Gary Oftedahl: More Forks in the Road
From DIAMOND to Denver, a week of transition, was written while sitting in a hotel room in Colorado, pondering the potential future paths in my personal and professional journey to support the transition in health care. It’s now two weeks later and I’m sitting in a hotel room in San Diego, looking back at those blog comments, and realizing one thing–I must stop writing in hotel rooms, they seem to have a strange effect on my thought processes.
You’ve likely gathered from my past posts that while there’s much uncertainty in my mind regarding the future of health care, it is imperative we continue to focus on moving toward a whole-person approach, and begin to eliminate the artificial distinctions surrounding mental/behavioral health and the traditional medical model.
I’m attending the national conference put on by the Collaborative Family Healthcare Association (www.CFHA.net). The focus of this organization, in existence since 1995, is using a collaborative approach to integrate behavioral health into the health care system as a basic fundamental trait. It likely is an organization once ahead of its time, but now finding its time. While having been involved in health care for more than 35 years, I only became aware of this organization a year ago.
I had the distinct pleasure yesterday of co-presenting a workshop on “Vertical Collaboration” with Dr. Frank deGruy (President of the CFHA, and a leader at the University of Colorado), and a colleague from the University of Minnesota, C J Peek. It focused on the types of approaches and underlying principles important in addressing regional issues, manifested by the DIAMOND initiative in Minnesota. Many in attendance seemed intrigued by references to methods, philosophies and principles useful in collaborating to address complex issues.
I reference back to the dualism advocated by Descarte, and the need to continue to challenge the ongoing efforts by many in the health care system to demonstrate the validity of his ancient but well-articulated concept–which as far as I can tell has little evidence base, but a strong emotional and philosophical contingent. One could suggest that we in health care have done our best to prove his thesis, through the separation of mental/behavioral health from the medical elements by professional approaches, and supported by reimbursement issues, “carve outs”, and multiple other attempts to create an artificial set of distinctions.
It’s time to change. This approach likely is a great representation of Einstein’s definition of insanity–trying the same thing over and over and expecting different results. We need to redouble our efforts to integrate these totally artificially created worlds. Humans come as a single complex package, not neatly compartmentalized into boxes of opportunities. They need attention in many spheres at the same time–quite difficult in our present system.
Therein lies the rub. While many may see a path for accomplishing this, I see a set of paths, some leading to dead ends, some leading to other paths. There’s no clear map to move us in a definite direction. I find myself talking with people proposing a collaborative care research network to forward the integration of mental health into primary care (CCRN), groups advocating for the patient-centered medical home (PCPCC-Patient Centered Primary Care Collaborative), being part of advancing DIAMOND in Minnesota, and considering how this will lead us forward, understanding how to involve patients in decision making, engaging citizens in the development of the health care system, etc.
What’s clear is–it’s unclear. Much like a maze, there will be many paths taken which lead to a dead end. But somewhere in this series of opportunities lies the chance to advance our learning. Personally, I think the DIAMOND initiative in Minnesota has not only advanced our thinking in depression care, but it has also begun to help us understand how and what it will take to nurture regional work at a scalable level. That’s my narrow lens on the world–I’m open to refraction if someone wishes to assist me.
I have hope. And I believe that now as opposed to years ago there may be a confluence of thinking and opportunity of which we must avail ourselves. The energy and passion of those whom I’ve met in the past few weeks, added on to the knowledge and commitment of others from past encounters, is encouraging. But in the words of that noted baseball Hall of Fame catcher, and worldwide philosopher, Yogi Berra–”When you come to a fork in the road, take it”.
We’re at an intersection with many forks, the signage is typical of health care (quite unclear), but rather than traveling alone, there’s now an evolving group willing to move this forward. We’ll make mistakes, we’ll likely be criticized, we’ll likely not even be around when the destination is reached, but it’s the thrill of being involved, in creating a new world, of taking on the traditional models which need revamping. As Frank deGruy says, we need to keep our eye on the “pole star” or for those of us from Minnesota, the North Star. But let’s take the journey together. Will you join in this yet unclear travel, and move beyond the fork in the road?