Salus June 4, 2025

Jack

I think we’ve, again, focused this on the mechanics of the gut rather than other components of the health care system. Gay had initially talked about referrals and the communication between parts of the health system. This is a great analogy because the gut is very neuroactive. It is an endocrine-based, and chemically oriented part of the body. And I agree that healthcare has lost its ability to communicate with itself. Health care is filled with different proprietary electronic health records. Neither the clinician nor the patient owns their own data. The data is owned by the proprietary EHR company, whether that’s Epic or Cerner or whatever.

I may send a patient to Gay. She may try to communicate with me. Maybe it gets back into my record. Maybe it doesn’t. There’s pseudo-protection of privacy issues. This protection is hampering communication rather than facilitating this communication. So, I think there’s a whole other level that has nothing to do with what’s inside the gut. It has nothing to do with communication done by the gut with the rest of the second brain. It’s an endocrine organ. It has microbiota. It has chemicals that come in and chemicals that go out.  And I think that’s another major piece of what we have lost in healthcare. The barriers of communication are damaging this other work that healthcare needs to do of moving information and coordinating healing processes between the various places and between the people who do the healing. And I would add communication with the faith community.

Jeremy

Wonderful. Jack, just to riff off that a little bit. My sense is that healthcare has focused on the mechanical utility of technology. Meaning that a robotic surgeon is a super cool thing on which we’re going to spend millions, if not billions of dollars. So that the surgeon can be on Mars and take your appendix out. Wouldn’t that be cool? There’s just a huge amount of energy that goes into that aspect of almost superhuman tech. The joke I’ll tell residents is that the ENT doctor can get rid of the earwax, but they’ll use their laser beam to put the Mona Lisa in there–given what they’re charging. They might as well be creating a work of art instead of just using a saline syringe and getting $10, like the family doctors who do the same thing.

The technology is used as a part of what makes things so expensive. Because who knows how much you can charge once a robot’s doing what a human used to do. And yet communication technology is still in its infancy, as you mentioned. It’s being done in a very proprietary, profit-oriented way rather than in a utilitarian way. Unfortunately, primary care is dependent on the nontechnological touch, as is psychology.  I agree totally with Gay. Health care needs to hear from those doctors who are dependent on the human touch.  Gay, a lot of people in your field don’t ever want to acknowledge to the doctor that they saw their patient. Because the privacy and stigma around mental health is so high that I’ve often never been able to get in contact. I’ve called and called and called. The idea of what is safe and healthy communication is unclear to all players in the health care system.

Jack

And when we were doing integrated behavioral health, integrating behavioral health into primary care, there was this whole issue around documentation and charting. And we had to actually use shadow charts because they weren’t allowed to document in the same coding system for privacy reasons. And so we did a shadow chart for behavioral health issues. We entered just brief notes into the electronic health record.