Mental Health Matters
Todd Weatherly, Therapeutic Consultant and mental health professional hosts #MentalHealthMatters. Interviewing doctors and therapists, treatment professionals, organizational leaders, and other members of the mental health community about the importance of mental health awareness, treatment and the future of addressing mental health in the US. Discussing how to support mental health in our communities from hospitals to the dinner table and what to do when crisis arises.
Mental Health Matters
Breaking Barriers in Mental Health with Dr. Alok Madan
We had the honor of sitting down with Dr. Alok Madan from Houston Methodist to dissect the critical issues facing behavioral health. Dr. Madan sheds light on the immense demand for mental health professionals and reveals the inefficiencies that plague hospital systems, often leading to inconsistent patient assessments and treatments. His integrated model of care at Houston Methodist offers a beacon of hope, emphasizing coordinated care and high-quality evaluations across multiple entry points.
We also tackle the broader challenges faced by mental health providers within the constraints of the current healthcare system. Time restrictions, profit-driven models, and insurance constraints that limit the effectiveness of diagnoses and treatment plans, leaving both providers and patients in a bind. Dr. Madan and I delve into the need for more flexible, patient-centered approaches, advocating for increased financial investment to enable thorough and continuous care. We discuss how transformative shifts in priorities—from financial gain to patient well-being—could lead to meaningful improvements in mental health services.
The episode concludes with a focus on the profound impact untreated mental health issues have on individuals and the broader healthcare system. Dr. Madan explains how untreated psychiatric conditions can exacerbate chronic medical conditions, resulting in increased emergency room visits and hospitalizations. By highlighting some of the innovative approaches he has fostered at Houston Methodist, such as negotiating better reimbursement rates and eliminating common barriers like co-pays, we envision a future where quality mental health care is readily accessible. This conversation underscores the urgency of rethinking our approach to mental health care and seizing opportunities for meaningful change.
Hello folks, welcome once again to Mental Health Matters. On WPVM 1037, the Voice of Asheville, I'm Todd Weatherly, your host behavioral health expert and treatment consultant, and with me today is Dr Alok Madan. Thank you very much. You know I'm from the South. I can brutalize any name. I promise you I'm from the South. I can brutalize any name, I promise you. Dr Madan is the John S Dunn Foundation Distinguished Centennial Clinical Academic Scholar in Behavioral Health. He's the Vice Chairman Department of Psychiatry and Behavioral Health at Houston Methodist Professor of Psychology and Psychiatry and Behavioral Health at Houston Methodist Academic Institute and the Professor of Psychology and Clinical Psych psychiatry at Weill Cornell Medical College. If that wasn't enough, he's also like a decent guy as well and a person that I enjoy a lot. I enjoy speaking to and spending time with Doc. Welcome to the show.
Speaker 2:Well, thank you, todd, appreciate you having me.
Speaker 1:I were just talking about this and it was you said something that that stuck with me, because I like when you say staffing and your stuff, what are you? Are you talking about Clinicians? Talk about doctors, you're talking about all of that.
Speaker 2:Everyone got no shortage of distress and suffering, whether that's across the country or just in my backyard. So we can't recruit people fast enough, can't see people quick enough. There's wait lists everywhere, right Like. I need research assistance as badly as I need psychiatrists.
Speaker 1:Wow, yeah, everybody needs psychiatrists. Wow yeah, everybody needs psychiatrists. Bad these days.
Speaker 2:Yes, I'm hoping that I'm going to have about, I think, six starting this year.
Speaker 1:Oh wow, how big is your team now?
Speaker 2:Oh, todd, I mean I've got inpatient, I've got medical surgical floors to take care of, I've got emergency rooms to take care of. I mean this is a whole continuum of care, so right, it's like. I mean I, I've got a whole employee independent clinic that I gotta take care of um, and then the acute care unit, the. I mean we're, we're an eight hospital system across the city across the city. So there are 30,000 employees. We've got some big city too.
Speaker 1:Yeah, it's a big city, that's for sure.
Speaker 2:So I got nothing, but need.
Speaker 1:I think what you're talking about, though, is you know, here's my experience with hospitals, right, and when I say experience with hospitals, I'm talking about hospitals from east to west coast, all throughout the country, a lot obviously in the southeast, because that's where I can. I've got a little more pull there, but California just as much, utah, new York, the whole nine yards. So, by and large, my experience with hospitals is that they are, you know, they're overfilled, first of all, so they're pretty maxed out and not to get on a huge kick about complaining about hospitals, but they are also in a position to, you know not. You know they're putting band-aids on stuff. You know person's coming in, they're coming in, and the kind of assessment that they're able to give is the psychiatrist walks in and, you know, throws his, you know grab sample if you will. They may look at a little bit of the person's history. They may talk to them for a minute. They're going to spend you know, a half hour or something like that, if that sometimes and they're going to make an assessment about what it is.
Speaker 1:Half the time they're not paying any attention to med history or what other docs have seen, because either they don't have a time where the records are not available. So I think you get this. You know, depending if your hospital serves every kind of person. You got a lot of people walking in there got no records at all. So doctors are used to just kind of dealing with the moment and figuring out what it is they're going to do. When you got somebody who's actually got a clinical history, they're not looking at it because they're in their practice of just kind of rolling. You know so. And then you've got the whole rotational doc thing. You know, if you're in the hospital for two weeks, hopefully you're not, but if you're in the psychiatric hospital for two weeks.
Speaker 2:You may end up with four different docs, and they don't all agree. Psychiatry has thrown this for a huge monkey wrench, making it further complicated. You might have a different doc every day.
Speaker 1:Every day exactly so a person walks out. First of all, even if it's a long-term stay a long-term stay in an acute care psych hospital is like two weeks Even if it's a long-term stay, we all know that it's not enough to constitute treatment. Maybe maybe they got the meds right, maybe they got them back on meds that were working. Or maybe they got the meds right if there was an error or something the person was dealing with and something wasn't effective, maybe. But they're in no way ready to kind of walk to the street and I think a lot of that could be managed if we're really taking the time to do an assessment. So in your world, like the model that you're running which is what I love so much, is that you've got all these places, all these entry points from which people are coming are. You've got all these places, all these entry points from which people are coming, but they're getting top dollar, best in the country clinical assessment which, at the very least, if you can walk out with that in your hand, it's worth its weight in gold Because you can use that and take it somewhere you can like hey, I've had, you know, some of the best docs in the world, come in and take a look at what's going on with me. They've done a really good clinical review. They've got a team of people that are interested in doing this. They've got an assessment center.
Speaker 1:You've got this model that's really operating and I know that you've got goals to try and increase the model so that you also, you know, you've got a PHP and an IOP for people who are sticking around they can go to. Not everybody can stay in a hotel because they're not stable enough. But you're also working on like residential piece. That would be hey, and if you need a residential component, you can step out of this assessment, acute stabilization, walk into a clinical model that's going to be able to deal with you at your level of need and provide you with housing while you go through what is ultimately structured to be, or look like, a residential program. Like if we could replicate that continuum of care in 50 more places in the country, I swear we would have a leg up on this whole problem.
Speaker 2:I think. I couldn't agree with you more. That's why we're trying to build it.
Speaker 1:If you're going to go get care you know you need it You're going to go get what you can and even if it's not enough, it's most of the time it's better than nothing.
Speaker 2:And you and I both know that. You know the brand can stick around much longer than the quality can, and sometimes that old reputation is there, but the actual what's happening on the ground is not where you want to send your patient.
Speaker 1:Well, people leave, as you know the person, that was really great when you went. When X person went there, I mean X years ago. That person is no longer there. They've gone off somewhere else or some big company came and bought the thing.
Speaker 2:That's the biggest challenge the big companies coming in and buying it and then really I've noticed the quality goes down pretty quickly.
Speaker 1:Yeah, yeah, I mean, more often than not it really does, because I mean, you know, I think I use this analogy it's like big companies, especially if they're investment companies, even behavioral health companies, you know they're, they're they're watching dollars, they're watching investment, they're watching, you know, expansion. They're watching their dollars increase. They've got goals They've they've set. And my, my analogy is like it's like driving, but the only thing you ever look at is the tachometer. And it's like our tachometer should be here. It's like, yeah, I realize that it should be here, but you do know that we left the road like four miles back. We're driving through open field. The tachometer is just going crazy. It's like, why is the tachometer going crazy? I'm like, did you look through the windshield, by the way? And that was.
Speaker 1:You know, I've worked for at least one of the large companies and you know that was my experience with them. It's got a lot of guys who were screaming and barking about the money. It's like, by the way, there's a ton of stuff that's happened here in the real world that you guys don't seem to be willing to acknowledge at all and, as a result, what they do is they start managing expenses. I mean, they start managing like you know. Let's kick out the. Can we reduce the team? Can we kick out the lead therapist? Do we really need this position over here? And it's brutal, it's what it is.
Speaker 2:Reaching to the choir Todd.
Speaker 1:I know I am, I know I find myself doing that a lot with you.
Speaker 2:This is one small little program within that larger one. I don't have any kind of mandate from leadership to make a profit. Our financial incentives are break even and then actually when we first started out, it's like try not to lose too much money.
Speaker 1:Right.
Speaker 2:This is now. It's like kind of break even. I'm on salary, I don't get paid, everyone on the team is salary. No one gets kind of volume based Take care of your patients, do right by them, and the finances tend to work themselves out.
Speaker 1:You're on a wait list. Nobody's asking to make a profit. Sounds great, great job.
Speaker 2:Really. I mean, here's the charge for my Houston Methodist leadership, right it's do right by our patients, make Houston Methodist proud and try not to lose too much money. And that's the departmental level, what I've got.
Speaker 1:Those are the metrics we need more of that, I know, you know, I mean this is where this is just it's been like I can't believe I work here.
Speaker 2:I can't believe this type of place exists um, and to have the the luxury of kind of creating whatever we think is appropriate and right by our patients. It's not like it's not like anybody across the country, across the planet, has this figured out. I mean, all our interventions are modestly effective on a good day and there's so much that we don't understand about psychiatric illness. We can do better across the board. It's just nice to not have the financial pressures to make our very blunt instruments do more than they're very capable of.
Speaker 1:You know, like mental health treatment we can. We actually know how to treat people Like like we could do it. We we know we can diagnose conditions, we can, we can have methodologies for treating them and medications and we also have like residential program and transitional living programs and the whole nine yards. And while it's not everybody, if you've got the money and the resources and you start in the right place and follow the path of treatment as it's, as it's laid out for you and either by me or someone like you, like person can get better and they can have a very productive life.
Speaker 1:But something you said is, like you know, it's hard for us some days to use this blunt instrument we've got for you know and your program does primarily at this time, of course, assessment, but also helping people find that next resource After you've diagnosed what's going on, providing them with some treatment.
Speaker 1:You have a PHP program which, if they're in the area, they can stick around with and you can really dial in their treatment plan so that you can address the very specific issues they may be dealing with. If you feel like it's in your bandwidth, but on the field as a whole, like do you feel like it's a? I mean, I know on some ends it's a blunt instrument. It's definitely a blunt instrument but at large, like, do you feel like every aspect of it is a blunt instrument or do you think that there's some, there's some, there's some, there's some finesse there in the like, on your end, the private pay end do you think that we've got a good bead on things when it comes to treatment or do you think we have that much further to go? What's your take on it as a whole?
Speaker 2:I think both, Todd. I think we've got good tools in our toolbox of options in our toolbox of options. It's not all of us know how to use them and most of us don't have the time to use them. I think what you described is it takes time. I mean, that is our special sauce. That is what Houston Methodist, I think, sets us apart. We've got a team-based approach, lots of sets of eyes at multiple times across multiple days. So we've got the luxury of time that people kind of pay for and it's given folks an opportunity to get comfortable in the setting. You know many of the folks that we see. They have horrible trauma histories, horrible trauma histories. Forget your diagnosis right. Why the hell are you going to come in and trust me with your deepest, darkest fears in minute three?
Speaker 1:right right yeah, I mean that's what we're kind of expecting hour 25 for that, for that matter, you know what I mean, so yeah, so it's.
Speaker 2:I mean you go to a new intake, take your pick of what provider that is psychiatrist, psychologist, social worker, therapist. You know most people have 45, 55 minutes to figure out all that's going on, establish rapport and come up with a treatment plan. That's asking a whole lot of any human being regardless of their credentials.
Speaker 2:Exactly of the provider and of the patient, Like we've set up these unrealistic expectations of our patient to be able to actually give us all of that in a cohesive, coherent manner, without being kind of afraid to a cohesive, coherent manner, without being kind of afraid to say something, forgetting to say something, it's we have a lot of tools, but the way that a lot of health care is structured, including mental health care in particular, it's we don't give our patients or providers enough time to actually figure it out or use the tools and the science that we have available to us.
Speaker 1:Right, right. Well, I hear the other part of that for you is we've got some pretty good tools and we know how to you know, given the time, to use them, we know how. But we also don't want to rest on our laurels. We also don't want to assume that we know what we're doing. We also want to. We're scientists, you know we're people who are trying to engage in a process of holding ourselves accountable to new information and new methodologies and techniques and ways to treat people that might be more sophisticated than the tool we got. And you know it's when I you know my end of the world like I have to use hospitals begrudgingly. You know you work for a hospital that I'm really happy is doing it, the way that they're doing it, but I end up having using hospitals begrudgingly because a person gets in there psychiatric hospitals that is and they got two days, maybe they got three or four, and in that time I'm cutting a jig.
Speaker 1:I don't know that I'm going to get accurate information out of the hospital because, just like you say, even if they only had one doc for that entire time, that doc still may not see them long enough or digest their clinical history well enough to really come up with something that's going to be useful. So what I'm doing is trying to find a resource or a placement where they can continue this journey of figuring out what's going on and get appropriate medication management, get appropriate treatment and care and all these other pieces, and do that based on what is ultimately poor information you know, and so you know.
Speaker 1:The other thing that you said that occurs to me is that you're which is my, you know, a tip of the hat to Houston Methodist is hey, run this program. So not only are people who are coming into the hospital with psychiatric needs getting an assessment team that's, you know, world class and can take the time that they need in order to really diagnose what's going on and provide resources coming out of that scenario, but they're also saying, hey, just break even, don't? You know we're, we're, you know, we're not worried about you making a profit. Break even and and and do do right by the clientele who are coming to you and with the whole world of, like equity partners and the private pay industry, which is watching the dollar and everything else, the thing that they, you know insurance companies that come in and they've identified, they've, over a period of years, they've caused us to identify what I would call false treatment periods 30, 60, and 90 days and then you've gotten you've gotten big money coming in, wanting to see its dollar back, and they start to hammer away at resources so the quality of care is diminished.
Speaker 1:So you've got kind of these high profile treatment organizations, companies, facilities across the country that are not necessarily doing the job that they're capable of because they're under the. They're under the, the thumb of some corporate entity that's driving the dollar, or they're under the thumb of an insurance entity that's driving the timeframe, or a combination of the two. And it's like if we were going to change the world and somebody asked us there. Look, todd and Ella, we want you guys to tell us what to do, and you got that opportunity to say what it is. What would you tell the world in order to run quality mental health care for the population at large?
Speaker 2:It's going to require a whole lot more money Initially. The money's going to have a whole lot more money, all right. Initially the money's going to have to be up front, right, and then you're going to have downstream cost savings. I think. I think you're going to end up it'll be a wash, but it will require investment up front, and this is where I'm saying it's going to be a wash, it's I. I think some downstream expenses that we as society take on and have accepted are some things that can be prevented if we do a better job of treating mental health concerns. So when I say we're going to need investment up front, what I'm saying is look, even if we have insurance-based coverage all right, it's that reimbursement, that dollar amount is really quite low.
Speaker 2:So what you're incentivized to do, is not pay not provide quality, it's quantity, Not provide quality, it's quantity. So if you could see one patient an hour and get paid well, or you can see six patients an hour and get paid poorly for each six of them, but then your dollar amount's getting close to the same. And then what are all these consequences of untreated mental health concerns? Our jails across the country are the number one providers of mental health care. That's where we provide health care. And then untreated psychiatric comorbidity puts a huge burden on our overall health care system in that it complicates and exacerbates a variety of chronic medical conditions.
Speaker 2:So you know, headaches, the GI problems, the cancer, the cardiovascular disease. This is what gets us into the emergency room, which lands us in the hospitals. It's frequently the comorbid psychiatric concerns that haven't been addressed because nobody ever thought to look at it, because there's not a whole lot of money in it.
Speaker 1:Well, and it's not the presenting issue or whatever you know. And then you get to the older population, which you know in our practice we see a lot of, and it's not just that. You've got the comorbidity, you've got a person that basically is in their 50s and they haven't been attended to any of their health concerns. They've got high cholesterol, they've got heart issues, they've got all these other things going on which we know if they start to compromise your health in any significant way, like your mobility or your energy level or any of the other things. If you've got depression on top of that, I mean, you know, you just threw rocks on top of that person, basically. So yeah, I think it's a wash. I think you're right that it's a wash if you look at it from a strict financial. You know features. We're going to spend this much money, but then they're going to start to get better because their care was of quality when we started and then we're going to start to they're not going to cycle back through the hospital as often and they're not going to need a lot of the other long-term care aspects that these people end up need. They're not going to end up on disability or they're going to be able to maintain a job full time, and I think that you're. I think that that's true. From the standpoint of dollars to dollars it probably isn't, but if you think about a person who doesn't end up in the system long term, you know that's the concept that voc rehab is built on. It's like, if I can, if I can cause this, if I can support this person to becoming employed, they are now an add to the economy as opposed to a minus and and you know it goes for, it goes for quality mental health care in general. I think at least it is certainly at the level that you and I see it, which is, you know, acute, undiagnosed or poorly diagnosed People who are having their lives interrupted by mental health conditions and are now come to the point where they need to figure out what's going on so they can do something about it. That person appropriate care on the other side, productive, able to lead their life, maintain jobs, keep families, not ruin relationships all the things that happen to people who go with untreated mental health and co-occurring substance use conditions that person in our society causes a worth and a value, a dollar value that is often not. I mean, I don't think we spend any time figuring out what it would translate to Like, even if the person just doesn't use the system again is a cost savings. Now let's talk about what they're going to add to society. And it's a social model, you know, but I, you know, until we start seeing things that way and valuing people as what you know, their ability to maintain a productive life causes them to be of value in a society, and that is a that is a dollar's worth.
Speaker 1:I don't, I don't know how we're going to bridge this gap, do you? I mean, you know, I, you know. Honestly, I think that you guys are probably one of the few maybe I don't want to say the only in the country, but certainly one of the few. I can't even pull up other good examples. On one hand, of a hospital that, yeah, there's a private pay value to it, but they're able to take insurance.
Speaker 1:Your team is just let's make ends meet. You're going to bring them in for the amount of time that they need to be evaluated. You're going to give them a quality diagnosis. On the other side, you're capable of giving them quality care and then, in theory, you know, if all your goals and aims and ambitions go well. You'll even have a treatment environment that you can utilize on the other side of that, which I'm really excited about.
Speaker 1:Hopefully next year we'll be cheering it on, but I don't know a continuum of care or a continuity of care kind of model that exists in the country that really operates that way, where you can come in the front end not knowing what the heck's going on and you come out the other end ready to resume your life. Like that. That's a model and I like what do we need to do? Like do you see it other places? What do we need to do? What caused these people to actually you know, you're in Texas, of all places what caused these people to think so forward? You know what caused them to be so progressive in their thinking about how to treat people in community?
Speaker 2:Wow, there's a lot there, todd. So one thing that I want to comment on, though it's like we've been talking dollars and cents right.
Speaker 2:But I also want to really emphasize kind of the humanity of this. Right, it's like keeping people out of jails, keeping people out of the hospital engaged with life. That's meaningful. It, you know, lines up with their goals, their values, their aspirations. I mean, that's also kind of I mean that is our main objective, right, that that's not. It's not about. It's not about the dollars and cents in some ways, but we have to keep the dollars and cents kind of in mind, right. It's like I've got a hospital system that isn't expecting me to make money, but at the same time they're're not expecting me that they can't subsidize all the mental health care for all of Houston, all of Texas. And then you know, if we're giving it all away, I mean we will be a hub for everyone. So it's to your point, though it's like why here, why now, why now? I think it it's so.
Speaker 2:What I've come to appreciate about texas is kind of risk takers. So this is, this is kind of you know the wildcatter mentality in some regards uh of, okay, we'll take high risk if there's a reward, right. And I think the team, the team that we brought here in some ways, did the same thing. We only had two year guarantees. We had two years of contract. That's it. That was five years ago, so we had to make it or we're done, so it's. It's. The hospital invested in us, but it wasn't an indefinite investment. Right, and can you actually live up to this promise, this ideal that you've created? Is there a market for it? Yeah, I mean, we've tapped into that market. We've taken care of a whole bunch of people from coast to coast, internationally, and I think they've gotten world-class care better than they would have gotten in their backyard. Hence they came here. I do think we've changed remarkably changed the trajectories of folks' lives by having a better understanding of what's going on and helping them engage with more longer-term care.
Speaker 2:To your point, there's not for some folks who've had this chronicity of illness. We're not going to offer this magic potion that's going to cure it all. This is the beginning of a journey of let's figure out what's going on and let's engage for a longer term commitment of kind of a path of recovery, which I do think is people can get better. People can get really much better and find meaning and purpose in their life outside of their illness, but that will take time. I mean that's not going to be easy. So it's a lucky place to be right now.
Speaker 2:And then, you know, on the department level, here at Houston Methodist, you know we've endured a pandemic throughout the hospital system, across the country, across everywhere, and our health care workers are really struggling. No one's been immune. So we've created programming just for them taking care of our own right here. You know it's if our nurses, our doctors, our techs, if they're not doing well themselves, they're struggling we're all human they're not going to be able to perform at their best and take care of the rest of us. So the institution is investing in itself and we're a core member of that team.
Speaker 2:No one's ever told me what I need to do or what kind of programming to make it happen. It's the leadership said this is what we have. We know our current systems aren't working. We need to turn this upside down and do something different and do it better.
Speaker 2:So what we did was we're a managed, we're self-insured, so I was able to negotiate with our own managed care office to increase reimbursement for the services.
Speaker 2:So everyone on my team has that luxury of time to be able to provide those services to the patients that they need, whatever the services that the patients might need, without co-pays without limits on this, without limits on that, without co-pays without limits on this, without limits on that. So that whole model that we were talking about, about how to blow it up, I'm trying to do it here as a microcosm of what can happen across the country. Within our small town of 60,000, that is, the Houston Methodist employees and beneficiaries on the health plan of, can we actually make it to where providers are incentivized to provide good care as opposed to high quantity of care per patient, and then, with the thought being that we do have downstream cost savings while helping people kind of live lives and engage meaningfully with their lives, so it sounds like I mean, you know, from this standpoint you need, you've got a backer, a funding source that's you know, was willing to take a risk, was willing to just kind of like ignore the profit dollar and see if the model could work.
Speaker 2:Right.
Speaker 1:So some patience. You know the part of the backing entity, you know you did some negotiation and your hospital system, so you got some negotiating power with insurance companies and those kinds of things. So I think the other factor is getting insurance companies to actually show up and pay for things instead of trying to deny stuff all the time. Absolutely, it's great, you know, great, you got leverage too is also identifying that your timeframes for treating, you know severe and persistent mental illness or any significant mental health conditions. It's, it's terrible, you know, like you're either you're only paying for one aspect of the care and the rest of it you're ignoring, and people have got to do residential care or PHP and IOP, all these other things like just getting insurance companies to actually participate. I think the other piece that comes along with that is probably the awareness piece. Like the country needs to. You know I run into people all the time. The country needs to. You know I run into people all the time you know they've got a family member that's now having issues or you know they're running into mental health as an issue for them personally for the first time, or they're running into it substantially enough to actually have to pay attention and realize that there are. There's a whole world of people that you know suffer from mental health conditions, that need treatment care. There's a whole world of treatment programs out there protocols, methodologies, providers, the whole nine yards. And it's like I know that awareness and you know the destigmatization is just a big issue on all of our minds. But and I think we're getting a little closer but some education, you know, I think one of the places that starts probably is in school systems, where you know there's like, hey, mental health conditions are real and you can do something about them. You know there's this social approach. I'm super happy about this microcosm. I'm interested to see how we can like bridge the gap a little bit and where this nexus point's gonna be, if it exists at all. I don't know if it does exist, but I certainly hope that it does.
Speaker 1:I guess the final piece would be or maybe in your mind is kind of this final piece. I see territorialism happen among providers. I'm sure you've seen it as well as a psychiatrist in the industry. You've seen it across the board. You've got these people over here and our methodology's the way or our program's the best. They'll try to say that they can serve and treat things that are really kind of outside of their bandwidth.
Speaker 1:In your mind, what is the thing that causes the sciences to come together and I'm talking addiction sciences across the table to primary mental health, across the table to medical health? You know what are the medical conditions and comorbidities that are happening in this person's profile. What is it that causes us to cross the aisle to one another in terms of treatment? I have to pull them together all the time, going crazy, like in your view, as a licensed doctorate professional who's in education, in program management, in all the places that you are. What is it that causes everybody to cross the table, put their degrees at the door and just say let's talk like human beings for a minute. Where does that happen?
Speaker 2:Where does that happen? Working?
Speaker 1:on it, Todd. I think that's an aspiration.
Speaker 2:It. Really it is a huge challenge. I think part of it is kind of the structure of health care in general, with all the specialties being so siloed, right, so it's no one really talks to one another. That's just kind of the nature of it. So your example of your inpatient physician in an acute care psychiatric setting you know they've got 15 patients that they're taking care of in the hospital and they don't have time to call up collateral they can try calling up collateral. There's going to be one phone call and then you're not going to be able to reach the other doc because the other doc is also busy anyway. So it's like figuring out that time is very hard.
Speaker 2:So I think one approach is trying to bring all those various specialties in-house and having one team under one roof. And that's been the challenge that you and I have discussed. It's finding the right people. I need the quality people who can come to the table, put their degrees and egos to the side and say let's talk about what's in this patient's best interest.
Speaker 2:And this is what I saw. This is what I saw. This is what I saw. This is what I saw. These are our thoughts and we put bits and pieces together. I think we're trying to do that here at Houston Methodist and again I say try, in that we don't have it perfectly done, in that we don't have it perfectly done, it's all aspirational. Where we are today is much better than where we were 20 years ago, and I think next year will be better than where we are today of trying to bring a cohesive group of people together from various specialties, who don't have a competing agenda but a collective agenda of let's figure out what the hell's going on, let's keep this person stuck and let's come up with a plan with the patient's input on what next steps should be.
Speaker 1:Well, I'm a big fan of the fact that you are emulating that and aspiring to it, but I think you're doing a pretty good job out there in texas and houston. Um, and I I can't wait to see what the future holds and what things that you bring. I certainly want to be any part of it that I possibly can, and uh and support what you're doing. Let's let's just try and make this model a little more flagrant across the country.
Speaker 2:Right, appreciate what you do, todd. Really I appreciate, and you know part of this we're talking about. You know the destigmatization, the increasing the conversation I think it's the show is part of that. Right, this is part of the solution, rather than us just saying we need to do something about it. So I appreciate you doing something about it. Maybe a few people will appear and learn something.
Speaker 1:Well, we'll lay it between the wires and see whose attention we can get. Dr Madan, it has been a pleasure, a distinct pleasure, to have you on the show today. This has been Ben Hoffman. It's on WPBM 1037, the Voice of Asheville. We'll look forward to being with you next time. Doc, take care. Thank you, Will.
Speaker 2:Bye. I'm an island man and I'm trying to escape anywhere that I can, anywhere that I can. I have no time left. Time is lost. No time at all for it in a garbage. Can Then I take God's hand, I jump up and let her know when I can. This is how I'm going to do it, guitar solo. We'll be right back. I'm making rocks from the ashes guitar solo you.