Salus Health Care Forum July 2, 2025

Jeremy

There was an experience that Mitch shared with me. Mitch does some work with our residency program, and engages in wellbeing discussions with the residents. One day he talked about resilience. The three residents raised their hands and said, “That’s a triggering word for me”. And he was like, what? And they explained, “Well, I keep feeling like everybody’s telling me I have to do something to change how well I’m feeling. And I feel like the health system is a mess and nobody’s talking about that.” They felt harmed. Exactly as you were saying, Craig, I told them that resilience and wellbeing are manifestations of community, not necessarily individual manifestations.

And so, Craig, it’s great to hear you reflecting that perspective. I think that’s a grossly misunderstood term because a lot of doctors get told, you need to meditate and you do. There’s something wrong with you. That’s why you’re burning out. And that may be true, but as I understand it, most of the research shows that two-thirds of burnout are systems issues and only a third are individual. So thank you for sharing that, Craig, because that’s a super important term, even for the community of healthcare.

Bill G

Well, the other overlay on this, Jeremy, concerns your clinical practice. You’re sensitive to the social determinants of health. Presumably, you include some aspects of that in your clinical interviews, but it is looking back at the person’s life. And so is it sort of like BRCA, where you say, well, you’re at very high risk for going down from a bad cancer, or it appears to me from my clinical investigation that you’re very fragile and you should be aware you’re very fragile and I expect you to have a mental breakdown in the next five years. It’s kind of like, what do you do with this clinically? I think that’s part of the frustration because we’re looking way back in a person’s life, which seems to have significant predictive value about fragility and resilience. But do you set up a fragility registry in your EMR? I think that’s part of the frustration. It’s just that we accept this conceptually, but when you’re dealing with an individual human being in front of you, how do you speak to them about their risks and your prediction of how that’s going to affect them?

Mitch

I think what Craig has been talking about is very important regarding lifestyle and overall health. And if we don’t address it, then I think problems continue to happen. I think it’s really important to talk about the community and the individual regarding resilience and the effect of AGEs on people overall. So, I think you can’t leave it out. It’s part and parcel of the whole. People aren’t sleeping and their cortisol is up, and then their diabetes is worse, and they’re not sure why. And then they’re nervous, then they’re not going out and then they’re not making connections.

I think it’s part and parcel with overall metabolic problems that we’re seeing the disease from. And this is just part of that, a big contributor.