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Beyond Better, Safer, Cheaper Health Care: What’s Ultimately at Stake?

Souba, Wiley MD, ScD, MBA; Tsai, Antonius MBA

doi: 10.1097/ACM.0000000000002879

Health care reform continues to be controversial and divisive and takes its toll on physicians, patients, and national unity. An emphasis on efficiency and profit that depersonalizes human interactions hampers building physician–patient relationships grounded in compassion and trust. The authors argue that health care reform will be more effective if it is grounded in and anchored by a physician–patient relationship that is relationally transformative rather than transactionally commercial. This health care paradigm shift, from the “transactional getting” to the “relational giving,” must be physician led. The authors propose 3 next steps. First, establishing discourse “ensembles” will foster conversations where new ideas can emerge and percolate and where participants can renew their collective stand for the humanitarian side of the healing relationship. Second, ensemble unity and effectiveness will be enhanced by the so-called inward journey of leadership. Without that journey, we cannot fully connect with the suffering of others, and we lack the wisdom and will to tackle our health care challenges. Third, to begin the process of solidifying this humanistic foundation, transformative leadership becomes essential. In contrast to transactional leadership, which motivates physicians by seducing their self-interests, transformative (relational) leadership connects physicians with their deeply held values that embody what it means to be a physician and what it means to be human. A shared, collective view of what’s at stake if we settle for purely transactional medicine would help create the necessary physician alignment and commitment to reposition medicine as a profession that values service above reward.

W. Souba is professor of surgery and former dean, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; ORCID:

A. Tsai is director of education strategy, University of Utah School of Medicine, Salt Lake City, Utah.

Funding/Support: None reported.

Other disclosures: Wiley Souba teaches an Association of American Medical Colleges–sponsored course titled “Being a Resilient Leader” and an Association for Physician Leadership–sponsored program titled “Creating a Culture of Well-being and Wholeness.”

Ethical approval: Reported as not applicable.

Correspondence should be addressed to Wiley Souba, 1 Rope Ferry Rd., Hanover, NH 03755; telephone: (603) 650-1200; email:

Copyright © 2019 by the Association of American Medical Colleges