S1 Ep 2 - Part 1 - Thinking Outside the Healthcare Box: Systems Theory Discussion with Guest Dr. Shelly Smith-Acuña

02/08/22 • 34 min

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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.

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

Resources

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.

Read a transcript, and the full show notes for this episode on my website.

To learn more about Third Opinion MD, please visit my website by clicking here.

I offer one-on-one integrative health consultations blending Eastern and modern medicine philosophies, putting you in charge of your health management and prevention. You can learn more by visiting my website, here.

Dr. Barbara de la Torre started Third Opinion MD as a way to spark a wave of change in the way we practice medicine, how we care for ourselves, how physicians are treated, and how we can navigate through the existing healthcare system. Information on this podcast is provided for informational purposes only and is not intended as a substitute for the advice provided by your physician or other healthcare professional.

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

Resources

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

Read a transcript, and the full show notes for this episode on my website.

To learn more about Third Opinion MD, please visit my website by clicking here.

Previous Episode

S1 Ep 1 - Time to Take the Doctor Out of the Equation and Put You in Charge of Your Health: An Introduction to Third Opinion MD

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Welcome to the first episode of the Third Opinion MD podcast!

As a medical doctor with a background in the American medical system, I’m concerned by the level of care that patients receive and more informed of the constraints in the current medical system. I’ve left the traditional medical world to create something new because I want more for all of us as patients and more for myself as a professional. My guess is that you also experienced some of the setbacks of our current healthcare system, and that you want to find something that supports you in a more holistic way. This podcast is part of my mission to change healthcare for the better while helping all of us to return to the basics of good health.

In this episode, you’ll learn more about forming what I call “your own third opinion.” I want you to trust your instincts, and for you to become your own best advocate. This takes understanding the current system, knowing how to navigate it, and learning how to speak up for what you need in a way that gets better results.

I’m just as frustrated as you are about the system and the way it works. The pandemic shed light on how bad things were and how healthcare can become worse. You might jump to the conclusion that the healthcare system is broken and that we have to replace it. You’ll discover in this episode that the better thing to do is to discover what works well within it, what we can do to navigate through it, and how to find ways to bring in other systems.

In this episode, you’ll learn about:

Creating your own third opinion

My background as a doctor

Why I’ve chosen to focus on educating rather than treating

The events and people who have influenced how I practice medicine

How my mother’s death changed how I understand medical care

How to fix what is not working in healthcare

A parable about what happens when we just look at one part of a larger ecosystem

Read a transcript, and the full show notes for this episode on my website.

To learn more about Third Opinion MD, please visit my website by clicking here.

Next Episode

S1 Ep 3 - Part 2 - Thinking Outside the Healthcare Box: Systems Theory Discussion with Guest Dr. Shelly Smith-Acuña

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This is the second part of a two part interview with Dr. Shelly Smith-Acuña. You can read about, or listen to, the first part of this conversation here. I highly recommend tuning in to part one first.

For both parts of this interview, I’ve proposed that Dr. Smith-Acuña and I take a unique look at the health care system. We are blending her background in Psychology and Systems Theory with my own experience of the healthcare system as a doctor. We set the scene for this discussion by having all of the “family members'' of the healthcare family attend an intensive psychotherapeutic session together. We are sending all the players of healthcare to get therapy because, let’s face it, healthcare systems are really dysfunctional.

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

Structure as the fifth principle, and the hierarchy that comes into play within the healthcare system. Structure encompasses sharing power and sharing responsibility, along with good communication.
How definition and clarity around the structure of a system gives everyone working within it a better sense of how to interact and work.
History and development is the sixth principle of Systems Theory. This involves understanding both the history of the doctor’s profession, or health history of an individual patient. Events such as trauma are not always considered when approaching care, and they have an impact on outcomes.
The role of transference and countertransference: unconsciously patients and doctors experience and react to one another based on their past personal experiences and what they encountered in their families of origin.
Social and cultural narratives is the seventh principle of Systems Theory. Each of us has encountered both social and cultural experiences that inform who we are now, and how we understand any given situation. These narratives also impact language shaping experience and form dominant narratives.
One example of this is a dominant narrative around passive-aggressive care. Within a healthcare system, the patient is often expected to be a passive recipient of care, with doctors using aggressive approaches and language around care.

Resources

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

Wise Mind, as explained by the founder of DBT (Dialectical Behavioral Therapy), Marsha Linehan in this short YouTube video. This Venn diagram is an amazing summary of where two people can be in healthcare interactions, from successful to polarized.

Correction and more information on the 20th-century physician, William Osler. Dr. Osler was actually one of the four founders of The Johns Hopkins Hospital rather than Johns Hopkins University as explained in the episode. For more information about William Osler, click here.

Read a transcript, and the full show notes for this episode on my website.

To learn more about Third Opinion MD, please visit my website by clicking here.