Dr John Mendelson of Ria Health: In Light Of The Pandemic, Here Are The 5 Things We Need To Do To Improve The US Healthcare System
Privacy — This will be controversial to some. We protect a lot of information that does not need to be protected. Bet you didn’t know that emails are considered a security risk but faxes — with paper exposed in trays — are considered secure. We secure your record but, sorry to tell you, no one cares what your cholesterol is or what your flu symptoms were. But all financial details and pharmacy records are widely shared. We need privacy for some things — like socially stigmatized diseases but not for at least 90% of what’s delivered in medical settings. The current rules make basic communication difficult and don’t really protect anything.
The COVID-19 Pandemic taught all of us many things. One of the sectors that the pandemic put a spotlight on was the healthcare industry. The pandemic showed the resilience of the US healthcare system, but it also pointed out some important areas in need of improvement.
In our interview series called “In Light Of The Pandemic, Here Are The 5 Things We Need To Do To Improve The US Healthcare System”, we are interviewing doctors, hospital administrators, nursing home administrators, and healthcare leaders who can share lessons they learned from the pandemic about how we need to improve the US Healthcare System.
As a part of this series, I had the pleasure to interview Dr. John Mendelson.
Dr. John Mendelson is a Board Certified Internist with over 30 years of research and practice in the field of addiction treatment. He is committed to evidence-based treatment for addiction, and has dedicated much of his career to researching new options and expanding access to care. Dr. Mendelson’s work has been widely published, and he has earned international recognition as an expert in his field.
Thank you so much for joining us in this interview series! Before we dive into our interview, our readers would like to get to know you a bit. Can you tell us a bit about your backstory and a bit about what brought you to this specific career path?
My dad was an academic psychiatrist interested in addiction. He worked all of the time so the one place we spent time together was at national and international meetings of addiction scientists. Eventually I became hooked on the science and developed an independent career in addiction research.
Can you share the most interesting story that happened to you since you began your career?
There is at least one interesting story every day. But here is a memorable one: I was seeing patients in my primary hospital when the 1987 Loma Prieta earthquake struck. After the shaking stopped a few of us went down to the ER to see what was happening. It was quiet with no alerts from the City — but then an ambulance arrived with 7 patients, all with mild-moderate trauma. We then realized that EMS had lost communications and that a disaster was unfolding. The Chief of Staff asked if anyone knew the disaster plan. By chance the week before I had been in a meeting where the plan was reviewed. I told the Chief and he appointed me as Chief for the disaster on the spot. We went on to treat more patients than any other SF hospital that night — and knowing the plan really helped make everything go smoothly.
Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?
One time I had a patient in the exam room at my office, and several patients in the hospital. It had been a very busy and long day. I thought I was all done seeing patients in my office, so I ran over to the hospital to see my hospitalized patients. But I had missed one patient in the office, and when I came back 2 hours later, he was still sitting there. Boy was I embarrassed.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
The relationship between authority and responsibility — can’t be authoritative unless you’re responsible and cannot be responsible unless you’re authoritative.
Or on a lighter note — 3 A’s of success: availability, affability and ability (in that order). But ability is always last.
Are you working on any exciting new projects now? How do you think that will help people?
Always working on interesting projects. I have been fortunate to be involved in many projects, some of which were spectacularly successful. I was part of the team that developed buprenorphine-naloxone combinations for treating opiate addiction. I was one of the first investigators to study the human pharmacology of MDMA, which is advancing as a treatment for PTSD. I lead an ultimately unsuccessful effort to develop new treatments for methamphetamine addiction.
Ria Health consumes all of my energy now. Ria Health has the potential to decrease the toll of alcohol abuse and addiction, the 7th leading cause of death and the 2nd leading cause of life-years lost in the world.
How would you define an “excellent healthcare provider”?
Professional, knowledgeable, and personable. You have to treat the person as well as the disease. No two people are alike. In the case of AUD, some people respond really well to total abstinence from alcohol. Others aren’t willing to do that, and that’s ok. The key is to offer options. If we can decrease heavy drinking days through a combination of medication and therapy, we can see tangible health benefits that improve the quality of life and overall health of a patient. The point is, take the time to understand the person, not just the ailment.
Ok, thank you for that. Let’s now jump to the main focus of our interview. The COVID-19 pandemic has put intense pressure on the American healthcare system. Some healthcare systems were at a complete loss as to how to handle this crisis. Can you share with our readers a few examples of where we’ve seen the U.S. healthcare system struggle? How do you think we can correct these specific issues moving forward?
I don’t think anyone was at a complete loss — thankfully there were and are disaster plans that were implemented and the US healthcare system was mostly able to provide hospital care for everyone who needed it. Unlike Italy, we never had people dying in the streets next to the hospital. However — it was an incredible struggle. All levels of the healthcare world needed to drop business as usual and learn how to treat a new disease while still treating everything else. This will not be the last pandemic or mass health catastrophe. I have not been involved in any formal planning processes to address the likely threats we face. But here are some ideas:
A renewed emphasis on disaster planning and training. We need to train and plan better. A big part of that planning is a need to develop health literacy that decreases the ability of partisans with other agendas to derail evidence based health programs. To do this we needed messaging and leadership that is usually not found in the public health sector. These could be politicians, entertainers, religious, industry and academic leaders who understand how to motivate people who do not share the same world view or experience. We need to learn from others who are adept at reaching everyone.
Of course the story was not entirely negative. Healthcare professionals were true heroes on the front lines of the crisis. The COVID vaccines are saving millions of lives. Can you share a few ways that our healthcare system really did well? If you can, please share a story or example.
My wife is an MD PhD Anesthesiologist at UCSF. UCSF built a system that treated everyone who needed it and protected the people who delivered care. Everyone pitched in and worked hard. One mission of a medical school is to train new MDs. Because COVID is so contagious with no specific treatment, acute COVID care was done only by senior physicians with the most experience — not by residents and medical students — there were special wards that only managed COVID cases. This led to better care with less risk to most medical staff.
Here is the primary question of our discussion. As a healthcare leader can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.
1. Access — We need everyone covered by some form of insurance.
2. Equality — All insurance products need to offer the same basic level of care. Right now the most unequal care is provided through MediCaid — which is chronically underfunded, leading to real limitations to care for MediCaid recipients.
3. Innovation — The NIH funds primarily basic research, the pharmaceutical industry funds clinical research. Hence, most innovation is driven by basic science discoveries becoming pharmacotherapies. We need more innovation in delivery of care and technology.
4. Bureaucracy — Doctors and nurses spend an inordinate amount of time working the electronic health record. Every day someone adds more items to the charting workflow. But more clicks does not equal better medicine. We need to reduce all levels of bureaucracy.
5. Privacy — This will be controversial to some. We protect a lot of information that does not need to be protected. Bet you didn’t know that emails are considered a security risk but faxes — with paper exposed in trays — are considered secure. We secure your record but, sorry to tell you, no one cares what your cholesterol is or what your flu symptoms were. But all financial details and pharmacy records are widely shared. We need privacy for some things — like socially stigmatized diseases but not for at least 90% of what’s delivered in medical settings. The current rules make basic communication difficult and don’t really protect anything.
Let’s zoom in on this a bit deeper. How do you think we can address the problem of physician shortages?
More medical schools, more residency slots for forign medical graduates, more immigration. We need to increase the number of US medical graduates to keep parity with population growth — the US population has increased by ~30% over the past 30 years but there are less than 10 new medical schools and the number of graduates has increased by <10%.
How do you think we can address the issue of physician diversity?
Please see the answer above.
How do you think we can address the issue of physician burnout?
Address the burdens of practice, which are now due to bureaucracy more than anything else.
What concrete steps would have to be done to actually manifest all of the changes you mentioned? What can a) individuals, b) corporations, c) communities and d) leaders do to help?
If you want a doctor years from now you need to start growing them now. That means focusing on physician education. Corporations can insist that some of their premium dollars go to expanding teaching. Communities can build medical schools. Leaders can develop and operationalize plans.
You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)
I am already walking the walk. I founded Ria Health to improve access to safe, effective and affordable care for alcohol addiction. Ria encapsulates many of the trends of the future. We see patients virtually, use technology to track outcome measures, use a collaborative care model where coaches, nurses and doctors work together to deliver care. Our model costs less and, we believe, delivers better outcomes than available options. Ria is a product of collaborations between expert physicians and technology developers. I predict this model will become as important and transformative as the collaboration between physicians and pharmaceutical scientists.
How can our readers further follow your work online?
Ria Health social media channels
Thank you so much for these insights! This was very inspirational and we wish you continued success in your great work.