Tenet 4: Health 3.0 Balances Part and Whole.

All things are parts of a whole. We find this understanding everywhere from the perennial philosophy of the world’s religious traditions, and the secular Stoicism of Marcus Aurelius, to the transpersonal teachings of Ken Wilber.

In the world of biology, for example, atoms are parts of molecules…molecules are parts of organelles…organelles are parts of cells…cells are parts of organs…and organs are parts of organisms.

The part gives the whole its capacity, while the whole gives the part its purpose.

Pathology occurs when part and whole usurp the roles of each other. When a part claims to be a whole, you’ve got cancer. When a whole dominates its parts, you’ve got tyranny.

Remember the Borg, from Star Trek? Like a part commandeering the whole, the Borg was a cybernetic alien race that went around the universe assimilating other species. Like a whole domineering its parts, the Borg also functioned as drones in a hive mind called the Collective.

So said the Borg:

We are the Borg. Your biological and technological distinctiveness will be added to our own. Resistance is futile.

But uniqueness is not futile. And what’s fascinating is that uniqueness is the key to harmony between part and whole.

Here’s how Marc Gafni in his book Your Unique Self explains right relationship between part and whole:

The mystery is that the more the part emphasizes its part nature, the more highly particularized the part is in its authenticity, the more freely the whole can express itself in the part.

The more unique each of us is, the better we fit into the whole. And the better the whole embodies itself through each of us.

Nature thrives in this balance between part and whole.

Look at a tree. No leaf of a tree looks exactly like another. Each leaf is unique. And yet a set of leaves with their branch mimics the whole tree.

Take the human body. Your specialized cells help make you the miraculous whole being that you are. But a cell becomes malignant when it mutates away from specialization and acts like your whole body. Conversely, if your body wanted all your cells to act the same, you wouldn’t be a human being — you’d be a collection of amoebae.

Medicine can thrive in the same way as nature.

Health 1.0 emphasizes parts. Health 2.0 emphasizes the whole. Health 3.0 balances part and whole.

We can observe this from a “micro” point of view, or from a “macro” one.

From the micro perspective, Health 1.0 reduces the patient into a collection of distinct organ systems. Isolate pathology in one organ system. Fix it. And you’re good.

If you’ve got a stomach problem, come see me. If you want to talk about your crazy wife, stop talking to me — and go see your shrink.

Specialists rule in Health 1.0.

Health 2.0 sees the patient as a whole being. You’re not just a collection of organ parts — you’re a whole biological system that’s greater than the sum of those parts.

I now want to know more about how the relationship with your wife is contributing to your upset stomach. Because there’s no boundary between your stress and your gut.

Primary care leads in Health 2.0.

From a macro sense, in a Health 1.0 practice I focus exclusively on my own self-interest and/or the interests of my own patients. I don’t care about the larger health care system that my individual decisions can influence and bankrupt.

For my individual practice, fee-for-service is my gravy train. I’ll order whatever you want. How that affects the whole health care system doesn’t matter to me. And so metrics to measure my patients as a population are irrelevant.

In Health 2.0 I see my individual practice in the context of a much larger health care delivery system. And I minimize variations in my practice so I can fit it into that larger context.

Capitation is now king. Whatever you want is subordinate to the needs of the whole population. Otherwise I will consume the health care system of which I am but a part. And metrics to measure the population are critical.


Health 3.0 balances the perspectives of both Health 1.0 and 2.0. In Health 3.0 I recognize that practicing medicine without regard to the whole health care system creates an unsustainable cancer on the system. But I don’t seek to destroy Health 1.0 — I just evolve beyond exclusive identification with it. I embrace the Health 2.0 tenets of cost-control, accountability, transparency, and regard for the greater good. But when I see, in the name of the greater good, Health 2.0 stifling unique approaches to health and consolidating the practice of medicine into a dictatorship of group-think — I will resist.

I now see that the ideals of Health 2.0 are not possible without uniquely skilled professionals caring for you as a unique human being, with health concerns in context to your unique circumstances.

Yes, there’s more to your health than just fixing each of your organ parts. A primary care quarterback who knows you beyond your organs is invaluable in your care. But to get you beyond your dyspepsia, it may take a team of specialized collaborators — a nutritionist, a chef, a psychologist, and a spiritual guide. With each person practicing at the top of their particular skillset.

Yes, stewardship of our whole health care system is a good idea. I won’t just order whatever you want. But I won’t subordinate your unique needs to the needs of the population at large. Because the patient-doctor relationship is too sacred.

Yes, capitation is now on the table. But I get to choose whether fee-for-service or capitation works best for what I do, with my specific community. And if I choose capitation, then I set my rates — not some omnipotent overlord. And I succeed or fail based on my choices.

And yes, metrics in health care matter. But they matter at the population level. They will never capture the complex relationship of care and healing between me and you.

In this patient-doctor relationship…the relationship at the very heart of medicine…you and I are a part of something bigger than ourselves.

But we are not the Borg. Our biological and technological distinctiveness will not be subsumed. The practice of medicine with uniqueness is not futile.

And if we as parts of this health care system do not resist, the whole of medicine will no longer evolve to what it can become for us all.

By | 2017-07-17T20:10:49+00:00 December 11th, 2016|Categories: Concepts|Tags: , , , , , |4 Comments

4 Comments

  1. Mary Alice Hunter October 8, 2017 at 12:46 pm - Reply

    I agree: the doctor-patient relationship is sacred.

  2. Nadereh Diane Shamloo October 10, 2017 at 9:42 pm - Reply

    Patient A goes to his doctor complaining of stomach problems like heat sensations in upper abdominal area and burping. His doctor asks him some questions about the frequency and intensity of symptoms and prescribes some proton pump inhibitors and orders an upper endoscopy. The patient pays applicable fees and the doctor bills the patient’s insurance carrier for any unpaid fees.

    Patient B goes to his doctor complaining of stomach problems like heat sensations in upper abdominal area and burping. The doctor asks probing questions about his dietary habits and discusses whether or not stress may be a contributing factor to his condition. Based on talks with his patient, the doctor advises him to make some dietary changes like giving up dairy and gluten for a few days to see if there is any improvement at all, suggests some methods for managing daily stress, and recommends the patient take natural supplements like apple cider vinegar with meals and aloe vera juice daily. He does not order endoscopy or prescribe PPIs. He doesn’t see a need for either at this point. He asks that the patient returns in about six weeks to see if symptoms have improved. Patient pays co-pay. Insurance company is billed for balance.

    Patient C goes to his doctor complaining of the same above symptoms. Just as in the second example, patient C’s doctor consults with him about his diet and identifying and addressing sources of stress. The patient implements some of the suggestions made by his doctor and returns to him in a few weeks. Symptoms have marginally improved, but he is still experiencing discomfort and maybe even a lower quality of health. The doctor orders in the “A-Team”. (remember the soldiers of fortune from the 1980’s TV series, the A-Team???–But here we are talking about a different kind of A-Team!).
    The team is made up of many talents who will serve as the patient’s health coaches: the doctor, the nutritionist, the exercise/fitness coach, lifestyle coach.
    The doctor says, “Listen up patient. We are here to help you. All of you. Not just the sick-in-the-stomach you, but the stressed-out-of-your-mind you, the nutritionally-depleted you, the overweight-and-out-of-shape you. We are partnering up to administer to you meaningful treatment. And you are not going to just sit on your behind and be a passive player in the mix. You are an important partner in your own care. You are accountable to the A-Team and to yourself to comply with prescribed treatments.”
    “What are the charges doc?” Asks patient.
    “Okay, this is how we are going to do this thing,” says doc. “You will pay us a monthly set fee of say, $65-$70, and maybe a fee-for-service fee as well. You are paying for the care, knowledge, and expertise the “A-Team” brings to the table. You are paying for your health. We are going to make sure we do everything in our powers to help you achieve your potential health.”

    Pop quiz: Which of the above examples embodies Health 3.0?

    Which patient will fare better in the long run?

    • Venu Julapalli, M.D. October 19, 2017 at 3:04 pm - Reply

      Love it! I think I know the answer…

  3. Bettie Nutter October 23, 2017 at 11:52 pm - Reply

    I too think I know the answer!
    . I look forward to your newsletters.. I’m doing okay but need constant reminding that it is an ongoing learning process and I and only I are responsible to make the right choices regarding food I consume. I’m one who thought organic was so expensive. Thanks to your comments I do more organic foods.

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