How "science fiction" may NOT be fictional: The future of health care

We sponsored a "science fiction" writing contest - asking writers around the globe to envision health care in 2100. The results ... stunning. Moving. Scary. And yes, they may not be all that fictional. Science fiction allows us to suspend disbelief while we encounter truth - truth we can accept when it appears to be somewhere in the distant future. But if you read these winners, that future is not distant. And how that future is shaped, depends on what we do now.

The contest winners are here: https://www.jefferson.edu/2100HealthOdyssey.html#modal-221489

Why did we do it?

Science fiction has been a huge part of my life. I was a teenager in the late 60s. I looked forward especially to Friday night, because I watched Time Tunnel at 8pm, and Star Trek at 9. Now there are two things you can infer from that. If at 16, I was spending every Friday night watching Time Tunnel and Star Trek: a) I had no friends, or b) I loved science fiction. I’ll leave it up to you. But I learned a lot from those shows.

I learned from Time Tunnel that if I really went back into time, and I didn’t stutter when I first met Diane Sharp, and she actually accepted my invitation to the prom, that probably would’ve totally messed up the time space parallax and the whole universe would’ve changed. So it made me feel a lot better that I never did that.

I also thought that maybe someday if I ever became Captain Kirk I could just say a few inspirational words and everybody around me would scurry around and do exactly what I said. Sadly, I have since learned that this doesn’t happen, even when I try, as Captain Picard would say, to “Make it so.” It took me 160K in tuition at Wharton to realize there’s a lot more to leadership than that.

And speaking of Wharton - Wharton in the 1990’s was a very analytic MBA program and while other students were doing their thesis on hyperinflation in Argentina or how Marxism and monetary theory go hand in hand, I did mine on the difference in management styles between Captain Kirk in Star Trek, the original series, and Captain Picard, in Star Trek, The Next Generation.

The dean at the time, Tom Garrity, asked me if I was kidding. Well, no. I turned it in. You can do something really weird, as long as it’s done well. And the spoiler alert is Captain Kirk was a visionary leader that didn’t like to manage, and Captain Picard was a great manager that didn’t like to do all the visionary stuff.

Then I fell in love - along came Star Wars. I watched the original Star Wars 10 straight times, on 10 straight days in the summer of 1977. In case you thought I grew up, for my 65th birthday I invited my son and we watched all 9 Star Wars over 2 days. But I learned so much then that has led me a lot to where we are today and I would argue that led to my success and our success at Jefferson.

This is what I learned from Star Wars: That age, color, and gender don’t matter when you’re trying to save the galaxy. Women, men, and even unexplainable species were essential and the deciding factor was the direction of the force and the willingness to be of service. The one lesson I always remember is, Do not let impossible odds hold you back. Do you remember that one? C-3PO, they’re going through the asteroid field. “Sir, the possibility of successfully navigating the asteroid field is 3,720 to 1.” Han: "Never tell me the odds.”

Never tell me the odds.

I learned that you should always have 5 people under you that think they can do a better job than you, and 3 that are right. In Star Wars, whether it was Droid or Chewbacca or Han the rouge loner pilot, Luke and Obi Wan surrounded themselves with a smart, independent and sometimes stubborn family that could fight it out but believed in the rebel alliance. Come to one of my cabinet meetings and you’ll see that.

Then I learned that sometimes it’s better to regroup if things aren’t working. There was a great C-3PO quote when R2 was getting beat up by the Wookie. "I suggest a new strategy R2, let the Wookie win."

But the most important lesson I learned was from Yoda, and you all remember this, “Do or not do, there is no try.”

It’s essential that we believe, or that lack of belief will create failure. As I say in every talk I give, healthcare delivery has underperformed. We certainly have Star Wars technology in how we handle individual patients, but we have a Fred Flintstone delivery system. Frustratingly, we do a lot of things, and end up in the same place. I won’t use science fiction, I’ll use an NBA quote. When Jason Kidd went to the Dallas Mavericks he said, “I’m gonna turn this team around 360 degrees.” In health care, we do a lot of turning things around 360 degrees.

I truly started applying science fiction myself at the beginning of my academic career. I started my career as a DJ, and then I started an OB-GYN practice, and eventually got into academics. In 1997 I started a company using Sharp. If you remember, the company Sharp had PDA’s to collect OB-GYN residency data, and the Council for Resident Education, CREOG, and the American College of OB-GYN, ACOG, asked me to give a mainstage presentation in Dallas. I’d never done anything academically and back then, but I knew I didn't want to populate slide carousels.

I created a Star Wars movie called Independence Day, Educating Residents to Seize the Future.  I gave all the leaders in OB-GYN Star Wars names. The head of CREOG became Frank Sky Linger. The head of ACOG became OB-GYN Doug Kalowbie. The CPTs became C-3POs. And Managed Care became Darth Vader. It started like this: Not so long ago and not so far away, ACOG, The Alliance for the Creation of Good was threatened by a bunch of bad guys, the MBAs (Make Business All Powerful). The Docs (Doers of Community Service), lived happy productive lives, but now the MBAs began telling them what to do, and how to do it. Led by their leader, Managed Health Care, the MBAs harnessed the dark side of cost vs quality in women’s health care and were about to stage an all-out attack on the residents on the planet of CREOG. The video concluded: Let’s join a small band of freedom fighters working to defeat the dark side and protect mom, apple pie, and the illusive 15 percent C-section rate.

That led to my academic career because it was one of those things where everybody was waiting to see if any of the leaders applauded. In about 15 seconds they all started to applaud and I became part of the team. It also led to the science fiction in such much of the books that I’ve written. My partner in my first two books was Greg Shea, and while Greg wasn’t into science fiction, he’s a professor at Wharton, and he’d talk about the history of the future.

The history of the future mind-map is this: It doesn't work if we think about transformational change happening right now. Whether it is politics or health care, we get tense and say, We can't do that. Look a year ahead, and all we see are budget figures - we can't afford transformation. But if we think about the future, we can put aside today's limits - what would an ideal world look like in 2029?

Most importantly, we can ask: If we are to achieve an optimistic future in 2029, what must we do in 2019, 2020, 2021 to get us there? What can we do today to prepare for the ideal future we all envision? That question lets us get a lot more creative. So that led me to my first book called The Phantom Stethoscope: An Optimistic Guide for the Future of Medicine, which predicted that a woman medical student got abducted by aliens on the day of residency match in 1999. They brought her back 15 years later. Unfortunately, they re-implanted the technical knowledge she needed to practice medicine 15 years later, but none of the business, legal, ethical or social knowledge. So that led the book to outline what we’re not learning in medical school.

The 2nd book was 2 years ago called, We Can Fix Healthcare, where we theorized that President Obama right before he left said, “Hey look guys, I did everything I could.” In that book, we brought together the heads of pharma, healthcare, insurers and everybody involved in the healthcare eco-system. We said: Obama's great accomplishment was the Accountable Care Act, but we know the ACA gave more people access to a fundamentally broken, fragmented, inequitable and occasionally unsafe healthcare delivery system.

When this fictional conference began, we did what we do best. We blamed it on everybody else. Then there was a science fiction event, a blackout and a vapor, where all we could do was look in the mirror and say, "What can I do?" Out of that came the 12 Disrupters for Demise of the Old Healthcare. Here’s what’s fascinating about that, with all the rancor going on politically, Michael Hoad and I talked to the head of Secretary Clinton’s healthcare team, they said, “Yea we agree with 9 of those 12.” We talked to the head of President Trump’s healthcare team and they said, “We believe in about 8 of those 12.” What that means is that if you put aside partisan politics, we could in fact fix health care. And that's why the book is science fiction.

And then my latest book called, Bless this Mess: A picture story of Healthcare in America* Not a children’s story, its scary literally predicted that the U.S. got inducted in 2035 to the intergalactic council of awesome healthcare systems. And they came back because they recognized that in 2019 we were really a mess - the intergalactic delegates were shocked that we'd done so well in the next 16 years.

So this is what I’ll leave you with. The great thing about Science Fiction is anything is possible. Once you free your mind to think that way you’re no longer shackled by a reality that is not working.

Captain Kirk, a Caucasian male, could kiss Lt. Uhura, an African American woman, in 1969 - because it was science fiction. Stunningly, that was the first interracial kiss on American TV. You can be 900 years old, little, withered and green like Yoda and still bench press 350. And while Betazoids can read people’s minds, they can’t reveal what’s in their hearts and souls.

So what I’ve learned from science fiction is if you start to take a no limits approach, anything is possible. I would remind you that Thomas Jefferson University was started against long odds, but for all the right reasons. Our founder Dr. George McClellan was thinking very science fiction when he said, “You know the way medical schools are in 1824 is that you do all your research academics and then you practice on humans. I think seeing humans as part of medical education is a better idea.” We were the first medical school in the country that said seeing humans and understanding humans is going to be important. And by the way that’s lasted 195 years.

We have the first Jefferson Scale of Empathy, we have one of the first in Jefferson's Center for Interprofessional Education. At Jefferson we’re leading the way in augmented intelligence deboarding machine cognition. We’re about to start and I’m really excited about this cause it took medicine about 40 years to get doctors and nurses to work together. We’re about to start the first Center for Inter-Sentient Education, about how doctors and robots can work together in the age of spiritual machines. That’s not science fiction anymore. 

Technology can make our lives better but only if we remember the human in the middle. That brings us to 2001 Space Odyssey. I was obsessed with that movie. I have to admit I might have joined some of the chat rooms: “What Happened to Dave” and “Who Messed with Hal."

But what I took from 2001 Space Odyssey is that in order for us to continue to refresh our humanness we need to reflect on our past, present, and future and that’s why my wife Colleen Wyse and I were so happy to give this gift to spur others' creativity. Because while I don’t ever expect to go back in the past and get Diane Sharp to change her mind and take me to the prom, I’m excited about how Jefferson in the present can look at a future that’s isn’t limited by our self-prescribed limits.

So what I’ll leave you with is a few Star Wars and Star Trek quotes, “May the force be with all of you.”

As Jean-Luc Picard said, “Live now, make now always the most precious time, now will never come again.”

As Spock said, “Computers make excellent and efficient servants but I have no wish to serve under them.”

So this is what I would tell you, healthcare is not that complicated. It’s just that we need to take a creative and science fiction approach of understanding what’s going to be obvious 10 years from now and just do it today. Do or not do, there is no try.

Thank you everybody that decided to take this journey with Colleen and me. Colleen, thank you for reading all those science fiction stories in the contest, and for being my partner in this, and thank you all for contributing to an optimistic future for health care.