Former Surgeon General Murthy Talks About Healthcare Change, Moral Leadership

Speaking at a healthcare symposium recently, Vivek Murthy, MD, the former Surgeon General of the United States, discussed the need to focus on both clinical and community-level prevention and the impact that community building has on health outcomes, as well as issues like moral leadership and the healthcare workplace.

Murthy spoke at Pepperdine Graziadio Business School’s fourth annual Future of Healthcare Symposium. He recounted learning about medicine from his parents, who set up a medical practice in Miami after immigrating from India. “They never dreamed that I would have this opportunity to serve our country,” said Murthy, who served as the 19th Surgeon General from December 2014 to April 2017.

His parents inspired him, as he saw that their relationships with patients were “mutually therapeutic for both sides.” His parents taught him that “medicine was not just an opportunity to diagnose and treat, but also to build a relationship based on trust and contribute to the betterment of people in a community.”

Like so many others, he went to medical school with similarly high ideals, but found a system upon graduating that was very different. Over time, an erosion of self-efficacy leads to physician burnout, he said, when providers realize they don’t have all everything they need at their disposal to fix a problem.

As Surgeon General, he saw his role as “one where he could craft his own vision and implement his own ideas …even if it meant disagreeing with the president.”

Besides overseeing the Commissioned Corps of the US Public Health Service, Murthy said, the 2-fold nature of the job was to communicate with Americans about important public health threats and translate science into language that citizens could understand.

During his time in the role, his office released a number of health reports, some of which drew criticism. While he said he was always mindful of political considerations, what was more important to him was to take into account what choices and decisions had to be made fundamentally and soon, because if they were not addressed, the country would be worse off. Issues like gun violence, e-cigarettes, opioids, and alcohol all fell into this category, he said.

He said he made “sure that whatever I was doing was backed by science.”

As one example, he cited gun violence as a “massive public health threat—60% were suicides. But Congress had not appropriated any money for research.”

“For me, investing in research is about investing in finding out the truth. That should not be an issue that we waffle on,” he said.

These issues also give rise to questions about moral leadership, said Murthy.

“Where is our moral leadership coming from right now?” he asked, saying that this is something, in his view, that society wants and needs. “To me, a moral leader is someone who has the clarity to see where there’s a gap between where we are now and where our values tell us we should be.”

It requires the ability to be uncomfortable, which means taking criticism and heat, and it requires moral leadership to transform healthcare, he said.

“Change can be viewed as a threat unless people feel like they are a part of it,” he said.

Leaders have to continually connect change with the vision of where they want to take organizations, and there is no such thing as overcommunicating how change can lead to something better, he said.

Murthy delved into several different challenges facing healthcare right now:

Technology. “How to use it to bring care and prevention out of the hospital to where people are? To neighborhoods? How do we use it to communicate with people so they have accurate information?” he asked. He said this is key for people living in rural areas that are not adequately served in mental health and subspecialty areas.

Workforce issues. He said the United States needs a workforce that can not only diagnose and treat individuals but can also communicate effectively with the public.

“There are credible voices with the public who can help distinguish what is true and what is false health-based information,” he said of the current workforce. He also cited how gaps are being filled in unexpected and positive ways, from the rise of peer recovery coaches in the United States, who work with those suffering from substance use disorder, to an example from the United Kingdom, where firefighters were trained to do home fall assessments for the elderly, because they are often the first to arrive on the scene as first responders.

Social determinants of health. This is where healthcare leadership can be immensely valuable, he said, addressing issues such as obesity, housing, schools, and more. One issue that needs to be addressed is which organization or industry is going to convene and lead these different sectors, Murthy said.

Creating a culture within health that supports well-being. He said the connection between emotional well-being and health is quite strong and has implications for how people perform at work and for how children perform at school.

Healthcare leaders need to set an example within their own lives if they want change to take place within the organizations they lead, and that can be difficult to do when providers and administrators work extremely long hours, said Murthy, who was the first Surgeon General to ever take paternity leave. He said he took the leave not just for his own family, but also to send a signal to the people working for him that it was acceptable and encouraged.

“Sometimes cultures exist because people are deeply invested in them,” he said. “Other times cultures exist because they just have for a really long time.”