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Even more firsthand symptoms of a broken healthcare system

Posted May 09 2013 8:32am

by Thomas Dahlborg

"You are not going to be a professional baseball player ... "

Jimmy is a player on the high school recreational basketball team I coach, and yes, the orthopedic surgeon who reviewed Jimmy's MRI and who spent a total of 30 minutes over two visits tried to destroy this boy's dream (unintentionally, I hope) to play professional baseball.

I learned of this healthcare encounter from Jimmy's mother and as she relayed these events to me I composed the following letter to this physician in my mind:

Dear Doctor:

  • Do you know Jimmy? Truly know him?
  • Do you know what Jimmy has overcome throughout his life to even get on the ball field?
  • Did you know Jimmy was born with neurological issues to the point where it was unclear as to whether he would ever be able to run?
  • Did you know that Jimmy struggled with childhood obesity?
  • Did you know Jimmy was bullied by both children and parents and is now one of the kindest boys you will ever meet with great empathy for others who are being bullied?
  • Did you know Jimmy overcame all of these challenges and plays and excels in school and at both basketball and baseball, even making the high school varsity baseball team as a junior prior to this most recent challenge?
  • Did you know that years ago while playing Cal Ripken baseball Jimmy broke the thumb on his pitching hand at a play at home plate and shortly thereafter struck out 16 players in a single game while wearing a special cast on his hand?
  • Did you know that Jimmy with this same cast on his hand hit a home run to help propel his team to another victory?
  • Did you know that same year Jimmy came in second place in the league MVP voting?
  • Did you know Jimmy led his Junior Legion team in batting average and power last year?
  • Did you know Jimmy has taught me and many others much about heart, courage, and empathy

Working in quality improvement, I began to take a systems view of this healing encounter and again recognized that as leaders in healthcare we have great opportunity. Great opportunity to adapt the system and better position physicians for these encounters so that care is optimized, clinicians find joy in healing again, and patients are safer and achieve better clinical outcomes.


  • By ensuring we are all aware of the importance of empathy and emotional intelligence in healthcare relationships, which according to studies not only saves time but also reduces patient anxiety, improves clinical outcomes and, by the way, reduces malpractice claims.
  • Once aware, embracing and prioritizing both empathy and emotional intelligence as critical to the success of the healthcare organization--e.g., adapting the healthcare system to ensure hiring practices include measures of each, training programs focused on each are supported, patient experience and satisfaction surveys assess each, and identifying and eliminating all barriers to full acceptance
  • By adapting the healthcare system to provide more opportunity for authentic relationship and connection between physician and patient to establish trust so the patient's whole story can be told and heard.
  • By positioning all who work in healthcare to be mindful and present when evolving the healing encounter (while working at the systemic perspective and level, as well as during each and every healing encounter). Mindfulness is key to the creation of high reliability organizations and improved patient safety. Mindfulness and presence also increase the opportunity for authentic connection and sharing.
  • By creating a culture within healthcare organizations where all clinicians and staff have the opportunity to take ownership and accountability for identifying when the optimal healing environment does not exist and working to improve and change for the better.

Will Jimmy play professional baseball? I have no idea. What I do know is that if it is Jimmy's dream, he will face each challenge with heart and courage, and with the support of many will do his best, learn from the experience and help others along the way.

I also know that as a healthcare leader I will continue to face the challenge of bringing mindfulness, presence, empathy and emotional intelligence into healthcare with hopefully the same heart and courage I have seen in Jimmy.

Dear Doctor:

  • Do you know Jimmy?
  • Do you know the measure of his heart ?
  • Have you heard his whole story?
  • Were you present and mindful when meeting with Jimmy and his mother?
  • Did you practice with compassion?
  • Were you empathetic?
  • Do you understand the type of impact you could have made if you were?
  • Do you understand the potential impact you made because you weren't?
  • Did the system position you to do so?
  • Did the system let you down?
  • Are you willing to evolve, adapt and improve the healing encounter?
  • If you are ... I am willing to travel the journey with you.

With much gratitude for your technical skills and much hope for even more.


A parent, a coach, a healthcare leader, a member of your community

Thomas H. Dahlborg, M.S.M., is chief financial officer and vice president of strategy for the National Initiative for Children's Healthcare Quality ( NICHQ ), where he focuses on improving child health and well-being.

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