Pope Francis in Chile

Thirty years after the pastoral trip of St. Pope John Paul II to Chile, the current Pope Francis undertook his sixth visit to Latin America, this time visiting Chile and Peru (between January 15 and January 22) during different historical, social, and political circumstances, that are always changing, of course. On the last papal visit in 1987, for example, Chile was under the military and dictatorial regime of Pinochet. Today, Chile lives in a regime of democratic government.

Enlightening the minds and hearts of men and women of good will, Pope Francis, in his mission and style, confirms and encourages the faith of Catholics, and helps clarify - by the light of the Gospel of Jesus Christ - today's problems, of the men and the peoples he visits. He presented the Good News of Jesus with current themes, very near and very close to the feelings and the deepest, most intimate, and most current experiences and urgencies of the life of each audience.

With the emotion of a Catholic and with the pride of being Chilean, with the fresh joy of the encounter with Francis and with gratitude to God for the privilege of having been present in this Apostolic Journey as a special guest of the Chilean government, let me emphasize here, very briefly, the thoughts, the themes, the strong ideas, and the most important moments, of the speeches delivered by Pope Francis to the Chilean people, transcribing his very words to preserve them - just as they were delivered, without interpreting them or changing them, for our reflection and Christian life.

At the MEETING WITH THE AUTHORITIES, THE CIVIL SOCIETY AND THE DIPLOMATIC CORPS at the Palacio de la Moneda in Santiago de Chile on Tuesday, January 16, 2018, the Pope reminded all Chileans of the challenge that should enliven the days of this Nation in its present and near future: "a great and exciting challenge: to continue working to make this democracy, as your forebears dreamed, beyond its formal aspects, a true place of encounter for all. To make it a place where everyone, without exception, feels called to join in building a house, a family and a nation. A place, a house and a family called Chile: generous and welcoming, enamored of her history, committed to social harmony in the present, and looking forward with hope to the future. Here we do well to recall the words of Saint Alberto Hurtado: “A nation, more than its borders, more than its land, its mountain ranges, its seas, more than its language or its traditions, is a mission to be fulfilled.”  It is a future. And that future depends in large part on the ability of its people and leaders to listen.”’ And, added the Pope: to especially listen: 

•  “TO THE UNEMPLOYED, who cannot support the present, much less the future of their families;

•  TO THE NATIVE PEOPLES, often forgotten, whose rights and culture need to be protected lest that part of this nation’s identity and richness be lost;

•  TO THE MIGRANTS, who knock on the doors of this country in search of a better life, but also with the strength and the hope of helping to build a better future for all;

•  TO YOUNG PEOPLE, and their desire for greater opportunities, especially in education, so that they can take active part in building the Chile they dream of, while at the same time shielding them from the scourge of drugs that rob the best part of their lives;

• TO THE ELDERLY, with their much-needed wisdom and their particular needs. We cannot abandon them. 

• TO THE CHILDREN, who look out on the world with eyes full of amazement and innocence, and expect from us concrete answers for a dignified future.”

And, at this moment of his intervention, Pope Francis added a request for forgiveness that was very just, necessary, and anticipated by the Chilean people in this Apostolic Visit: "Here I feel bound to express my pain and shame, shame at the irreparable damage caused to children by some ministers of the Church. I am one with my brother bishops, for it is right to ask for forgiveness and make every effort to support the victims, even as we commit ourselves to ensuring that such things do not happen again.”

In the Homily of the Eucharistic Celebration FOR PEACE AND JUSTICE at O'Higgins Park in Santiago de Chile on Tuesday, January 16, 2018, he reminded us that "the Beatitudes are not the fruit of a hypercritical attitude or the “cheap words” of those who think they know it all yet are unwilling to commit themselves to anything or anyone, and thus end up preventing any chance of generating processes of change and reconstruction in our communities and in our lives. The Beatitudes are born of a merciful heart that never loses hope. A heart that experiences hope as “a new day, a casting out of inertia, a shaking off of weariness and negativity” (Pablo Neruda, El habitante y su esperanza, 5) and he added that "peacebuilding is a process that calls us together and stimulates our creativity in fostering relationships where we see our neighbor not as a stranger, unknown, but rather as a son and daughter of this land.”

During his brief visit to the Women’s Penitentiary of Santiago, the Holy Father reminded the inmates that " losing our freedom does not mean losing our dreams and hopes.... Losing our freedom is not the same thing as losing our dignity.... No one must be deprived of dignity." He also said that "public order must not be reduced to stronger security measures, but should be concerned primarily with preventive measures, such as work, education, and greater community involvement.”

On the same day, Tuesday, January 16, and at the MEETING WITH THE PRIESTS, CONSECRATED MEN AND WOMEN AND SEMINARIANS at Santigo Cathedral, he encouraged them to "renew our ‘yes’, but as a realistic ‘yes’, sustained by the gaze of Jesus.” He invited them to pray, saying “the Church that I love is the holy Church of each day.… Yours, mine, the holy Church of each day… Jesus Christ, the Gospel, the bread, the Eucharist, the humble Body of Christ of each day. With the faces of the poor, the faces of men and women who sing, who struggle, who suffer. The holy Church of each day.” And he ended his speech asking them: "What sort of Church is it that you love? Do you love this wounded Church that encounters life in the wounds of Jesus?”

At the MEETING and GREETING OF THE POPE WITH THE BISHOPS OF CHILE in the Santiago Cathedral Sacristy, he told them that "the lack of consciousness of belonging to God’s faithful people as servants, and not masters, can lead us to one of the temptations that is most damaging to the missionary outreach that we are called to promote: clericalism, which ends up as a caricature of the vocation we have received.”

On Wednesday, January 17, in the Homily of the Eucharistic Celebration FOR THE PROGRESS OF PEOPLES at Maquehue Airport in Temuco, the Pope addressed especially the members of the Mapuche people, as well as the other indigenous peoples who live in these Austral lands: the Rapanui (Easter Island), the Aymara, the Quechua and the Atacameños, and many others... and at this airport in Maquehue, in which serious human rights violations took place. The Pope called for our construction - as artisans - of unity and the recognition of (original) cultures without violence, saying that "the unity sought and offered by Jesus acknowledges what each people and each culture are called to contribute to this land of blessings” and that “you cannot assert yourself by destroying others, because this only leads to more violence and division. Violence begets violence, destruction increases fragmentation and separation. Violence eventually makes a most just cause into a lie.”

In the MEETING WITH THE YOUTH, in the National Shrine of Maipú, he exhorted them to be "the protagonists of change. To be protagonists. Our Lady of Mount Carmel accompanies [them] so that [they] can be protagonists for the Chile of which [their] hearts dream.” And, he reminded them that "maturing means growing and letting dreams grow and letting aspirations grow, not lowering your guard…” He also said: "How much the Church in Chile needs you to ‘shake the ground beneath our feet’ and help us draw closer to Jesus!  This is what we ask of you, that you shake the ground beneath our fixed feet, and help us to be closer to Jesus.”

In the VISIT TO THE PONTIFICAL CATHOLIC UNIVERSITY OF CHILE, the same Wednesday, January 17, he recalled the importance of the identity, of the existence and mission of the Catholic University for national coexistence and for the construction of community, telling them that the construction of coexistence “is not so much a question of content, but of teaching how to think and reason in an integrated way. What was traditionally called forma mentis.…The university, in this context, is challenged to generate within its own precincts new processes that can overcome every fragmentation of knowledge and stimulate a true universitas.” And, added the Pope, we must "seek out ever new spaces for dialogue rather than confrontation, spaces of encounter rather than division, paths of friendly disagreement that allow for respectful differences between persons joined in a sincere effort to advance as a community towards a renewed national coexistence.”

Finally, in the Homily of the Eucharist in honor of OUR LADY OF MOUNT CARMEL and in the PRAYER FOR CHILE as a Farewell, in the Lobito Campus of Iquique, on Thursday, January 18, the Holy Father encouraged us all to "like Mary at Cana… be attentive to all situations of injustice and to new forms of exploitation that risk making so many of our brothers and sisters miss the joy of the party. Let us be attentive to the lack of steady employment, which destroys lives and homes. Let us be attentive to those who profit from the irregular status of many migrants who don’t know the language or who don’t have their papers “in order”. Let us be attentive to the lack of shelter, land and employment experienced by so many families. And, like Mary, let us say: They have no wine, Lord.”

After this wealth of prophecy delivered by the Pontificate of Francis in Chilean lands, nothing remains but:  

• Regret, if the sensationalism and the media’s curiosity focused voraciously, rampantly, vulgarly and commercially on the subject of sexual scandals and on the person of a Chilean bishop accused of protecting a pedophile priest, a matter that the Pope himself denied and in which he came out in defense of the bishop and - as noted above – for which he asked for forgiveness. Sensationalism and curiousity that - in some moments and sectors, then, could overshadow and forget the wealth and importance of the visitor and his pastoral and evangelizing mission. 

• To hope, with the construction and the active and generous contribution of everyone, that the Gospel’s seed watered in our Chilean Homeland by Francis bears - in the near future of our beloved Nation - good and abundant fruits.

Trust between doctor and patient is key to superior healthcare.

This fall, smack in the middle of the ongoing debate about healthcare reform in the U.S., a consummate medical professional published a remarkable book that pinpoints the structural imbalance that ails the country’s $3 trillion healthcare industry. 

In “Back to Balance—the Art, Science and Business ofMedicine” (Disruption Books), Dr. Halee Fischer-Wright, president and CEO of the Medical Group Management Association, writes: “We have lost our focus on strengthening the one thing that we know has always produced healthier patients, happier doctors, and better results: namely, strong relationships between patients and physicians, informed by smart science and enabled by good business practices that create the trust necessary to ensure that patients do what they need to do to achieve” good, long-term health outcomes.

No doubt, something is seriously amiss: among industrialized nations, the U.S. spends the most per capita, but the quality of healthcare and patients’ health outcomes rank lower than those in Germany, the UK, France, and a host of other developed countries. Fischer-Wright knows her stuff: the organization she leads “represents 40,000 practice administrators and executives in 18,000 health-care organizations across all fifty states, where more than 400,000 physicians practice, providing close to 50 percent of the health care in the United States.”

The “art of medicine,” she asserts, “is being crowded out by the science of medicine—and its emphasis on evidence-based procedures, well-meaning protocols, and advances in Big-Health-Data-churning information technology.” There is a relentless “focus on time-consuming but questionable quality metrics, endless billing procedures, and an adherence to process that doesn’t necessarily put patients first.” Case in point: the author cites findings that show that “the average physician now spends nearly two hours on paperwork [digital entries included] for every hour spent with patients, if they’re lucky.”

These factors “keep creating greater distance between patients and their doctors,” writes Fischer-Wright, who insists that “we need to bring the art, science, and business back into balance — with each side playing its part and no more to drive the healthy outcomes that we all desire from health care today.”

The art of medicine, she insists, hinges on trust, the authentic bond between doctor and patient. It is the vital importance of the “human side — the big-hearted, patient-focused, high-touch, active-listening, caring, compassionate, empathetic part of medicine that has been at the heart of the doctor-patient relationship from the very beginning.” 

“A trusting relationship between physicians and patients,” writes Fischer-Wright, “based on compassion, empathy and good communication can have a profound effect on patient health. Trust aids efforts to control diabetes, lower cholesterol, and control pain. Trust improves the mental and physical quality of life of cancer patients. Trust encourages people to get regular preventive care. Trust gives older patients better outcomes and more long-lasting independence. Relationships built on trust have been shown to reduce anxiety, depression, post-traumatic stress disorder, and a patient’s use of end-of-life care. These relationships are linked not only to lower hospital readmission rates for heart failure or pneumonia, but also to more successful treatment regimens, lower health-care costs and much higher patient satisfaction scores.” Trust is everything!

Hence, the book argues, the business and science of medicine must be de-emphasized in favor of more holistic and humane treatment and involvement of the patient, making room, quite literally, for the human touch.

Fischer-Wright proposes a number of intriguing remedies to bring the art, the business and the science of medicine into proper balance. Among them, a suggestion to “design medical care for healthier people instead of strictly for diagnosis and treatment of disease.” The human person is far more complex—emotionally and spiritually—than the sum total of his or her physical condition.

Also, she recommends: “ask the people the right questions, genuinely listen to the answers and then take the right action” for doctors to find out what their patients expect from medical care, without making assumptions. 

Finally, she calls for the creation of “empowered relationships that demand balance in the art, science and business of medicine”—the doctor, the billing person, the office assistant and the patient him or herself working toward a common goal.

Restoring the fundamental trust between doctor and patient is both the foundation and objective of these vital adjustments; it holds the key to putting “the needs of people at the center of the [health-care] industry again.”

As the CEO of a unique health-care network comprised of independent New York City-based physicians, I am most heartened by Fischer-Wright’s insistence on the primacy of the doctor-patient relationship. SOMOS Healthcare (formerly Advocate Community Providers) is a so-called Performing Provider System (PPS) operating under a mandate from the New York State Department of Health as part of its Delivery System Reform Incentive Payment (DSRIP) program. The initiative’s bottom-line objective is to save taxpayers some $12 billion in unnecessary hospitalizations by the end of the program’s five-year term in 2020.

That goal is achieved, quite simply, by providing better care in terms of prevention, diagnosis, treatment, patient follow-up with CHW handholding. This way, medical conditions may be avoided and managed, avoiding emergency room visits and hospitalizations that drive the burdensome cost of the Medicaid system. 

SOMOS Healthcare was formed by community physicians to revitalize the role of the community-based primary care physician. Like the family doctor of old, these physicians often live and work in the same neighborhood as their patients. Often, they speak the same language and share the same cultural background, ensuring sensitivity to the cultural context of patients’ wellbeing. That, we are convinced, is the key to creating an intimate, trusted bond between doctor and patient.

A cadre of specially trained staff and Community Health Workers at SOMOS Healthcare help to reduce the administrative burden of our network physicians by improving workflows, streamlining billing and maintenance of Electronic Health Records, and exchanging data with the Department of Health. SOMOS staffers are also in a position to make home visits and ensure that patients are following their medical regimes. Thus, our approach echoes the author’s recommendation that shifts the balance back to the doctor-patient relationship.

As to the encroachment of the science of medicine, our primary care physicians can readily refer their patients if specialized treatment is in order—but only after a thorough discussion and examination that takes into consideration possible cultural influences or mental health issues. Ours is a sharp departure from the impersonal, transactional, and test-driven practice of Medicaid medicine.

There is one critical area, however, where we part ways with Fischer-Wright. At the core of DSRIP is a shift to a Value-Based Payment (VBP) or Pay-for-Performance formula: increasingly, compensation for doctors is pegged to the longer-term health outcomes of their patients. We respectfully disagree with Fischer-Wright’s rejection of pay-for-performance, even as efforts she has studied over the years may have missed the mark.

For SOMOS Healthcare, pay-for-performance is at the heart of enabling our doctors to be true to their calling of delivering patient-centered health care. For too long, fee-for-service has economically favored large hospital systems. A value-based formula ensures that incentives are appropriately aligned to reward physicians for personal, relationship-based, comprehensive care.

Those with the most to gain are the people — let’s not call them patients, which connotes illness — whose health and well-being are front and center. After all, shouldn’t our health care system focus on health rather than illness?

Over time, that extra effort will include the so-called social determinants of health, such as a patient’s housing and employment situation. It’s not a matter of what Fischer-Wright labels as using “money to force compliance,” but of recognizing and supporting the risk our doctors are taking as small business owners to link their professional success to the genuine well-being of their patients. That, too, is a matter of trust; rewarding virtue is a good investment.

Post-2020, when the DSRIP mandate ends, SOMOS Healthcare is poised to continue supporting our network of community physicians as a for-profit organization, one that likely will begin to address the needs of Medicare recipients as well as our base of Medicaid beneficiaries. As our operations expand and, hopefully, as other organizations in New York State and beyond follow our example, we are confident that Fischer-Wright will discover that pay-for-performance will be a crucial element in balancing the art, science and business of medicine — be it government-sponsored or commercially driven.