The truth of the matter is that you always know the right thing to do

“The truth of the matter is that you always know the right thing to do. The hard part is doing it.”  General Norman Schwarzkopf, Jr. (1934-2012)

Army Surgeon General Lt. Gen. Patricia D. Horoho recently announced implementation of the Performance Triad pilot program. The idea for the program was developed during Horoho’s deployment to Afghanistan, where she observed the detrimental impact unhealthy choices in sleep, activity and nutrition had on the general health of deployed soldiers. The Performance Triad program, at its most basic, recognizes the essential importance of adequate sleep, regular physical activity and balanced nutrition on the health and optimal performance of any person. Soldiers who maintain a healthy balance of these three factors are likely to be more resistant to disease, less prone to injury and better able to recover from both. In short, healthier soldiers are more resilient and mission capable.

The need for innovative ideas in healthcare, like the Performance Triad, is not unique to the military. The entire nation requires a cultural readjustment to how we perceive health and healthcare. The United States spends more per person than any other country on healthcare — more than 17% of gross domestic product ( GDP) — yet ranks last in terms of overall health, compared with 16 other developed nations (The Atlantic-New Health Rankings: Of 17 Nations, U.S. Is Dead Last. Grace Rubenstein JAN 10 2013, 2:04 PM ET).

The cause of this contradiction between health investment and outcomes has many factors, although the business that is medicine in this country deserves considerable responsibility. As portrayed in the award-winning documentary “Escape Fire: The Fight to Rescue American Healthcare” (, the American medical establishment is in the grip of a healthcare industry that is extremely profitable and, therefore, accommodating to our current dysfunctional system because the industry “doesn’t want to stop making money.”

Healthcare in America is motivated by what is best for business, not necessarily what is best for the patient’s health.  Health is not the focus of this system. Profit is.  The film suggests that we really do not have a healthcare system in this country but instead have a disease management system that offers little incentive for patients to get better, as long as they are consuming healthcare resources. In this same documentary, examples are noted of large companies that have reduced healthcare costs for employees simply by encouraging and providing incentives for adopting healthy lifestyles. I have mentioned this documentary before in this column, and I do so again because I believe it is a “must-see” for any federal medicine provider.

As an aside, I distinctly remember 25 years ago when I was asked during a civilian medical school interview if I thought of medicine as a business or a fundamental human right. I have always thought of healthcare as a basic human right of a free society, and I believe that answer possibly cost me an acceptance to that institution. I did not understand at the time that this question was only the first salvo of the national debate, which is raging within our political system today, about universal access to care..

I am grateful to be part of a federal healthcare system that is somewhat insulated from the business of civilian medicine and the political upheaval it has caused. Federal medicine is certainly not immune to the impact the present healthcare political debate will have on civilian medicine in this country. Federal medicine serves this country, and we take our standards of care and training from the civilian system. It is a system like ours that can provide a model for the country as we struggle to redefine health and healthcare.

 LTG Horoho’s Performance Triad is one example of the leadership role federal medicine can have concerning this most basic and vital conversation about how to prevent the collapse of the U.S. healthcare system. A cultural shift in how  Americans perceive their personal health is likely the first and most important transformative step. It requires some personal responsibility and provides the basis for a conversation with those who make less responsible choices on the consequences of those choices.

In broad strokes LTG Horoho’s focus on sleep, activity and nutrition allows soldiers, and possibly the whole country, to begin to bring “health” back to the American healthcare system. The simplicity of this plan is its greatest strength because we know what we need to do for better health, just like we know what we need to do for a better, more sustainable, healthcare system. The hard part, as Gen. Norman Schwarzkopf so eloquently put it, “is doing it.”

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