Thinking Outside the Healthcare Box: Systems Theory Discussion with Guest Dr Shelly Smith-Acuña – Part 1

Feb 8, 2022 | Podcast

Many of us have seen first hand how the healthcare system has been overtaxed by the pandemic. One of the things that the recent strain revealed is that healthcare has actually been in trouble for a really long time. Whether you’re a patient, a healthcare worker,  or an administrator, you have likely felt some of the same common themes like disappointment, blame, and wanting something better from the medical system in the United States. In this episode of Third Opinion MD, I’m examining our healthcare system through the unique lens of systems theory and psychology.

Thinking Outside the Healthcare Box

Recently, I discovered a fascinating book, Systems Theory in Action: Applications to Individual, Couples, and Family Therapy by Dr. Shelly Smith-Acuña. She is the dean of the Graduate School for Professional Psychology at the University of Denver, and is a licensed  psychologist who specializes in couple and family therapy. While I was reading her book, I couldn’t help but imagine how each of these different players in the healthcare system struggle for different reasons. In this episode, I’m sending all the players of healthcare to get therapy because, let’s face it, healthcare systems are really dysfunctional.

Systems Theory Discussion with Guest Dr Shelly Smith-Acuña

In parts one and two of this interview, Dr. Shelly Smith-Acuña and I take a look at our healthcare system through the lens of system theory. Specifically, we are looking at the six members of the health care “family”: the server (healthcare workers), the bureaucrat (administrators), the patient, the guard (insurance companies), the dealer (pharmaceutical industry, or Big Pharma), and the judge (state medical boards). Dr. Smith-Acuña and I will structure this therapy session to help unpack the principles of systems theory, which are: context, causality, communication, change, structure, history, and the social-cultural narratives.

Part one looks at context, causality, communication, and change.

Impact on Your Third Opinion

In this two-part series, I’m hoping that you will get a better understanding of the context of the current medical system. It’s easy to get frustrated or feel lost as a patient trying to get care, and many people oversimplify things by trying to blame one portion of the larger system for their concerns. You might find yourself thinking, “the doctor doesn’t listen to me” or ask “why do I keep getting shuffled around to different specialists?”

These frustrations and questions are at the heart of systems theory. The answers can help guide you away from blaming just one thing for a problem, falling into communication traps, or taking things out of context. Instead of fixating on what could be changed, or placing judgment on change being good or bad, systems theory can give you a better understanding of the difficulty in changing a large system.

It’s my hope that when you better understand the system, you’ll also better understand how you can get better care within the system. You need to trust your intuition, advocate for yourself, and develop your own third opinion as you navigate the system. I believe that all of you are at the heart of changing this healthcare system into something better. You can be the drivers of effective and lasting change.

In this episode, Dr. Shelly Smith-Acuña and I discuss:

  • The definition of Systems Theory, and how it relates to psychology
  • The healthcare system as a family unit includes: the server (healthcare workers), the bureaucrat (administrators), the patient, the guard (insurance companies), the dealer (Big Pharma), and the judge (state medical boards).
    • The seven principles of systems theory: context, causality, communication, change, structure, history, and the social cultural narratives ( first four reviewed in this episode, part 1):How context can give us a better understanding of the relationship between the parts and the whole in healthcare systems
    • The nature of causality (or cause and effect), andhow we tend to blame from a linear perspective rather than consider a more shared responsibility.
    • Communication: the inconsistency between message sent and message received, the intent and the impact of communication, and how communication can have various purposes like: establishing status, solving problems, creating emotional bonds
    • How the healthcare system both creates and resists change


Systems Theory in Action: Applications to Individual, Couples, and Family Therapy by Dr. Shelly Smith-Acuña, 2011.

Burnout in Healthcare Workers: Prevalence, Impact and Preventative Strategies. Local and Regional Anesthesia 2020:13, pp.171-183. A graph called the job demand-control model, introduced by Karasek in 1979 focuses on the balance between the magnitude of the demands (height of strain) and the level of control (decision latitude) in a person’s work situation. This article refers to the research on burnout in the 1970s mentioned in the episode.


Barbara:  Welcome to Third Opinion MD Podcast. I’m your host Barbara de la Torre. I’m a physician and artist bringing a blended perspective to you about healthcare and exploring simpler ways to restore and maintain your health.

In this episode, I’m sending all the players of healthcare to get therapy because, let’s face it, healthcare systems are really dysfunctional. I’ve invited a guest who is an expert on systems theory and how systems affect human behavior. Stay tuned for what should be a great discussion.

You’ve heard a lot about broken systems without long lasting solutions. The pandemic revealed that healthcare systems are not struggling because of COVID; healthcare has actually been in trouble for a really long time. There’s a book that I recently discovered called Systems Theory in Action: Applications to Individual, Couples, and Family Therapy. I know it’s not an action adventure or a true crime story, but it’s an amazing book because it breaks down complex theories into simpler concepts that apply to different types of therapy.

While I was reading this book, I couldn’t help but imagine how each of these different players in the healthcare system struggle for different reasons. Whether you’re a patient, a doctor, a nurse, or an administrator, there are common themes like disappointment, blame, and wanting something better. I believe that all of you are at the heart of changing this healthcare system into something better.

I’m so excited to introduce you to our guest today. My guest for this episode is Dr. Shelly Smith-Acuña. She is the Dean of the Graduate School for Professional Psychology at the University of Denver. She’s the author of the book, Systems Theory in Action, and this book has really transformed the way I think about healthcare and the steps to making more effective changes in the future.

Thank you so much, Dr. Smith-Acuña, for joining the podcast.


Dr. Shelly Smith-Acuña:  Thanks for having me. I’m delighted to be here.

Barbara:  This is so exciting. I can’t tell you how I geeked out on your book. I had to figure out why am I so excited about this. I think it’s because of all the applications that it has, not just on therapy, but on just the rest of life. You actually helped me discover that I have been a systems thinker for most of my life, so thank you.

What I wanted to start with is just getting into what systems theory is. How would you define it to the public who are not graduate students or in medicine, what does it mean?

Dr. Smith-Acuña:  I think if we’re very literal about this, systems theory isn’t actually a theory; it’s a framework or a set of approaches to really understand other theories. What systems approaches have in common is really looking at organization structures entities in a holistic way, in a way that really focuses on relationships and patterns and interactions.

When you said that you’ve been a systems thinker maybe all of your life and weren’t aware of it, it’s not that there aren’t these kinds of approaches that we see in day to day life, but really systems thinking evolved to kind of counteract a lot of the limitations of our traditional Western scientific method, which is very reductionistic, isolationist. When we talk about science, we say how are we going to understand the phenomenon, and systems theories say we understand it best by a holistic approach as opposed to a reductionistic approach.

Barbara:  What you mean by reductionist is that you reduce the variables or the parts that make the whole.

Dr. Smith-Acuña:  Of course, there’s legitimacy in that kind of understanding cause and effect, that kind of linear. We watch a baby drop a spoon off of the highchair and it falls, and you say, “I understand cause and effect.” That’s a legitimate approach, but it’s also limited. Systems theory really helps us not only understand the limitations, but counteract the limitations.

Barbara:  Why did you write the book about systems theory for your graduate students? What was the motivating factor?

Dr. Smith-Acuña:  One of the wonderful things in my program is that all of the students are required to take systems theory. In psychology, we often think of systems theory as family systems, so people will say, “I don’t need to learn systems because I’m not going to work with families.” In reality, that hasn’t been helpful. In my program, as I teach this general systems theory class for all of my psychology doctoral students, I found it hard to have a text that really did take this higher level general approach to human nature. Everything was a little bit too specific, and maybe ironically a little bit reductionistic, looking at families or at couples or at communities. I really wanted to tie all of that together.

Barbara:  You mentioned the assumption that it was in certain subsets of psychology study, but it actually can apply to all. What are the possibilities that it’s existing or being utilized in other industries. Are you aware of any?

Dr. Smith-Acuña:  Yes. That’s been really gratifying for me, particularly being in more of a leadership position and recognizing that in business, in particular, there are a lot of systems approaches thinking about things like looking at causality differently, understanding the importance of context. It has taken off in lots of different areas.

Barbara:  I would really like to delve into how you write about systems theory and apply it to the dysfunctional issues with healthcare today. You write about applying general systems theory to the world of psychology in order to assist with individual, couples, and family therapy, and beyond. I got excited about your book because I imagine healthcare undergoing this intensive psychotherapeutic session. We’d have these players that we can call a healthcare family unit. They’re so unhappy that we assume that it’s patients that are unhappy, but it’s really doctors, nurses, administrators, it seems like everybody is unhappy with the way the system is working right now.

Would you consider, as a part of our conversation today, applying your seven systems theory principles to these groups as if they’re in a family therapy session?

Dr. Smith-Acuña:  Sure. That sounds great.

Barbara:  For the audience, this is my imagination, but it’s my podcast, so we’re going to try it. I’m going to stop to tell all of you, though, the seven principles. I want to name them before we start talking about them just so that we plant the seed and you have an idea of where we’re going. You don’t have to memorize them, but it’s nice to hear them.

The principles are: context, causality, communication, change, structure, history, and the social cultural narratives.

Let’s introduce the family members in this imaginary therapy session. As the therapy evolves, I imagine that their names may also change to a new identity, as it is with people and how they change how they view themselves and the world around them. We have six family members. We’ll start with the server, the bureaucrat, the patient, the guard, the dealer, and the judge.

Going down the list, the server, who would you think that would be? The clinician. A physician, a physician assistant, a nurse, a medical assistant. The bureaucrat, the administrators. The patient, I left as patient because the Latin origin of patient is patior, which means to suffer or bear. That’s actually assuming that a patient is in a passive place, that they wait patiently to recover, they wait patiently for the doctor to see them. That’s something where there’s room for change. Then there’s the guard or gatekeeper, the insurance companies. The dealer, or pharma. The judge, which one example would be state medical boards, which are in place to protect the public, but it gets interesting if we look at it in the context of systems theory, whether that’s in balance or not.

Let’s begin with the first principle, context. In your book, you mention that understanding a problem in context means seeing that in all the systems and subsystems in which a problem is embedded. Could you tell us more about the idea of these multiple perspectives and the relationship between the parts and the whole?

Dr. Smith-Acuña:  This concept seems so common sense, and yet when you really boil it down and say each one of these six players in this family creates its own context and exists in other contexts simultaneously, then suddenly you see the complexity of dealing with any kind of a human system.

Within this particular group, when we talk about the context of the system, we also are talking about the context of the problem. We want to say what is the problem that this family is coming to solve. What we can be almost certain of is that each one of these individuals has a different perspective on the problem and a different definition.

A lot of time gets wasted on blaming other parts of the system for the problem or on a very narrow problem definition. Taking a step back and saying, “What’s the context of the problem? And what’s the context of each of the players that contributes to the problem?” is already going to set the stage for the other constructs that we talk about in systems theory.

Barbara:  That sounds amazing. Yet again, we’re not really hearing that in our day-to-day language. What I did see, at least in my experience in healthcare, where healthcare got it right with context was in the world of pediatrics. What’s interesting is that’s where they assume the child really can’t speak for himself or herself, so we have to understand the other worlds around them, anything that defines who they are, the context of who they are.

We have a saying in healthcare that the worst historians are children and drunk people, so we have to make sure that we gather data, what we call collaborative information. That’s where I see they got it right. Now we have to look at how can we get these players, or let’s call them the family members, the server, bureaucrat, patient, guard, dealer, and judge, how can we get all of these to start communicating or bringing an awareness to the context of others.

Dr. Smith-Acuña:  Yes. Very literally, at my university, we just changed our insurance system. Patients had to sign up with new providers. In all of that process of change, we could see that there were many different things that went wrong. As we tried to have the administrator from the healthcare system and the physicians who were signed up with that healthcare system and the patient, they all had a completely different description of what the problem was. You could see that they existed in a different context and they weren’t interested in the others’ context.

Barbara:  Was that resolved, or how did you come into that conversation?

Dr. Smith-Acuña:  It’s partially been resolved. It’s not resolved yet. I think part of my involvement in the conversation is basically to advocate for the patients who were the people who work for me, but also to try to take a step back and just say, “What are we missing here, because something isn’t working?”

Barbara:  I can share at least some of the other family members, the medical boards, which really they have great people serving and trying to do good for the public. What I also hear, there are also physicians who suffer incredible trauma from complaints that are placed. Definitely there are problems with context from the get-go. It’s not something that can be resolved because it always goes back to what we tend to see as the dominant narrative, which is the bad doctor in the media and the danger to the public.

What we don’t see is the highest suicide rate amongst professionals are now physicians. They have no place to go. When they also try to give context, they’re given little choice. I don’t know if you’re aware that there are many states where physicians are forced to go through a physician help program that is sanctioned by the board and not by a private psychiatrist or therapist. They are paying thousands of dollars, they’re also hiding their mental illness, if they’re having any type of trauma or depression or any other type of diagnoses, they have to stuff that in. There are issues with that, the dominating issue is usually the patients dealing with insurance companies, who are dealing with the hospitals or the administrators. They’re a minority that I think gets lost in the conversation.

With context, we also have these other principles that we have to bring in. There are a lot of moving parts here, but it’s interesting. Causality, cause and effect, what’s causing something. There’s a lot of blame, you mentioned, that goes around. It fails to help those who need it and often shames those who deliver it, to healthcare.

Conventional medicine, alone, follows this reductionist and linear thinking. Take it apart to understand and control it, that’s sort of the motto. Evidence-based medicine, which has been a large movement over the last couple of decades where, if it’s not evidence based, it’s not real or it’s not valid. People have a hard time introducing new ideas.

Do possibilities get dismissed by the way we conduct clinical research? That would be my first question to you.

Dr. Smith-Acuña:  Yes, definitely. I love that question. Where it goes very quickly to causality is that idea of circular causality. You can have evidence-based practice, but simultaneously you should have practice-based evidence. It should turn into a feedback loop where you gain information, assuming that there is multiple causality, that there’s not one single cause.

Of course, somebody doing these randomized clinical trials, that’s an important part of medicine, according to systems theory, would never want to do that independent of then going back to the practitioner and saying, “How does this fit in your experience, and what have we missed? What are the other elements that are contributing to the kind of causality that we’re identifying?” Of course, that’s not the way that we practice, and it’s hard to think that way.

Barbara:  That’s so interesting. I remember there was an article that I was asked to read while I was an employed physician about how the clinician experience pales in comparison to evidence-based medicine. Isn’t that interesting?

Dr. Smith-Acuña:  Yes.

Barbara:  Just to clarify what you mean by practice-based evidence, would that be similar to the keen observations that were made with Chinese medicine that has been recorded for thousands of years, for example?

Dr. Smith-Acuña:  Exactly. Yes.

Barbara:  That’s dismissed because it’s not evidence based?

Dr. Smith-Acuña:  Exactly.

Barbara:  Who is at fault for medical error then? How do we answer that question? In the system, what we have right now because we live in a litigious society, we have to take steps sometimes rapidly to cover the areas of who is to blame, but it reminds me a lot of the airline industry where they try to blame the pilot for the plane crashing. When there are grave medical errors made, largely it comes from the system and not from an individual. What are your thoughts on that?

Dr. Smith-Acuña:  I think immediately I go to using those ideas about causality to think about responsibility and blame differently. It’s not an either/or. It’s not that you’re trying to find one cause. As you look in a more complex way, you’re saying, “What are all of the factors that contributed to this not going well?”

You mentioned a litigious society, so people are trying to avoid taking responsibility for what they did wrong and avoid that accountability, legally certainly. But I think the idea that accountability doesn’t equal blame, to be able to say, “This is the part of the problem that I did actually contribute to,” doesn’t mean that the whole problem was my fault. I understand with medical malpractice, and I don’t know the answer there, to look at a mistake and to say what could have been different.

I could give some other examples. Thinking I misdiagnosed a child based on an assessment instrument because I didn’t understand bilingual kids well enough, so I attributed something to intelligence that really came from a different factor. To look at all the different things that played into why did the child perform at this particular level is going to give you a better outcome than to be able to say, “Here’s the IQ score, therefore here’s where they should be placed in school,” for example.

Barbara:  I see. I have another possible example. The issue of physician burnout. It has fascinated me for a long time. We blame the burnout often, just by the actions that we take in our system, on the physician, “Oh, there must be something wrong with them. We need to make them feel well and adjust their wellness.” I have seen that through the institutions I’ve worked for, and they all have them. What’s really fascinating is that people are not allowed to question the system at all. It’s only about this is about you. It’s almost like gaslighting. There’s a little bit of that going on, whether it’s implicit or explicit, but there is something happening there where the assumption is made.

I’ll include this as a resource on the history of burnout, there was an excellent article written in the ‘70s about burnout, and there’s a table that puts an X and Y axis that talks about the less autonomous you are, the higher risk of burnout you have. It’s very clear with the decline in autonomy that burnout has gone up.

Dr. Smith-Acuña:  Yes. I can’t help going back to circular causality again, because the more burned out you are, the less energy you’re going to have to correctly identify all of the different factors, including that lack of autonomy, that are really keeping you down. The more down you are, the less you’re able to articulate what could actually make things better for you, including the changes in the system.

Barbara:  Oh my gosh, I love systems theory. This is amazing. It’s just so interesting. Things fit into these principles so well, and you could think of so many examples.

The next one, communication, I think very few people need an explanation of why communication is a major principle in systems. There are daily examples of communication breakdown at home, at work, in politics. Could we go over some examples with our healthcare family that we have here in therapy?

You mention a few critical concepts in your book. You mention the inconsistency between message sent and message received, the intent and the impact of communication, and how communication can have various purposes, like establishing status or solving problems, creating emotional bonds. How would these communication concepts apply to situations for this healthcare family?

Dr. Smith-Acuña:  You can maybe help me think of some different examples, because now I’m stuck on what I heard at the townhall that we had with the patients and the couple of physicians and then the administrators for the insurance company.

The intent of the insurance administrators was to decrease the patient complaints and to help them trust the system more. Yet the way that they were presenting the outline of the problem solving techniques of the insurance group did just the opposite. The impact was that it felt defensive, it didn’t feel like there was new information, and the patients were feeling very unheard.

The more the healthcare folks were trying to present their good intent, the poorer the impact. The disconnect there was really powerful. To try to dislodge that and to acknowledge, yes, insurance administrator, we know that your intent is to provide good service, and yet the impact of your communication is not showing that, not moving things further. Even with that positive intent, you can’t ensure that the impact is ultimately going to be adequate.

The purpose of the communication, if it’s to decrease complaints, as opposed to if the purpose of the communication is to actually solve problems, that was another disconnect that was evident in that communication. Regardless of the intent of the administrators to decrease complaints, if the problem wasn’t actually addressed, the purpose of the communication was completely different there. It wasn’t going to satisfy the patient until there was some different problem solving.

Barbara:  That’s almost a precursor to our next one, change. Change is really hard for people. We’ll get to that.

I have an example or two. One is the term, patient. So, again one of our family members here in therapy, has been changed by some organizations. The name change has happened, for example. It’s not the name, patient, but they’re referred to as a member rather than a patient. The intent was to make them feel like a part of something, that they have some ownership.

The impact, however, is very interesting because it impacts other parties and other members of the family. There’s a powerlessness that is felt from the healthcare workers who are the servers. They feel that because it’s always this sort of discussion of the member is always right, like the customer is always right. So, there’s that.

I’m not really sure whether that has changed the intent or if the implicit and explicit messages were successful or not. Just because you change the name without changing other parts of the system, will that end up just being lip service?

Dr. Smith-Acuña:  Especially because it isn’t clear exactly what that change was supposed to create. Or, to get to some of the other concepts, structurally, does that actually mean that there is a different change? I think that you might take feedback from the member, maybe. I don’t know that it’s different from the kind of feedback that you would seek from a patient. What does being a member give you that being a patient wouldn’t necessarily give you? I think often we don’t articulate these deeper levels of meaning.

Barbara:  There’s also something called Press Ganey. Are you familiar with the Press Ganey scores?

Dr. Smith-Acuña:  Yes.

Barbara:  That is the bane of a doctor’s existence or a provider’s existence. What they do is they send out surveys to patients to say, “How was your experience,” and then they have these different parameters. Different organizations will take one of those key parameters and use it as a measure of managing that physician. Not as a learning point, but as a form of management, or holding off compensation, or not promoting the physician. It has a deep impact.

Dr. Smith-Acuña:  I’m really fascinated with understanding, I’ve seen this written about looking at the opioid crisis, and how would physicians, who should know better than to be overprescribing, be lured into this pattern and understanding that a patient, or whatever you call them with our traditional Western medicine, is going to assume relief from symptoms and going to assume that the way to get relief from symptoms is medication. Of course, medications like opioids do relieve a number of different symptoms. Doctors who give that medication are going to be more highly rated.

We’re talking about circular causality again. You have a vicious cycle in a physician trying to do the right thing in saying no to a patient requesting medication, and then what? That’s what gets lost. What instead of medication would fill that gap?

Barbara:  They’re not protected from the potential repercussions of the low scores, for example. One of the parameters is doctor’s concern for a patient’s comfort. Pain medication deals with a patient’s comfort, but not necessarily with their wellness.

It’s interesting. We’ve seen that context, causality, and communication are key players. We move into the next principle of change. This principle is a bit visceral to me when I think about how many times I or other physicians have tried to change the system. Abrupt change, slow change can affect people differently.

I think the audience can relate to the frustration that comes from trying to change any system, not just healthcare. It’s so easy to say a system is broken, but we rarely witness changes to make it better. One thing you point out is the mistake to view a change as just progress, and that systems theory can offer a more balanced of how systems react to change.

How does the system both create and resist change? That was what I found fascinating in your book.

Dr. Smith-Acuña:  Understanding that systems are designed to create homeostasis, change is really difficult. Part of that predictability for a system to manage these kinds of day to day turbulence in a way that has something that is consistent underneath is not a bad thing. we can say systems are resistant to change as though that’s all negative, and it’s not. There are positive and negative aspects to homeostasis and to systems remaining the same.

Barbara:  It’s very similar to the body staying healthy, too, if we look at it from a circular viewpoint, a multi-systems viewpoint. We have in place all of these systems in our body to have both – I’ll use these terms of positive and negative feedback loop – but the idea that there is positive feedback and negative feedback in order to keep it ain’t broken, why are you trying to fix it? And that’s the idea of resisting change.

You have something that works well, we’re walking miracles can actually live and breathe. These organs that have really not changed for thousands of years are still doing what they’re doing. But if we make changes outside of our system of our body, we are actually causing adaptations and disease and issues. That’s the idea of Chinese medicine is that we don’t just look at the organ and the system, we’re looking at the environment around us because we’re the ecosystem living within another ecosystem, and we’re inseparable from it. That’s why I love it so much and why I want to talk about it.

What do you think it would take for us to witness a larger transformation in the healthcare systems in our lifetime?

Dr. Smith-Acuña:  I have a handful of reactions. One is I remember, gosh, this must have been the mid-80s, there was a Ted Coppell townhall about the healthcare system and just talking about how hard it is to have a purely for-profit system actually serve people. I know that’s not a very popular thought, but I think some kind of regulation that would really look at outcomes, other than profit, would be really helpful.

If we take that sociopolitical piece out, I do think very much listening to patients and servers in much more detailed ways about what’s not working and not trying to fix a problem until you really understand the problem more completely. Frankly, actually looking at even your list of everybody in the family, starting with patients, and with patients understanding what’s not working for me outside, but also what am I contributing to the problem. That’s part of that multiple causality that also sets the stage then for the change process. Not to say the change is all external, but the change being internal and external both.

If we ask patients to say not only what’s not working for you, but what are you doing that is not helping your own health, and then taking that a step further, “Why not? What conditions would need to be different for you to actually take charge of your health in a more robust way?” I think that would begin to change the system.

Barbara:  Absolutely. It has to start from where ground zero is, which is the patient. By doing so, by becoming more proactive, we change the name of the patient becomes something different, more proactive, the driver of one’s health. From that internal change, and again we move into more philosophical talk, but it’s the idea of changing from within has an influence on others, because we really can’t change other people. You can try really hard, but you’ll come up with the resistance, unless there’s that internal buy-in and a response.

What’s interesting is that you mention how in the ‘80s they were talking about that. In the ‘80s they were talking about that. In the ‘90s my mother was talking about it to her patients. I was recently listening to a seminar she gave in the ‘90s to her patients about healthcare and the state it was in. It was as if I was listening to it yesterday, like she gave the talk yesterday. There are some things that just don’t change.

Do you think that the larger the system is, the harder it is for a system to change? Does it have to do with how many are involved in the system, or does that not matter?

Dr. Smith-Acuña:  Probably it does make it harder. Again, to me, I think what’s really hard is that we define the problem incorrectly and incompletely, so then we can’t change.

I think the basics, in my world, you have the classic parent who comes in and says, “I can’t get my kid to do their homework. This is terrible. We have to solve that problem.” The kid says, “My parent won’t treat me well. They keep yelling at me, they punish me all the time.” You have each blaming the other. We want to say, “What is the problem?” Is the problem the parent or is the problem the child? Of course, the problem is both.

When you acknowledge the problem is both, then you can take a step back and just say not only what could promote change, but what is inhibiting change. I think when we’re talking about the healthcare system, of course it’s huge, it’s very complex and there are lots of players. What’s easiest is just for all of us to have our own part of defining what we think the problem is and to turn that into blame and to miss the opportunity for other potential solutions, I think.

Barbara:  Small changes breed larger ones, too. My dream for healthcare would be for the variables to change in terms of how we define healthy. Like a wellness visit will no longer be the way it is, not by these metrics, but by what the patients are actually doing. That insurance companies reward it, that they say, “Good job on this.” If the doctor keeps a patient healthy, we’ll pay the doctor.

This is again my dream, I’m not forcing this on anyone. I really think that will create a whole different situation by saying you take ownership, we reward you for that, but it’s a collaborative effort from all of the family members in this healthcare family.


We’re going to stop here for this episode, instead of going through all seven principles, because these are really major concepts to digest all at once. What we’ve gone over so far are what we can even abbreviate as the four Cs; context, causality, communication, and change. Those are four of the seven principles related to systems frameworks and they’re really important to know so that we don’t fall into the trap of blaming one thing for the problem, or falling into communication traps, or taking things out of context, or even being confused about whether change is good or bad, and understanding the difficulty in changing a large system.

Stay tuned for the next episode where we’re going to finish with structure, history, and social and cultural narratives. We’ll continue to have some really interesting discussion surrounding healthcare and around this constructed family of healthcare players who are in group therapy to try to make the system better.

Thanks. Take care.


Third Opinion MD Podcast is produced by me, Barbara de la Torre, and is generously funded in part by a grant from the Regional Arts and Culture Council. Music is licensed through AudioJungle.

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S3 Ep 8 – Season Finale Part 1: Looking Back is How You Move Forward for Your Health Strategy

S3 Ep 8 – Season Finale Part 1: Looking Back is How You Move Forward for Your Health Strategy

Imagine a healthcare system where you actually matter. Not just the symptom you walk in with, but who you are as a person, the struggles you face, your family legacy, your family secrets. Imagine all of these things matter.

In the season 3 finale, Episodes 8 and 9 reveal Ramey’s layers of family history in the context of relationships and identity. By looking backward, Ramey moves forward with the knowledge and confidence to form her own Health Strategy.

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S3 Ep 7 – The Tapping Experience: Ramey Practices an Emotional Self-Care Tool for Her Health Strategy

S3 Ep 7 – The Tapping Experience: Ramey Practices an Emotional Self-Care Tool for Her Health Strategy

Sometimes good medicine is so simple that people don’t even try it. In Episode 7, Ramey is prepared to practice a powerful self-care tool for emotional balance called EFT. When you learn to become a systems thinker, becoming healthier is not only possible, you believe in yourself again.

Be sure to also listen to Episode 6 on Ramey’s preparation for this transformative tapping experience.

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