We Must Build a Reservoir of Trust with Big Medicine

Many people are content to focus on their job without concern for their field or industry. Our field has been steadily merging with larger entities in the healthcare industry, making us a small part of a big, costly industry with many parts and little cohesion. “Big Medicine” is a term sometimes used to capture the amalgam of big pharma, big payers and big providers. The overall size can be intimidating.

Healthcare is also troubling due to the basic instability of its economics. Everyone agrees that its escalating costs are unsustainable. A small field like ours need not focus much on high-level solutions to correct this. It would be best to assume that cost-cutting will arrive one day, and healthcare funding will be allocated among many worthy fields. How will decisions be made? Let us start strategic planning.

Our executives must take on our future along with our present. They know our business realities and scientific proof points. They passionately care about our patients and our staff. The stakes are huge. Our field will be properly valued and funded only if persuasive leaders make our case. Building trust is job one. Success will be based less on the factual merit of our case, more on the people representing us.

The politics of healthcare

Education focuses on facts and rational arguments. Business is often driven more by political realities, power and influence. We have little influence in our industry for three key reasons: our small size, the unique nature of our services (both medical and psychosocial), and a history of relative independence from the rest of healthcare. A secure future for our field depends on our gaining more influence.

Powerful businesspeople, like most citizens, hold strong views about healthcare. Many think they know our field. We must know where they turn for information, who they trust, and how we can shape their view of our field as being essential. This approach runs contrary to my educational training which focused on having the best ideas and arguments. Just present the data and let people judge.

Knowledge has become contentious. We no longer seem to have common, reliable sources for facts, and opponents in debate are well-armed with their own experts. The media have called it a crisis of truth. Others refer to it as “truth decay.” Disagreement about facts seems to increase as trust declines in sources of knowledge that were once trusted. Is truth on trial, or are the experts?

Historians of science suggest that the focus should be on the experts. Most people possess little real scientific knowledge. We rely on trusted sources for our knowledge. The question is which sources to trust. Intellectual debate is fine within academia, but the best way to advance one’s field is to focus on the decision makers and their trusted experts. Target them for old-school lobbying.

Advocacy for our field in an evolving healthcare industry

The best model for meeting future funding challenges is how we manage legal and regulatory issues today. We hire lobbyists. We should cultivate similar advocates to focus on big medicine. We are not currently well-positioned with these large corporations and their leaders. Our top executives should lead us by setting aside personal business interests to advance behavioral healthcare as a whole.

Celebrity therapists should not be shaping the public’s view of psychotherapy. Academics should not be shaping public policy. Researchers naively envision a world of empirically supported therapies with therapists strictly following guidelines. Therapists treat real people using all their mental and emotional faculties. Our public image is better left to executives to craft a real, balanced, and compelling story.

Our field needs an association of leaders and lobbyists to represent our common interests rather than our narrow business interests. For example, the APA supports the needs of one professional group, and ABHW focuses on behavioral healthcare payers. Each may care about the field, but there is no organization lobbying for the business of behavioral healthcare in all its settings and functions.

Like any business, our industry wants stable, long-term growth. Yet one grim prognosis for our field is that of a shrinking, isolated specialty. Consider this alternative vision. Our field can be a vital part of healthcare with its outpatient services reconfigured as an integral part of primary care. Our higher levels of care might then primarily stabilize crises as step-up programs. This vision will require funding.

Our leaders should reflect on how we gain credibility and trust within the broader industry. How we integrate with medical care matters. So too does our public image. Disparate voices represent us today, and many are self-serving and untrustworthy. We cannot afford a poor image. Decision makers should see our field as essential and effective. Their trusted sources should be assuring them of this reality.

Ed Jones, PhD, is senior vice president for the Institute for Health and Productivity Management.