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(Don't) Climb Every Mountain

Posted By Randall Reitz, Thursday, August 28, 2014

“Climb every mountain,”


--Theatrical claptrap


"Ford every stream.”


--Musical rigamarole


"Follow every rainbow,"

--Rodgerian drivel 


"'Til you find your dream.” 


--Hammersteinian Hokum 



While this counsel might make sense in a world where singing nuns marry strumming captains, it should never be the theme song for integrated care.

Lest you think I’m being overly dramatic, I’ll explain with a story. This summer I had the pleasure of visiting the mountain countries of Europe with Ana and our children.  One of the highlights was a day trip to Grindelwald, Switzerland.  I had visited this alpen village 14 years previously and my descriptions of the bucolic valley had the kids primed for a thrilling day of fanciful chalets, rugged edelweiss, merry cows, and alpine slides.



Arriving in the town, I quickly got my bearings off the tourist map and oriented myself to the enormous crags that crowned one entire side of the valley.  We excitedly set off to hike up the chosen mountain, rent scooters, and then zip down the switchbacks.  Unfortunately, over the next 2 hours we marched up, down, and across the town, just trying to find the trailhead to get us started.  We enquired with many people who each seemed to give us conflicting directions. The signs were all written in German.


And then it dawned on me that we were pointed toward the entirely wrong side of the valley.  Based on my memories from the previous trip and the map (which emphasized form over function), we had focused on the wrong set of peaks.  After turning the map 180 degrees the correct landmark was immediately apparent, but our children were exhausted and in no way interested in an additional 2 hours of hiking.  They had lost faith in their father’s orienting skills and now only wanted ice cream and the community pool.


In our day’s pursuits, we shouldn’t have climbed every mountain, but rather the 1 right mountain. We shouldn’t have followed the happy images of a rainbow map, but rather referenced reliable data. 


We need confidence that we are climbing toward the correct peak 

Integrated care strives to be an evidence-based best practice.  While it is too soon for us to positively affirm that our models are all empirically certified, we should at least hold ourselves to a standard of not implementing operations and interventions that have been debunked by the literature. Or, returning to my story, we need to have confidence that we are climbing toward the correct peak.


And similarly, as Alfred Korzybski famously opined “The map is not the territory”. As scientist-practitioners we rely on the scientific and scholarly literature to guide our steps across the lay of the land.  For this reason, our progress in the integrated care terrain is often predicated on the accuracy of our discipline’s maps and the helpfulness of our road signs. 


At this year’s CFHA conference, participants will have numerous activities to find their own bearings and contribute to the scholarly maps of our terrain.  I’ll highlight 2 opportunities:


DEBATE:  Over the past 10 years of the development of integrated care, the following 3 assumptions have been central to our efforts:

1.       The patient-centered medical home is the ideal setting for achieving the Triple Aim of improved patient experience, improved population health, and reduced cost. 

2.       Integration of psychotherapists into primary care is the key first step in building integrated settings.

3.       Clinical teams should be led by physicians. 


But, what if each of these assumptions were wrong?  What if each these core tenants oriented us to the wrong mountain and we would have been better served by investing our time and resource summiting entirely different peaks?


On Friday, morning Jodi Polaha and I will host a debate in which 1 contestant will make the empirical and theoretical case for 1 of these assumptions and his/her opponent will attempt to debunk the assumption or make the case for a different peak more worthy of our efforts.  Our debaters will be Susan McDaniel, Sandy Blount, Ben Miller, Barry, Jacobs, Andrew Pomerantz, Jeff Goodie, and Paul Simmons. The audience will choose the winners, who will be awarded a signed copy of the losers most revered publication.

Come See the Debate! 


WRITING WORKSHOP:  On Thursday, Lauren DeCaporale-Ryan and Laura Sudano will convene a free pre-conference workshop targeted for early career professionals seeking to contribute to the professional literature of all formats (research reports, case studies, theoretical analyses, personal narratives, and professional blogs). In addition to instruction from Colleen Fogarty, Larry Mauksch, Susan McDaniel, Matt Martin, and myself, each participant will benefit from 1-to-1 coaching related to a manuscript they submitted to the workshop faculty before the conference.  


Onward then, to climb relevant mountains, ford reasonable streams, and follow evidence-based rainbows in pursuit of our dreams.  Rodgers and Hammerstein it is not, but we suspect you’ll leave equally inspired.


Randall Reitz , PhD, LMFT is the Director of Behavioral Sciences at the St Mary's Family Medicine Residency in Grand Junction, CO. In addition to training residents he also directs a fellowship in Medical Family Therapy. His scholarly pursuits include medical family therapy, professional development, healthcare ethics, and integrated primary care.

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