Why the Future of Healthcare Will Require Unlearning
Health.Inspired Talk -- Jack Uldrich
Futurist Jack Uldrich bends minds and pushes us toward wisdom through unlearning what we think we know about health care. Find out how challenging our assumptions can lead to better treatment.
Good afternoon. In the next couple of minutes, I hope to make you wiser, and I hope to do this without teaching you anything. I am, however, going to ask a couple of questions, and this idea is not really a new one. In fact, it’s thousands of years old. There is a famous quote from Lao Tzu, a famous Chinese philosopher, who said to attain knowledge, add things every day. To attain wisdom, subtract things every day. And that’s really what unlearning is all about. And to demonstrate why we need to unlearn, I’m going to begin asking a series of questions. The first question is this: I want all of you to think what two colors are the Yield sign? Take a minute. What two colors are the Yield sign? And if you said yellow and black, congratulations, as most people over the age of 40 do, but that is the incorrect answer. The correct answer is red and white, and the Yield sign has been red and white since 1971. Now I know that some of you are thinking, “No way. That is not the case.” Yes, it is. In fact the first Yield sign you’ll see after you leave will be red and white. And I know that some of you are saying, “Well, in my rural area, they’re still yellow and black.” No, they’re not. But it’s this idea that, look, many of us learned Yield signs were yellow and black way back when we were in driver’s ed. We also learned things early in our career, early in our education, that were in fact true but the world passes us by, and it changes. And so I have some bad news for you. Those of you who said the Yield sign was yellow and black, this is in fact what your brain looks like today. [Image on screen of man in 1970s attire. Laughter from audience.] Now this is kind of a funny example but I have another question for you, and I ask a lot of people, well, what causes ulcers? And a staggeringly high number of people say ulcers are caused by stress and spicy food. That was conventional wisdom. We had heard that for years. But for 25 years, we have known that ulcers are caused by bacteria. But this isn’t just average individuals who thought this. When Barry Marshall first discovered that bacteria were the cause of ulcers, he went before an august group of ulcer experts, and he was laughed off the stage. He came back the next year and was booed off the stage. Why? Because the ulcer experts knew how ulcers were caused. Well, they were wrong, and it took them a decade and a half to unlearn that idea. In fact, it is a fact within the health care community that from the time an idea has been identified as a best practice, it takes 17 years to work its way through the system and become adopted as conventional wisdom. So, in order to prosper in the future, we’re going to have to unlearn. And let me just give you a couple of other examples. I’m now going to ask you this question. I want all of you to think of a Roman numeral watch. And I ask my audiences, what does the Roman numeral one look like? And they say, it’s a capital “I” and two, two “I’s” and three, three “I’s” – and the four? They say it’s an “I” and a “V” much like this picture. Well that is wrong. Any of you who have a Roman numeral watch, the four is not an “I” and a “V.” In fact, four capital “I’s.” And people have looked at their watches for years and never noticed this simple fact. What does this have to do with unlearning and health care? Well, one of the things we have to unlearn is the idea that, you know what, going to the doctor isn’t always the best thing. In fact, one-third of our health care costs could be eliminated if people would just give themselves a little bit of time. So let’s just start seeing what’s already in front of us. We like to think we see what’s in front of us, but we often don’t. Because this is after lunch hour, I want everyone to stand up with me. We’re going to stand up and get the blood pumping. I want you to watch what I do, okay? [Speaker demonstrates.] Everyone put your hands out, clap them together, flip them over. Take your right hand, put it over your left thumb. So now I want you to clap your fingers together. So, if you were all watching closely, you should all be able to do this. How many of you can do that? Or, are you locked up? You can sit down now. So even when we see things, there are certain things we are missing. And we always have to remind ourselves of this. And one of the things that we are not seeing, or we’re not good at seeing, is new signs. Just this year, a study came out that said that with 20 minutes of training, individuals can learn to meditate and reduce their pain level – the equivalent of morphine. Doesn’t that sound almost impossible? But it is happening. But people don’t pay attention to what they can’t see, but they have to start listening and seeing these things. Why? Because chronic pain in the U.S. is a $6 billion a year issue, and we might be able to solve it quite effectively with very little money, but first it requires us to perhaps unlearn some things. So now I want you to look at this visual* and I want you to look at the vertical sequence and it’s numbers. If I asked you what is the middle number, you would say, “Well, it’s 13.” But if I were to ask you to read it horizontally, the letters, you would say, “Well, it’s the letter “B.” And what this reminds us is that depending on your perspective, you see the world differently. [* Visual on screen:] I2 AI3C I4 This is really rampant in health care because do you know what the single largest indicator of health care treatment is? It has nothing to do with your history or your ailments. It has everything to do with the background of the specialists themselves. Think about this. If you have back pain, if you go to an orthopedic surgeon – surprise, surprise! – they’re going to recommend surgery. If you go to a chiropractor, they’re going to recommend something else. If you go to a homeopath, something else. We like to believe that people see the world, and then believe what they see but that’s not the case. Often they see what they believe and patients have to remember this that when you go to specialists. So now, the next question is this. Are you more likely to get killed in a crosswalk or while you’re jaywalking? It might surprise you to know you’re more likely to get hit while you’re crossing a crosswalk. And you’re safer jaywalking. Doesn’t that sound counter-intuitive? Well, here’s the mistake people make because they assume that those white lines protect you. But counter-intuitively, if you’re taking some small risks, you’re a little more vigilant. So, it’s actually safer to jaywalk than it is to walk across the crosswalk. I now want you to keep this analogy in mind because with prostate cancer and mammography we have been led to believe that more testing is better. It feels safer, but it is not. It’s a very counter-intuitive idea but the science is backing these up. For example, if you have prostate cancer, there is a small probability that if you have it tested, you will live a slightly longer life. There is, however, if you have the treatment, there is almost a 50% chance, if you are a male, you are going to lose use of a very important organ. It might seem risky but you just want to understand the consequences. So here’s another question I have. All of you have already made an assumption about me, and the assumption is this. You assume that I need these glasses and you assume that they have glass in them. But they don’t. In fact, I don’t need them, but it goes to show that we are constantly making assumptions. And one of the assumptions we make is that doctors – health care providers – know a lot more than they actually do. This is not to say that they’re not intelligent and well-intentioned. They are, in fact, both of those things but they don’t know everything. Earlier today I was talking about the explosive growth in genetic testing. Well, it has been documented that 98% of all health care professionals admit they don’t know enough about this genomics revolution. And what this then manifests itself in is that less than 1% of best of care – the care based on genetic testing – is actually being provided. We assume the people trusted with our treatment know everything. They don’t know everything, and we have to start being open to that idea that they’re not perfect. This question and answer are going to surprise a lot of people. I often ask my audience, in general terms, why does it get hot in the summer? What happens in relationship to the earth and the sun? And they asked every graduate of Harvard University this question a few years ago, and a staggering 98% of Harvard graduates gave the wrong answer. They said, in general terms, the reason it gets hot in the summer is because the earth gets closer to the sun. Now intuitively, that sounds right. I mean, if you step close to a fire, you’re going to get warmer, but it is wrong. It gets hot in the summer why? Because the earth tilts. We learn this in fourth or fifth grade but our intuition over time overrides science. So we have to start questioning our intuition. And we now know the science documents this that it is riskier to text and drive than to drink and drive. I’m not advocating either, but I just want you to know that it’s actually riskier when you’re texting and driving. Here’s another thing that might surprise a lot of people. Do you know what the third leading cause of death is? After heart disease and cancer? It’s hospitals themselves. The third leading cause of death. That if you go into a hospital, there is a chance that you are actually going to come out less well. Why? Because of infections, because of bad surgery, because of errors. We don’t like to acknowledge that but it is a fact, and we have to start seeing these things. But unlearning also requires us to fundamentally see the world in a different way. A couple of years ago, some psychologists showed this slide to a group of westerners – Americans and Europeans – and said identify the characteristics of that lead fish. They said, “Oh, well, that’s a leader.” They showed the exact same picture to a group of East Asians, and they said, “No, that’s a social outcast.” It’s the exact same picture but perspective matters. And this has a lot to do with health care in this sense is that in certain provinces in China, do you know how they pay their health care providers? They pay them for every month you stay healthy. Well, your incentive, you want to stay healthy, they are then aligned with the physician. But in the West, for the most part, you get sick and then you pay for services. It’s actually in hospital’s interest that you actually have more procedures. That we have to start seeing the world differently, and unlearning is an important and critical component of that. So now, I’m just going to wrap up with a few questions. As soon as you recognize what’s wrong with this card, I want you to raise your hand. In the interest of time, it takes most people about 30 seconds to recognize, well, it’s a spade but it’s red. If I would have told you, oh, would you recognize a red spade before I showed it, you would have said, “Oh, yeah. Of course I would recognize that.” Well, that’s not the case. When our way of the world has been so conditioned to see something one way, even after it’s changed, we don’t see it. We try to fit the old paradigm into the new, and we are missing extraordinary opportunities. One of the things we all have to start unlearning is that the power of social networks is absolutely extraordinary. This idea that there are individuals who are not professionally trained health care providers can know something about your health condition if they suffer from the same thing. In many cases, they are just as smart and know more information than even the best health care providers. So social networks are providing average citizens a whole host of new, and in many cases, high-quality information. But the final question is this. If I were to show you this picture of the world and ask you what’s wrong with it, what would you say? You would say it’s just upside down. Well, here’s what’s really strange is that it’s not upside down. Think about this. From outer space, there is no North, South, East or West, and yet we never see the world from this perspective. NASA never even takes a picture from that perspective. They do, however, train their astronauts to see the world this way. Why? Because they recognize it’s just as legitimate a way to view the world. My message to you is one of the things we have to start seeing differently is this idea of do you know what the most underutilized resource in health care is today? It is you. It is the patient themselves. They are the source of incredible knowledge. They know what ails them. We have to start having real partnerships with the patient and the health care providers, and if we do that, we’re going to have an extraordinary future. With that, I just want all of you to stay humble and keep on learning. Why? Because the future is going to increasingly require it. Thank you very much.