Salus Health Care Forum: November 5, 2025

Rich

If I could pick up on that, I think one of the challenges, as you look to redesign health systems, is you have to have a very basic conversation about what you value. I mean, if mortality is the thing that we are most concerned about, and that’s a reasonable thing, certainly, to measure and talk about, then it doesn’t matter where in the world you are and what kind of health system you are in. Eventually, we all end up with the same outcome. We’re dead. And yet, it’s really the journey along the way that, in many ways, becomes more important. I agree with Jack. One of the problems when they look at rural areas is that they don’t really take into account the fact that those living in rural areas tend to be older, which means they are more likely to have chronic conditions. These older rural residents tend to have access issues. And the thing that worries me today is that I see flaws in the solutions that are proposed. We’ll just set up telemedicine hubs and connect them to the big city hospital, which if filled with health care professionals who have no idea what that community is like.

And as Osler reminded us 120 years ago, we don’t take care of diseases. I mean, we do a lot of disease care, but we don’t take care of disease. We take care of people who sometimes have diseases.

And the final thing I wanted to say on the rural issue is that early on in my time at Belleville, that new university rural site, we were part of a roughly three-to-four-year rural development grant that was looking at introducing concepts of community-oriented primary care. We were to more actively engage the community. And these sites ranged from a huge public health department in rural western Virginia, to a tribal clinic outside of Tucson, to a small hospital system in Montana. A pretty wide array. And what was fascinating to me about it is that the principal investigators for this grant were based at the University of New Mexico. All good-hearted, smart people, understood community health well, great folks to work with. But when the group, the 13 sites, would come together twice a year in Albuquerque, we’d get grilled.

Okay, what are your outcomes? And how are you measuring your outcomes? Because they had to have something they could write down. And it just sort of happened over the first two or three meetings that the group nudged me to become the principal advocate or spokesperson for the group. And finally, after they were finished, they finished grilling me because we were the last ones of this particular weekend. I said, You guys don’t get it. The process is the product. You’re looking for biometrical indicators like blood pressure control and heart attack rates, and those are important. But creating a sense of community cohesion and possibility is what’s really important. And that’s the foundation you have to build.

I think our telling times now are more indicative of that than ever before. I mean, the stress that people are under, especially young people, is really quite concerning for me. They are feeling increasingly isolated, despondent. AI chatbots are supposed to take care of that. I don’t think so. We need to find a way to make connection and communication and compassion highly valued attributes of a health system. However, we don’t.