond their limitations. Everything in the natural universe has potential for symbolic value, because symbols acquire meaning only when you supply them with their power.

A friend of mine watched a Navajo Roadman (a spiritual leader in the Native American Church) take out a fluid-filled vial and sprinkle some drops onto a patient. Later, my friend asked the healer, what the stuff was that he sprinkled on the man. The Roadman said it was very powerful medicine and then dropped the subject. The next morning, while my friend was taking a drink from a water bottle, the Roadman took it from him and poured a few drops from the bottle into a teaspoon. Holding the bottle in one hand, and the teaspoon in the other, the Road Man looked at the bottle and said, “If you drink this when you are thirsty its water.” Then, turning to the teaspoon he said, “When you need it for healing its medicine.” Symbols only have meaning when what you bring to them supplies then with power.

Erickson knew that if you look again at everything you know, you might see it from another perspective. If you can move beyond your ordinary consciousness, and suspend your preconceptions, you can create new endings to old stories.

All healers find ways to penetrate into the unconscious without direct interpretation. They know that conscious mechanisms of defense can keep patients from understanding the most insightful interpretation. Healers create a symbolic language that speaks uniquely to each patient and illuminates the undefended areas of the mind. Using stories, rituals, ceremonies, even ordeals, healers make a connection with a patient’s soul that opens up channels of healing.

Early in his career, Milton worked at Worcester State Hospital in Rhode Island. One of the patients was a harmless catatonic schizophrenic who was called “Jesus Christ #1.” Having ground privileges, JC #1 wandered the campus draped in a white bed-sheet prayer shawl blessing everything and everyone. One day, when Milton was out walking, he came upon JC #1 who said to him, “Blessings on you my son.” Milton thanked him, and then told him he was also seeking a blessing for the other doctors at the hospital. They needed to take a break from their strenuous work and exercise. They needed to replenish themselves so they could take care of patients. Unfortunately, the tennis courts were not in good shape. He told JC #1 that he understood he had the power to bless things and make them beautiful. These tennis courts were God’s creation and he could save them and the doctors. JC #1 said he was here to serve mankind and if Milton could get him the right tools, he could do the job.
JC #1 became the court-keeper, gardener and carpenter; he kept the grounds beautifully and was greeted by the entire hospital community with respect and appreciation. If you can speak the patient’s language, you can tell the story in a way that helps them mobilize their strengths.

All healers create sacred space for their work. This does not mean a religious tabernacle, but a place that is different from ordinary space. A setting that invites people to come in and open themselves up in a way that encourages a soulful connection. Milton’s waiting room and office were filled with magical symbols — a dried stingray was twisted into a crucifix and hung from the ceiling. On a bookshelf was a pelvic bone that looked like a skull with flashing lights for eyes, and everything came with a story. This was a sacred space that encouraged the journey into the unexplored mind.

All healers create a partnership with their patients. They understand that it is both of them together who make the healing work happen, and that there are lots of other helpers (people, flowers, animals, fire, and drumbeat). Everything in the natural world provides the symbols that can intensify one’s healing power. Milton didn’t mind if some saw him as odd; he thought it was a blessing that helped him see the world from a unique perspective.

Healers do not separate themselves from the therapeutic experience, they are right there with the patient. They are not detached, unresponsive, trasferential objects; they are totally involved in the event.

A friend of Erickson’s asked him to visit his aunt if he ever spoke in her city. The aunt had become increasingly depressed and now was reclusive. She no longer went to church or spoke to anyone. When Erickson was in her city, he visited her in her home and asked if she would guide him around. Slowly, she led him from room to room. In one of them, he noticed three well cared for African violets. Each was a different color and next to them was an empty pot in which she was clearly going to propagate another plant. This lady was a talented horticulturist, and Erickson told her he knew these were delicate plants and easily destroyed by the slightest neglect. He said he wanted to prescribe something for her, but before he did so, he wanted her word that she would fill it. She agreed to do it.

He told her that there were 13 different hues of African violets and that she was to go to a specific florist who needed a talented African violet lady to help save them. Then he told her to purchase pots and transplant leaves to grow more. When she had an adequate supply he wanted her to put one in a gift pot and send one to every baby born to a member of her church. Then, to every member of her church who was hospitalized. She kept her promise and moved beyond her despair.

To totally participate in the healing event does not always involve preparing for the event; it just requires spontaneity and a willingness to take creative leaps of faith.

Erickson was a healer. He provided me with a structure that helped me move beyond my boundaries and own my own power. He encouraged me, as he did all his students, to tell the story our own way, and not mimic his; to be authentic and use whatever works into our healing repertoire.

On one of our last times together, I gave him a Hopi Sun Kachina and told him it reminded me of his influence on me. He provided the light that helped me shift my need for certainty and enjoy the free-flight into the unconscious, where the magic of our work is realized.

Tom Cruise And the State of Psychiatry

2005-07-28T11:47:00.000-07:00

PR Newsletter July 05

Tom Cruise, the preeminent actor and public spokesperson for Scientology has been in the press recently calling psychiatry a pseudoscience and that psychiatrists have never helped anybody. He says “there is no such thing as chemical imbalance in the brain” and what people need to do is explore the underlying reasons and then move beyond their problems. Presumably Scientology is a way to do that. To the actress Brooke Shields, who suffered from serious postpartum depression and took medication which helped her significantly, he said, she was doing terrible things to her body.

Tom Cruise is wrong, there are serious mental disorders that are dramatically helped by pharmacologic intervention. And even if we can’t always explain how they work psychiatrists and neuroscientists are learning more and more about those mechanisms. But it is also true that psychiatry may be moving beyond its arenas of expertise. And I say this as a psychiatrist, not an actor, I believe we are prescribing too many drugs and defining too many behaviors as diseases.

The results of a just-published, governmental-sponsored survey of the nation’s mental-health predicted then in a decade, more than half of Americans will develop a mental disorder in their lifetimes. The apparent good news is, that at the moment, only one quarter of all Americans is suffering from mental illness. How did we get so many sick people, you may ask? It has something to do with how we define mental illness.
The American Psychiatric Association, first defined mental illnesses in a manual printed in the 1950s. This first Diagnostic and Statistical Manual (DSM I) included 60 disorders. In the last 40 years, there have been four editions, the current DSM IV, includes 300 disorders. Everything from sexual arousal disorder , excessive shyness, hypersomnia (sleep too much), hypersexuality (too much sexual activity), dozens of shades of depression, bipolar disorders, borderline disorder and being hyperactive.
Psychiatrists developed the DSM, in the hope it would refine our understanding of mental illnesses. What happened however, was that we defined problematic feelings and behaviors as diseases, and in so doing we implied that because we named these manifestations, it meant that we knew how to treat the problem. We often don’t know how to best treat behavioral problems, and even when we do, what we prescribe for them often causes as much harm as good.. What we have done is to re-define what is ordinary in the human experience, and turned it into drug-taking conditions.
In most parts of the world, if you feel anxious, sad, can’t sleep, lose your appetite for food or sex, you’re not defined as mentally ill. Families gather, healing rituals are performed, support is mobilized and people generally pull themselves together. What’s happening in contemporary America is that we are defining lots of people as mentally ill, for diseases they may not have and over-prescribing drugs with all of their complications.

Consider this, there are close to 4 million children in the United States diagnosed with Attention Deficit Hyperactivity Disorder (ADHD), representing 7 ½ percent of school-age children. Millions of prescriptions are written for these children every year for potent drugs. These drugs always come with a price; they are aimed at a specific constellation of symptoms, but they invariably cause others. A child diagnosed with the ADHD may get better focus but get more depressed, aggressive, sleepless, even suicidal. Today, 25% of all overdose deaths are from prescription drugs. According to the Substance Abuse and Mental Health Service Agency(SAMHSA) over the last decade there has been a 63% increase in emergency-room visits tied to the abuse of prescription drugs. SAMHSA estimates that 9 million people are now abusing prescription drugs, 3 million of them are kids between the ages of 12 and 17.

Often, these ADHD drugs don’t even work. In a recently completed national study, The New York University Child Study Center reported that 28% of parents with kids between the ages of five and 18 who gave their ADHD kids these drugs on a daily basis, said it didn’t work. Parents gave them anyway, because mental-health professionals teachers and administrators encourage it as the most expedient solution to the child’s problems. Furthermore, the medication is often covered by insurance, and it certainly easier then a commitment to counseling which is often not covered, or in the best of circumstances, is quite limited.

We need to stop defining the ordinariness of the human condition as a mental illness for which prescribing potent drugs is the best solution. When it comes to children’s behavioral problems let’s not use drugs as the first choice in changing their behaviors and consider other options:

Talk to somebody who can help you look at yourself and your children from another perspective. A therapist who doesn’t believe that drugs are the only tools to change behavior

Set limits, it’s an ego corrective experience. Saying “no” or “you can’t have it” is critically important if we are to survive as people and planet.

Restore the evening meal to a central family ritual. Gather around the dinner table with good food, sharing traumas and joys, things that are important to each member.

Watch less TV, limit phone use, take vacations somewhere you can suspend yourselves from all the ordinary expectations and demands and appreciate the awesome.

Exercise, eat more nutritional food, laugh and make connections with others who share your enthusiasm.

Tom Cruise doesn’t know much about psychiatry, and his certainties about its uselessness relegated to religious zealotry. But that doesn’t mean we ought to ignore the demoralizing trend toward the psychopathologizing of the human condition.

Bluegrass Blessing

2005-05-01T11:23:00.000-07:00

Caring Magazine – (Vol. 24:5)

My friend, Rubin, is a university chemistry professor, and also a practitioner of Ericksonian psychotherapy. His focus is treating patients facing end-of-life issues. Rubin wrote to me recently about his friend, Mary, living with ovarian cancer for the last four years. After the initial surgery and chemotherapy, she went into remission. A year ago doctors found brain metastases which subsequent treatment did not eradicate.

Trained as a scientist, Mary is also a peace activist and a ceramicist. A student of Native American culture, she has participated in Native ceremonies and wears a Native healing amulet around her neck. Rubin had given her one of my books awhile back, with which she resonated. Then he wrote several weeks ago, to ask if I’d send Mary my guided imagery CD, Facing Serious Illness. I was happy to and sent it along with a short note saying, I hoped my voice would speak to her between my written lines.

A week later, Rubin got in touch again and said Mary was declining and that it would mean a lot to her if I called. I did, and we spoke for a while. She said hearing my voice on the CD was great and that she loved my books, but hearing me live, right now, she could also feel my spirit. It was a wonderful connection and before goodbyes, I asked her to send me a photograph of herself so that I could picture her when I sent blessings.

A week later, I got some photographs of Mary, her husband, children, and grandchildren, along with this note:

I very much appreciated your call yesterday, it was definitely a big moment in my life. Without Rubin in my life we would not have made this connection. I think that’s the most important thing I’ve learned in life. It is my connections to the world that are healing. That’s different from how I was raised. I’m from Knoxville, have a Master’s in bacteriology which made it hard for me to break away from rational, scientific, tunnel-vision, about how people get sick and well.

But life shakes you up, so you have to approach things differently. Opening my self up to a healing community has been a transforming experience. All my relations keep my spirits up (and I hope my immune system is well). I am optimistic, look forward to every day. Thank you for being connected to me, I feel your blessings.
--With love, Mary.

That evening, I went to a concert featuring my favorite contemporary bluegrass band, Alison Krauss and Union Station. I love bluegrass music; the infectious, toe-tapping banjo riffs make me happy, and those plaintive wails of endless suffering touch my soul. Alison is a magnificent fiddler, and she has surrounded herself with a band of world-class musicians. It is her voice, however, that penetrates my heart — a clear, high-pitched voice of an angel. Alison came back for an encore following thunderous applause. She walked out alone and sang a’ capella. It was a bluegrass spiritual, “ . . .let my life, be a living prayer my God, to thee . . .” and I saw Mary’s smiling face, surrounded by her granddaughter wearing a red clown nose, and again sent my blessing.

Connecting with someone this way is a gift to them and to you.

To read an interview with Dr. H click here

Accelerated Unlearning

2005-04-19T15:19:00.000-07:00

By Carl A. Hammerschlag, M.D.

Welcome to the new business world of fast companies, nanotechnology, zero time and E-commerce. This is the information revolution where all new information becomes old with the click of the keyboard. Success in today's marketplace has nothing to do with having access to information or being able to transmit it rapidly, it's about creating environments that generate new ideas and that value relationships. To generate new ideas means that you have to accelerate the unlearning of old ones.

What this means for the Association industry is that those who create environments that welcome new ideas and who value relationships will thrive. I spoke to several friends in the business about what will define successful associations in the future. Susan Sarfati, CEO of G.W.S.A.E., said "we need to create 'safe harbors,' places that encourage courageous, open, and honest exchanges where people can take risks and even talk about fears and failures." Russ Abolt, CEO of International Sleep Products Association, said, "successful associations are those who continue to build community. We are a global phenomenon, so the need has become even greater to make tangible what it means to be family." Ed Griffin, CEO of Meeting Professionals International, said "we have to master the technology, otherwise we will only depend on virtual relationships. More than ever we have to remember to maintain personal relationships with our memberships."

I share their opinions. If you care about what you do and you like the people you're doing it with, in an environment that encourages new ideas, you'll be the fast company. ASAE reported that associations provide 90% of all post-graduate education. Associations can do what politicians and diplomats have been unable to do through their meetings, break down the boundaries that separate people and nations.

Seeing things from a new perspective, however, is not so easy. We tend to see what we already know. As a species we seem to look for ways to maintain the status quo. We get settled into old habits.
Neurophysiologists and learning theorists have long taught that the brain does not change after you are six years old. The theory was that the longer the learning, the harder it is to give up. It's as if the young brain is a fast-hardening Jell-O into which a fruit cocktail of facts and behaviors is poured. Once the Jell-O solidifies, it's hard to get the fruit out.

Current findings tell us that there are dramatic anatomical changes in the brain throughout adolescence and that cellular changes continue throughout one's life. The brain is continually changing itself through a phenomenon called "pruning." The body trims cells that aren't being used, so it's continually evolving. It's still incredibly difficult, though, to loosen patterns of behaviors and thoughts that have been reinforced by years of repetition. The things we learned as children are teachings that can build character but they can also be the source of later pain and dysfunction. For example, be nice, honor your parents, share what you have, be strong, don't cry, make us proud of you, be perfect, don't speak up.

The greatest block to creativity is old judgementalism. We stifle our ideas because we judge them as unlikely to be attainable. To be creative means accelerating the process of unlearning or in today's language, "reprogram your software." The crux of creativity is seeing things from a new perspective.

Here are some ways to accelerate the unlearning of old judgments and limitations:

1. Learn to play again. Kids are the most creative creatures because they let their imaginations run wild. Kids don't put down their ideas; instead, they jump in with wild enthusiasm, excited by their originality. Let go.

2. Take more risks. Seek out new experiences (sky dive, scuba, climb a mountain, write a poem, try improv comedy). Do something that gets you outside your comfort zone. These experiences invite the brain to consider things it might not otherwise encounter.

3. Seek out the awesome. Find something or some place that leaves you with your mouth wide open in awe-watching the birth of a newborn, standing at the edge of the Grand Canyon. Seek out experiences that help you not take yourself so seriously. Awe is the best way to keep your ego in check. Taming the ego allows you to make mistakes, even fail, and still feel okay about yourself.

4. Trust your unconscious. Our most important self is that part over which we have no conscious control, like breathing, responding instinctively to threats or falling in love. Our unconscious mind, or intuitive self, has a lot to teach us. Anyway you can see beyond your ordinary consciousness opens you up to new ways of seeing. Some people get in touch with their unconscious minds through long distance running, practicing yoga, listening to music, looking at a fire all night long while listening to drumbeats, or other ceremonies.

All of these ways open the unconscious mind to allow fresh ideas to bubble up. Accelerate your unlearning in an environment that values openness. Perhaps Marcel Proust said it best, "the real voyage of discovery consists not in seeking new landscapes, but in having new eyes."

Sustaining our Calling and Cause

2005-04-19T15:13:00.000-07:00

Excerpted from a presentation to the VHA/SW Annual Trustees Conference

I believe we have reached the point in health-care delivery when the trajectory of culture, economics and technology are colliding to compromise the care of patients. You are all familiar with struggles: constantly changing legislation and regulations which make it hard to stay in compliance; new technology is changing the way we do business; the impact of managed care; and decreasing reimbursements all challenge our survival. You are non-profit community hospitals whose mission and charter is to address the needs of your communities. How are you going to deal with these issues? How will you absorb the costs of the uninsured, which accounts for 25% of the population in some states? In the old days, paying patients would cover those who couldn't pay, but this is no longer the case.

Community hospitals, and especially teaching hospitals, are laying-off workers, rationing care to the uninsured, even selling control to "for-profit" companies. Competition for scarcer resources does not breed good neighborliness; as physicians, administrators, and trustees we are increasingly struggling among ourselves. Doctors are feeling that their clinical judgments are being subordinated to fiscal considerations. In order to do right to by their patients, doctors feel it necessary to play games with insurance companies. Forty percent of 720 doctors interviewed in an article in the April 12, 2000 issue of the JAMA said that they exaggerated illness, changed diagnoses, or otherwise "gamed the system" in order to do what was best for their patients. Lots of doctors are leaving practice and many say that they would have chosen a different profession if given the chance to start over.

Administrators are saying the same things; fiscal restraints are forcing compromises. They cannot buy every orthopedic appliance known to man or every new machine. With everyone struggling to preserve income and territory, we are no longer sure we have each other's best interests at heart. It's creating an environment that is dividing us and threatens the foundation of our profession. We cannot allow this atmosphere of dissention to divide our communities and our values. We must remind ourselves what we stand for, and that's a sacred obligation to heal the sick.

The first thing we need to do is stop blaming everybody else for our predicament. Pointing the finger of blame is a narcissistic response that creates fear and division. We need to find ways to come together openly and honestly if we are to sustain a healing community. We can't all have it our way, so we need to set some limits that we can all live with.

Unless we maintain our faith and trust in each other, we will never be able to address the new pressures that the technologic age and genomic revolution hold in store for us. This is how the future looks: surgeons will be able to operate remotely; altered chromosomes will eliminate some diseases and create new ones; transplanted organs will be cloned, and as a species we will be growing older. How will you sustain community hospitals when patients will be able to get Internet advice and treatment from experts geographically far removed? I believe it is by inspiring their faith and trust in you. Opinions will always differ; surgeons in Boston recommend a different type of back surgery than do those in Seattle for the exact same pathology. Patients can get as much information as they can handle; the task in today's environment is not getting more information, but getting help processing that information. Community hospitals and physicians will always be relied on because our patients still trust us. Health outcome studies show that improvement in a patient's health is most directly correlated to the patient's trust in their hospital, their physician, and their physician's knowledge of their home life. We must sustain that trust, which is our cause and calling. Our patients will stay with us if they have faith in us and know that if what they need exceeds our capacity we will refer them elsewhere.

These are my recommendations for how to ensure our success.

1. Lighten up. Find more ways to love what you do. Get connected to things that bring you joy everyday.

2. Be open. That means going away on retreat somewhere and sharing your strengths and weaknesses, successes and failures. No finger pointing. The more we come together, the more ideas and solutions will come about naturally. Focus on problem solving and you will create unity.

3. Take risks. Even if the venture doesn't work out, successful innovation is built on trial and error. The way it was is not the way it is.

4. Use technology. Get an Internet presence, share information but not at the expense of sacrificing personal relationships. We must stay connected to each other and to our patients. High touch is as important as high tech. The huge rise in the cash business of Complementary and Alternative Medicine (CAM) is a statement that people want more hands-on, personal attention

5. Think generationally. We are now thinking quarterly in the language of balance sheets. When the bottom line compromises care we will become just another industry. Healthcare is a ministry and we must look ahead to twenty years from now, and know that we have retained our fundamental values. Remember your mission and advertise it

6. Establish coalitions. Make relationships with others who can complement your services. Nobody makes it alone. Build a community of support, away and at home. Remember the lives that place themselves in your hands and believe in you, and go with joy on our shared healing journey.

Excerpted from a presentation to the VHA/SW Annual Trustees Conference