It's my privilege to be with you this morning. I look forward to our conversation.

It was.

It's my privilege! As I tell people, I’m sort of on my 3rd career, I had the opportunity to be a surgeon, fixed kids with cleft lip and cleft palate to cure about 10,000 patients and families, we did it really well at great depth, but 10,000 is a relatively small number. I became CEO in Kaiser Permanente and had the chance to take care of 10 million people, a far fewer or far lower percentage of them as a consequence but the impact is obviously broader, both on the East Coast and West Coast. I think of myself now in this 3rd career, which is trying to move American medicine to affect the health of 300 million people. And like yourself, I’m interested in a broad range of ways to do it, the systemic problems, the cultural problems, societal problems, and you're an expert in that area. So I look forward to our discussion of those various intersecting forces on the health of the American people.

It's essential because the 3 levels are so intertwined. When you think about that, you can't really improve your health without addressing the system and the people around you and you can't trust the people around you without addressing your own health.

It's very hard. First of all, physicians work very hard. Right now, being a doctor in America is a very difficult task. There are bureaucratic requirements, the billing and the documentation. The computer system is getting between doctors and patients. Doctors are working very hard today. It's because the system is problematic. It's because the culture that sits in place and there are people who try to make a change. I teach both the Stanford Graduate School of Business and Stanford Graduate School of Medicine, and I have people in my business school classes from the university who are wanting to be able to make that leap. But first of all, remember, it's about a decade of intense training to become a physician between medical school and residency. You give up most of your twenties to do that, and quite a number of physicians at that point are not coming from the people providing the care. It's often coming from people in the financial world around them. It's not that we don't need those financial experts being in the business school. Obviously, I'm well aware of the contributions that can be made, but without bringing that critical lens of care delivery, the intersection of the doctor and the patient, it can't work.

So, my answer would be not enough people are making the leap. Not to give up one for the other. I had to do that as the CEO, which is too big a job, obviously, to be able to be practicing. I couldn't be on the East Coast having operated on a patient in the West Coast, but I think that having leadership and direction done in conjunction with the clinician and the business administrator, is the best way to make the change and that is not happening as much as it should in the United States today.

Sam is a physician, obviously in the book I make much of the details blurred so that I can protect his privacy, his legacy and his family. He was a physician who would always ask me questions. When I was the CEO, I'd go to every medical center. There's 20 of them in Northern California and three of them on the East Coast and I would go there that evening. I'd give a little tiny talk, and then I'd take questions. As you know, as a speaker, getting the first person to the mic can be difficult. Of course, once the first person comes, the flood of people follows soon after and Sam would always be the one to break the ice. He would always ask me about the various measures of physician performance.

Now, as a health care delivery organization, performance is crucial. You want to measure your quality. Are you nation leading? You want to measure the satisfaction of the people to whom you give care? You want to assess the access, and obviously you need to make sure that financially the organization is viable. These are crucial pieces. So that data is collected, but Sam would always be asking questions about it. After hearing that time and time again, I looked into the data thinking, well, maybe Sam's problem is that he's not performing as well as he should. But no, he was an excellent physician. In fact, he was the physician that his colleagues would often rely on when they needed someone to cover during vacation times. He would step forward and be the great colleague that was there. When he'd go on vacation, he’d always bring his computer, to make sure his patients were fine. He could not have been a more dedicated physician.

If you asked his colleagues, “Was Sam doing well?” They would say, “Absolutely, he's terrific.” So, one day when Sam took his own life and there's a lot more in the book of the details of the story, it's always impossible to separate out those things that come from the workplace, from his own family's place, from his relationship issues. But I tell the story because, no one actually ever asked them, how is he doing? No one ever saw the challenges that he was experiencing and I think that that is a hallmark of American medicine. Physicians are trained to repress their emotions, to not talk about them. Certainly never to admit how much they are hurting. They're loathed to talk about psychiatric and psychological assistance that they are getting. Although I wrote the chapter long before Covid hit, it's a very relevant chapter today because physicians are experiencing or about to experience, in particular what I think of as PTSD. The military experience says that the PTSD pain actually doesn't come during the battle. It comes afterwards when you realize what you've been through and the emotional pain that's there.

I have spoken with doctors who've lost four patients in a single day. I mean, doctors are overwhelmed if they lose more than one or two a year and here, four in a single day and doctors are not able to talk about it. I've encouraged the medical profession, the hospital administrators, to bring together groups to support by bringing in psychological resources and I think that could make a big difference, and I very much worry about the consequences. We may see a lot more Sams afterwards than we even saw before Covid-19 came ashore.

People often ask me about my work trajectory. “How did you become the CEO?” I tell people everything was serendipity. I went to college actually to become a college professor. I majored in philosophy and my hero, who, by the way, ended up getting tenure becoming the chairman at Reed College. But he didn't get tenure at the university, not because he wasn't a brilliant philosopher and PhD expert, but because of his political views. I know in retrospect this sounds really absurd, but I wanted to go into something that would have no politics. Medicine.

It seemed to me, I was 17 years old. This is life and death. In my mind, I never minded not being good and admitting it. Those were the facts. I couldn't stand the thought of being someone who is able to contribute highly and then being overlooked as part of a political process. I assumed that medicine would be very different. Went to Yale Medical School. Then I went to become a heart surgeon. Once again, I got very disillusioned in the medical world because heart surgery to me was the epitome of what we're talking about. This was really life and death. The people who were getting the most referrals weren't the best surgeons. I knew that I was operating with all of them all the time. They were the ones who were at the country clubs, and had the right social connections. This was not about how do you maximize quality? How do you recognize expertise? How do you make sure patients get the best outcomes? This was an internal social culture sitting in medicine, and once again I became very disillusioned.

It's interesting that I had the opportunity to be sent to Mexico by my program director, where I had the opportunity to fix kids with cleft lip and cleft palate in a very remote area of the country and I became enthralled by this opportunity to take individuals born and destined for a horrific life and now be able to change that very quickly and found my love and my passion for that. When I finished my residency at Stanford, by serendipity, the plastic surgeon in Kaiser Permanente had crashed his plane in an unfortunate accident, and they asked me if I'd come for a few months. What can you lose for a few months? I said, “Sure, I'll get there.” I loved that environment, that sense of collegiality, that group work. And after one year, I got asked by the Chief of staff would I become the Director of the OR Committee responsible for the performance in the operating room? Wow! I said, “I must be a really big deal.” They must have seen my credentials now. Everyone else had turned down the job. I was the last guy there. I was just naive enough to think I could actually accomplish something, because this was the time of a nursing shortage and I came up with a program where we were able to retain nurses who otherwise would've retired, to put in a training program that would allow people to move up their skills, to bring in nurses on a temporary basis to fill in the gaps. That was really the start. I enjoyed this opportunity at first, but I loved my craft. The hardest thing for me becoming CEO was giving up that clinical practice. I didn't want to do it. I just knew that I had to. But I also loved this other side. To me, it was a creative process and I enjoy that creativity. I do some artistic stuff, but this to me, art. How do you take a system of people and evolve it, let them see something they otherwise couldn't recognize and then create it? Take something in your mind and help to make it happen into practice, particularly when the outcome is saving human life and improving health.

So I would say this was the entire transition. I was at the Stanford Business School. I was able to then bring it back to the organization and take jobs and then, as I say, ultimately become the CEO.

Sure. Let me touch first the point you made before, because I want to close that and then let me take on this question, because it's so important and so tragic. There's a series that I'm writing now for Forbes called ‘Breaking the Rules.’ One of the things that's most interesting to me is how the circumstances of the individual intersect. This combination back and forth, the things happening in the world around you affects you and the things that you have to bring out to the world. I talk about a lot of rule breakers and it's fascinating for me to ask the question, “How much of it is circumstances? How much of it is fact?” Steve Jobs, is his personality or the evolution of the computer world that happened? Elon Musk sitting there today, a variety of individuals who I'd call rule breakers. I don't mean the regulations. I'm talking about the unwritten rules. These are the ones now that we're talking about inside the healthcare profession. I mentioned one of them before, which is never to express your emotion. It's not ‘textbook.’ You don't hear a lecture on it, but you look at behavior. When I see 90% of people doing the same thing, to me that tells me there's an unwritten rule, because if not, it would be random. You wouldn't see 90% of the people doing it.

When you get to the issue that you're raising, a word that is talked about a lot in medicine these days is burnout. People are well aware of burnout. The studies say that 44% of physicians have burned out. Those numbers went up in this pandemic as doctors had to confront the tragedy and the impossibility of delivering care and often felt unsupported in that process. 400 physicians take their lives every year, more than one physician a day on average. That's tragic. There are physicians who have jumped off roofs and physicians who have in many different ways, in many different forms chosen to end their life very prematurely. So it's well known. But, if you ask physicians these studies have been done, they'll point to what I label as the systemic issues, the bureaucratic tasks they have to do, the fact that they have to call for authorization for things they know is necessary for patients and the moral injury it inflicts upon them. The fact that they see way too many patients a day to generate the income they need to repay the medical school and residency debt, often averaging $200,000 a year that they've incurred, this computer system that literally comes between them and their patients that they would point to in the pandemic. The issue of the fact that they took care of patients without having the protective gear they needed, often donning garbage bags and no gowns and solids when there were no masks. These are the systemic factors that they see.

In Uncaring, I write a lot about the cultural ones, about why Sam's problems weren't recognized. Why weren't people shocked that when his family went on vacation, he stayed and worked. What was he doing? What was he thinking? What was the impact? That's just not talked about. We think that this is just part of the heroism.

In a piece I wrote recently, if you look at this burnout, women physicians have always had more burnout than men. But it's soared in the past two years. The specialties that have seen the greatest rise, OB-GYN and family medicine are ones that have a lot of women in the profession, and it has gone up significantly. We're talking about a 15 point gap, 56% vs 41% between women and men. Can you ask why OB and Primary Care haven't seen a huge increase in the number of Covid patients in the hospital? They took care of them, obviously, as part of their overall profession. But it wasn't like the ED and the ICUs. No, that wasn't the reason. These bureaucratic tasks didn't change. There has been a problem with discrimination and harassment, and of course time. But that didn't elevate during these past two years. No. It’s what happened at home. Because we know that women took on a massive amount of added work, 8 to 10 to 12 hours a week.

Now you put that in terms of a burnout situation that exists. So this is cultural. This is societal problems that are there. And this burnout problem, the suicide problem, is far more complex. Again, I fear that we've come up with or try to come up with simple answers and in a sense, we need a much more comprehensive solution.

When I observe actions that I can't explain, I think that it's not a question of people acting illogically. I think it's a question of impact left over from the past. Psychoanalysts understand this well for how our childhood affects our adulthood and it happens in professions as well. Coming back to medicine. This is a thousands of year profession that's evolved across time, for 95% of the time or even more, doctors could do very little. For the most part, they could fix some bones. Once they had anesthesia, they could take out the appendix. But it's only very recently that physicians could actually make a major impact in both preventing people from becoming very sick and saving them from dying. What you see therefore culturally, is that we embraced denial as a powerful tool. Because if not, you have to confront your inability to make a difference, your inability to save a life. Psychologically, that is really crushing across time. That denial sits inside medicine today. Again, think about how much you give up, training to be a doctor, and you've got to deny that in order to keep going. You confront death every day, and you've got to deny that, to keep going. You touch people in the most private of ways, and you've got to deny that these are human beings and we dissociate our emotions as part of that process. Yes, we talked about the doctor patient relationship, but for the most part, we deny so many of the parts that are there because it's necessary. It was necessary in the past, we could do so little psychologically and it's necessary today. Think about just putting a knife and cutting into a human being. You've got to be able to deny these things. We don't think about it that way, but this is intrinsic inside the profession left over from the past.

Now, some of the things are heroic and actually glorious. Early in the pandemic, we mentioned that the doctors did not have the protective gear they needed, and yet they still went to the ER, still went to the critical care units to take care of patients. They had to deny the risk they were taking, similar to the doctors’ way back in the middle ages, confronting the plague. When patients couldn't breathe, they passed a tube through the mouth, down to the lung that goes through the vocal cords. The patient always coughed, spewing virus to your face, and the doctors still did it. So it's not that denial is always bad. It's essential for some of the functions that doctors do. But at the same time, it's causing the medical profession to not see some of the things that are happening.

We tell ourselves that American medicine is the best in the world, but there's not really a shred of evidence that it's true. The Commonwealth Fund has looked at health care provision in the most industrialized nations. We are last. We have the lowest life expectancy. Five years less than almost every other highly industrialized country. We are last in childhood mortality. Last meaning worst. We are not only the worst in maternal mortality, we have a rate that is 4 to 8 times as great as most other countries, and we're the only nation in the world where maternal mortality is going up.

We can talk about the fact that black women have a 20 times higher level of mortality or likelihood of dying during childbirth and we ignore many of those things. We ignore the discrepancies, the disparities in health care based upon race. There are so many things that we deny sitting within medicine as a consequence of that and I concur with you.

The first step in the process that I've talked about this as a 5C model, is confronting the problems that exist. Being able to look at them in a much broader sense. Today, particularly in medicine, doctors are seeing themselves as victims and not seeing all the things that we can do to improve the health care process. The second C, is that we then have to commit to making a difference, to making a change and connect to our colleagues. Again, and the culture of medicine where the doctor elevates the individual, we need to understand how you create teams, how do we collaborate, and then how we contribute to improving, not just reversing the diseases, but actually keeping people healthy in the first place. This is a massive evolution that has to happen and we can talk about how it might happen. But right now, the progress unfortunately, I believe, is far slower and less successful than it needs to be, given how much more rapidly the problems are developing.

Beautiful! It is really bad for her to lose someone early in life that obviously, based on her words, that she loved deeply and to have that experience be so negative. It's a terrible experience, but it's a common experience. I think as physicians, we don't do a good job of telling patients the truth. After not telling the truth for a long time, then we do things that are less than empathetic because we've not had the type of personal relationship that we need to have with patients. I have a chapter in the book in “Uncaring” about the 9 sets of questions to ask people. One of the questions to ask them as you're getting care is, “What's going to happen to me? How much pain will I be in? What are my real chances of getting cured?’ And that requires an honest answer.

Again, in the culture of medicine, what do we tell ourselves? Never let a patient lose hope. I think that's important to maintain hope. But I also think it's really important to tell the truth, to let people grapple with it, because you can have hope in a negative situation. You don't have to have deception in order to be able to have that kind of hope. The last question is, “When I decide I don't want anything else done, will you still be there for me or you desert me?” And I think often physicians end up deserting patients not because they want to, but because of their own internal emotional situation. To them, it's a failure. And I hate to say that we're all going to die, but how we get to that point, how we live our lives, I think is really important.

You're a master at the stories, and I think a lot of the motivation for me came out of my father and his experience. This is where I think about the denial, not seeing the problems that are there. My father was a remarkable man, Jack Pearl. He was the son of two immigrant parents. He worked his way through college and dental school. Then when World War II broke out, he volunteered for 101st Airborne. He parachuted on D-Day. He was captured by the Germans. He led a group of them through the darkened forests at night, escaping, bringing people back, everyone coming back. He was really a great American hero, He was a very energetic man. He rarely slept more than 4 or 5 hours a night. One day, he became tired. He didn't know what was going on. He saw his doctor. The doctor diagnosed a low blood count. The reason for the low blood count was that his spleen was enlarged and was breaking down the red blood cells. So, they took out his spleen, which allowed him to regain his blood count and his energy. He received care, though, in both New York and in Florida, because that's what a lot of people do based upon the weather. He had excellent doctors in both geographies. My brother's the chairman of anesthesia at Stanford. He and I hand-picked his doctors. They were superb. They all knew that after your spleen is taken out, you're at great risk of developing a problem. And the problem is a particular bacterium called the Pneumococcus. The origin of the word pneumonia. There's a very effective vaccine against it. But the physicians in New York thought the ones in Florida had given it to him and the ones in Florida thought the ones at New York had given it to him. But my dad never got it.

My dad came out to visit my brother and I in California, slept in my brother's house and my brother got up at 5.30 for rounds and there was my dad on the floor, unconscious, unresponsive. He raced him over to the ICU where my brother was attending, got great care. My dad ended up surviving that episode, but going on to develop the complications from having spent 4 days in the ICU unconscious and 2 weeks in the hospital, and of course, the diagnosis, pneumococcal septicemia, a totally preventable problem had he had the vaccine.

Think about how many broken pieces of the system, the poor communication of two doctors, the lack of a common electronic health record, a lack of focus around prevention, everyone is assuming that everything was being done right, when in reality, there were cracks to which the patient falls. It's that kind of preventable medical error that kills in the United States. It’s estimated by the people at Johns Hopkins as 200,000 patients a year. We're talking about one of the leading causes of death in the United States, and everyone sees it as someone else's problem. We just don't understand how broken the American healthcare system is. I think not only does it harm patients, it also harms doctors because they are part of being, I don't call them cogs in this system, but they're caught in the system, in the eddies that sit in place along the river. We just somehow can't figure out how to break it down and get out of there. As I said, I think they'll start by breaking many of these rules, one of which is making sure that we tell patients the truth when it comes to what they have, how likely they are to get better, just whatever's going on in the disease. My observation is that doctors think that patients can't take it, and I think patients are far stronger than we give them credit for.

I love that model. It is so accurate for what's going on in medicine related to burnout, to the challenges of the health care system, to the medical errors I mentioned earlier. I think denial was the dominant emotion as you described it. I think the coalescence around the problems that we are all experiencing is the second phase and there's a lot of emotion that sits there today. I think your solution is brilliant. There is this fear that exists in medicine right now. Doctors don't realize that no one's going to solve the problem for doctors today. The medical system is so problematic for patients that, it's not as they're not concerned about the doctor's pain and suffering, but it's that they're very concerned about whether they can afford health care, feed their families, be able to maintain their livelihoods, their jobs, their lives, all the issues that sit in the broader society right now are getting worse progressively and I think that notion of hero, not the hero who harms him or herself in order to be able to accomplish something, but the person who's able to elevate everyone to accomplish that. I think as a physician, I had never thought about it before you mentioned it today, but I think it is true, seeing the hero in the patients. I've seen so many individuals overcome remarkably negative problems, remarkably severe diseases, taking care of quite a number of people with spinal cord injuries that have paralyzed them and watched as they've been able to recreate their lives. I think that hero happens in everyone.

Now, why is that a leap in medicine? I think from stage 2 to stage 3 today, not moving as fast as it should because it requires sharing power. Again, I go back to these unwritten rules. The unwritten rule in medicine is that the doctor is the expert and the doctor tells the patient what to do. In the exam room, physicians will listen for about 11 seconds before they interrupt the patient. And understanding that if we can't get to a shared place.

Why are chronic diseases, which account for 70% of both deaths and medical costs in the United States today, so prevalent? Because, they require this shared work. If I tell you, go out and lose weight. That's not particularly helpful. I have to work with you and help you to lose weight. And what will doctors say? I'm not paid for it. They're saying, well, but I don't have enough time to do that. And they're right. So, the solution is to be able to change the system of medicine so physicians get rewarded when they work with patients and achieve prevention, avoid chronic diseases, eliminate or minimize diabetes type II, the type you get at older age, minimize the complications from asthma, be able to control hypertension, the number one cause of strokes and heart attacks and kidney failure. These are tremendous opportunities, but they don't happen until you start to see, as you said in this phase 3, that the patient is as much of a hero as the doctor or has that potential.

I think you're describing what is going to be necessary. I love the Kubler-Ross 5 stages of grief model. Even though Kubler-Ross probably never said it, and it was never meant to be interpreted the way that it is. But to me, what I love about it is that the sciences are, loss of denial invariably leads to anger that leads to bargaining to be able to maintain what you had before rather than moving forward in depression, where you realize, “Oh my gosh, it's never going to go back to where it was.” But, it's this notion of acceptance. I think people misinterpret acceptance as saying, “Oh, it's what I want. It's a desire to say no.” It's reality. And reality and denial are two absolutely opposite and conflicting experiences and emotions.

You raised an important point earlier in our conversation about this intersection of the individual and the world around that person and how the two need to evolve. As I said, right now, I'm focused very much on the ways that it's not evolving and needs to with these unwritten rules and why they need to be broken. If you look at how you get accepted to medical school? Probably that's a very tough thing to do. Only one in every three applicants are able to find a place in an American medical school. If you look at the residencies and the training programs with the highest prestige, that's even more of a select group. How do we do that? We test people on memory. We give them these eight hour examinations that ask a series of arcane facts because you can't test people on common facts. If you want to separate the memory ability, you've got to find the people who can memorize 5,000 to 10,000 facts rather than the ones who can just memorize 2000 facts.

Now, why do we do it? As I said earlier, people don't do things foolishly. There's always a reason. The answer was because for all of history, I'll call it the 20th century, if you want it to carry all of medical knowledge within a £50 backpack, and even then it would be very hard to access it. So memory was a crucial skill. Today what happens? Sitting in the pocket of every physician sits a smartphone. You can look up 90% of the things. You can still memorize them. But that's not the crucial skill anymore. The ability to take data, access data and use data. And yet I'm not aware of any courses in medical school that train people about using these tools rather than telling people, take your smartphone and check it at the door to the exam room. You should have to bring it in there the way you used to bring a pencil or a computer or whatever it was to take to your exam. This is how medicine is practiced, but we still select people based upon what happened in the past.

I was in Spain once and I saw people taking bull’s blood and painting it on the walls. These are the PhD students who are able to be recognized because it started hundreds of years ago, we still retain that and we need to make changes. One of the things that I've suggested is that every 4th year medical student should spend a month in business school, learning the skills. How do you create a team? How do you motivate people? How do you find opportunities to use technology? These are skills that are taught, as you know, in business schools in the first semester. And yet these are skills that doctors often don't acquire because they're so busy memorizing all these facts. How do you communicate? What we know is that the majority of patients, when they leave with a complex set of problems, when they leave the doctor's office, don't know what the doctor is talking about. They give you 8 or 10 medications. How likely are you to be able to remember to take them, to be able to remember which ones are twice a day? We don't learn those skills. We define the job as telling you what needs to happen and then, I also think about the evolution across time.

In the past, the biggest challenge for medicine was that we didn't have the ability to take care of disease. We didn't understand the basis of disease. The problem today, we have too many options. We need evolution and change and that requires humility. It requires the ability to use data analytics and artificial intelligence. It requires the ability to acknowledge the limitations of what you can do and to bring in others who are able to add expertise. These are the skills that are going to be required.

The biggest problem to me is the knowing, doing gap. We know the things to do now. We don't necessarily do them. We know the ways to keep patients healthy. We don't help them to necessarily accomplish that. You're absolutely right. Medical education is now left over. It's still painting that bull's blood on the wall when it should be using 21st century tools to be able to help patients, to be able to have a healthier life and to confront limitations. This is a hard one, end of life. We have the ability now to extend life so far that we lose the line between treatment and torture. We need to be able to have those types of honest conversations, not imposing our values, but being able to bring out from the patient, his or her and the family's values to be able to have the conversations. There may be sadness, but there won't be regret.

I appreciate that very much. I do believe that if we did that, we would have a much more compassionate, empathetic and higher quality. It's interesting to me how often doctors will go around a system to get care for themselves and their family. The right answer, obviously, is to change the way the care is provided.

My first book, “Mistreated.” While we think we're getting health care, we're usually wrong. I talk about four pillars, and I think it's these pillars that we need to be able to build into medicine today and they don't exist. We need to get past the fragmentation of today. American medicine is very much like a 19th century cottage industry. Doctors working alone, hospitals being separated. How do we bring people together to collaborate, to coordinate? We need to change the way we pay them. We pay them on a piecemeal basis. We call it a fee-for-service. The more you do, the more you get paid, whether it has a value or not. No one ever actually really measures. You don't get paid more for helping patients significantly better than doing something that adds minimal or no value at all being in place. The system of payment today doesn't reward doctors for prevention, only rewards them for intervention. It's not that physicians intentionally will do something in a negative way, but as you know, I teach in business school, you're in the business, incentives drive behavior. We use technology left over from the last century. Although really, it's hard for you to imagine this. The most common way that doctors communicate is with the fax machine, an 1834 invention. My students and your students have never heard of a fax machine or seen a fax machine, but that's how the medical profession is. We think of it as being so cutting edge and advanced that sends vital information back and forth and a leadership structure.

Physicians are not very interested in being told what to do. Having someone else be able to create that. When you teach in a business environment, I challenge you to tell me about another industry. A business that can be successful, that is so fragmented that it's paid on a piecemeal basis which uses technology that’s outdated and has no leadership structure capable of making these types of decisions and making operational improvements. That is the American healthcare system. I think that what we get, being twice as expensive as almost any other nation in the world for care that lags, is an inevitable outcome that I spoke about in the piece that you're talking about.

You're describing something that is very important, which is that it's not either or it’s at. It requires that we use the best of 21st century Western medicine, but that we not lose the other parts. I wouldn't want someone who's having symptoms to change their diet before they've had it checked out. But I don't think that just because medicine doesn't have something that can be offered, there are no other ways to address what's going on. Actually, people at the University of Wisconsin have looked at the impact of various aspects of care on one's health, and only 20% related to what happens from doctors and hospitals. The biggest one actually comes out of your social environment. Whether you have access to housing, warmth, education, jobs, a good community, safety and lack of discrimination. The next big piece comes out of the things that you're able to do for yourself. There is a piece of genetics. Then finally, actually what happens in the physician area.

What we know is that there are major opportunities around diet and people who are able to change their diet, which is not easy, are able to better manage their weight. They have far fewer chronic diseases and within the diseases that they have, they're going to have far fewer complications as a consequence. Our bodies are designed to exercise. You can walk, you can run, you can swim and you can bike. There are a lot of things you can do, it really almost doesn't matter. But if we allow the engines to not be used, they're going to end up rusting. We know that meditation, yoga, relaxation, these are things that we need. Sleep, relationships, all these pieces that doctors see as somewhat irrelevant, intangibles. It can't be studied exactly through a scientific piece.

The first CEO in Kaiser Permanente before me was a gentleman named Dr. Sidney Garfield, and he said, “What we need is a health system, not a disease system.” And we have a disease system. You have a disease? I will do something for you. You have an elevated blood pressure. I give you a drug. Everything is A to B, and what you're describing is a much more holistic piece sitting in place. I think if we could address the nutritional issues, the lack of exercise, and the other positive benefits that come from it, the need to relax, the need to align our bodies and do many of these things that the ailments, lack of health, in many ways often the lack of fulfillment would go away. People say, “I don't have enough time.” And somehow when we have disease, we find the time.

The opportunity, I believe very strongly, is around prevention and being able to take care of ourselves, but also not ignore the things that medicine does know and can add tremendous value around.

I love your five facets, if I can call it that. But as I listen to you, if I had one thought that would be helpful for listeners and viewers is that, sitting in the way is fear. The fear of change inhibits growth. The fear of rejection inhibits love. You can go down the entire list of things that sit in play. Fear is an emotion that is very human, particularly when it comes to your health, your life, or disease. All the problems that sit there. But getting beyond that fear, I think, is what we need to do. We need to do it as patients. We need to be able to ask the hard questions. We need to do it as providers of care. Tell the truth sitting in place. And we need to do it as a profession.

I talk in my book about Christopher Wren, the architect designing the cathedral in London, about how the bricklayers, the first level of bricklayers were doing a job to support their family, and the second one were doing the job in order to fulfil a contract. The third one was doing the job in order to build a cathedral to the greater good to God. It is the same thing in health care. It starts as a job, then it moves on to a career. But ultimately it has to become a purpose, as you say at the end.

I think we're afraid that somehow if we commit to doing our purpose, we won't be successful. So we aim low. I encourage everyone, both as a patient, as a provider of care, as a doctor or as a nurse, as everyone in the health care profession, to aim high. Don't be afraid. You can accomplish and your patients can accomplish far more than you ever imagined.

I thank you so much for having me in your show today. It's been wonderful to hear about your book and your ideas and to see how well they mesh with some of my own. Thank you.

My pleasure. Thank you.