Compassionate Health Care
A Conversation with Dr. Deb Roman
In a time when health care often feels more like a business than a system of care, Dr. Deb Roman is working to restore its heart. In this conversation, Deb, as she likes to be called, reflects on the state of medicine in the United States today — what is working, what is failing, and what is needed to move toward a system that truly supports healing.
Drawing from her years of experience as a physician, educator, and advocate for integrative medicine, she emphasizes the importance of connection, compassion, and whole-person care. She describes the toll that current systems take on both patients and practitioners, and how a shift toward more humane, relational approaches can transform not just outcomes, but the very experience of health care.
At the core of her vision is a belief that medicine is most effective when it acknowledges the full humanity of everyone involved. This means treating patients not as problems to be solved, but as people to be understood; and supporting providers so they can practice medicine in alignment with their deepest values.
Listen to the full conversation to hear her insights on how we can reimagine health care as a space for healing — not only of bodies, but of relationships and communities.
Transcript:
With gratitude to Elizabeth High for this transcript!
Stephanie Van Hook: There's so many distractions, I'd say, in terms of justice and peace. We could explore any conflict in our world at length and feel like we're still incomplete about it. And then other topics get really pushed aside. And that's part of, I think, the agenda of what's taking place in the United States right now is that we're distracted; the way that our systems are being consciously broken: healthcare being one of them, education being another. So I wanted to dedicate this show today to talk a bit about the healthcare system in the US and especially from a nonviolent perspective of “what does the next healthcare system look like? What does a better healthcare system look like and how do we salvage what is working in this system?” and just sort of let's just put everything on the table and “hope tank” about the healthcare system. Really interested in your background if you could start us off telling us about yourself.
How did you get involved in this field? What's your specialty? What's your story?
Dr Deb Roman: Sure. So I'm an integrative family physician, and I worked back in the times when physicians would go into the hospital after hours and take care of their patients. So I'm going to date myself very quickly here, and I loved that actually, because it's just this wonderful continuity of care that we were able to provide always. Patients would be so happy when I would show up at the hospital because they're like, “Oh, you know, tell him, tell him what you know.” And it was so helpful for the specialist and I also, because we could connect that way and help each other navigate whatever was happening. So it really provided a circle.
I love practicing medicine, always have. Yet I started to notice about 20 years ago, 15 years ago, how unhappy many of my colleagues were and started to research that, “What is this about? Why are people so unhappy?” And this was when a lot of the research around physician burnout and suicide and depression was starting to emerge out of Mayo. So I contacted one of the researchers and asked him to help me understand, and he's this wonderful human, Colin West, and he said “Just call me, Deb, Let's talk.” So again, you know, when I think of nonviolence, right? Like this, “let's talk, let's talk.” And he taught me much of what I, you know, learned at that time about the overload that physicians were feeling due to the law changes and the administrative details and the regulatory demands.
And, we worked, we always worked long hours. We always expected that this would be difficult in many ways, but there was the nourishment of the time with patients, the nourishment of the time with peers, the ability to try to get through difficult things together. And much of that was interrupted by adding so many more details that physicians have to bring things home. We call that pajama time, right? So in your pajamas, you're still filling out charts for hours, right? Which means you're not going to be with your family or yourself as much.
And then we had COVID, and COVID caused a lot of trauma also in the healthcare world, in the world in general, of course. But it's led to violence, really, against healthcare workers who don't necessarily agree with a particular way that a patient might feel. And then we added the politicalization of medicine, which has been what you're referring to, Stephanie, a whole nother element.
Within that, I don't want that to sound like I'm tapping into the negative. Many of us who have been in medicine, we love the work and we love what the possibilities are when we partner with people to help them find health. We're searching now for how do we navigate all those interruptions in that beautiful circle and allow the things that are really beautiful that have worked in the past for centuries, millennia maybe, to be at the forefront and help us to get through some of these struggles that we're facing right now. And so, the work that you guys do with nonviolence is such a critical piece of what we're trying to do.
So we've done conferences and workshops, and we have study groups, and we have all different ways that we've tried to bring people together to explore "How are we going to do this together? What's this going to look like?” “What are you feeling?” is the first question. “What are you feeling?” you know, “what is your day like?” In Idaho we have some very strict laws that have changed, that have created a tremendous amount of distress. We're losing a lot of our physicians, people are not coming here, and we have not many physicians to start with per patient. We're looking at, “How do we navigate that level of trauma in a way that can be supportive and nourishing, nonviolent, kind?” In much of our work that we've done, we start with this piece of “how do we care for each other?” So we start a lot of our meetings with "How are you?” And then the question becomes, “how are you really, how are you really, because you can't be okay, right? How are you really?” And then if it takes us 20 minutes, 30 minutes to start navigating, “I'm not so good. I don't know how to do this right now, and it's not making sense to me. I can't find the meaning. I'm overloaded.”
We talk about that and we'll get to the agenda – or not. Most of the time, once we feel healthy with each other and safe, the agenda just goes quickly and people are always as surprised at that. Like “how do we get that done in 15 minutes?” Because we were supported and we knew people cared. And that's been our focus with all of our initiatives is relationship. It's not as much who I am as kind of who we are all together as we're trying to navigate what's happening in medicine.
Stephanie: I am really moved. I felt like crying all of a sudden as you were talking. I think the immensity of the problem the way that you described the variety of layers from not just the politicization of the healthcare system at this point, but think how far off track it's gone from the good intentions of good people who want to be in a field doing good things and thriving. I think that I find that emotionally overwhelming to even hear about. And so I want to go into that a little bit more. I think it would be interesting for our audience to better understand the workload of physicians, of doctors, of the medical profession, really. Of everyone, nurses, everyone. Tell us more about the experience of what it's like to be a medical practitioner today. Like really help us, because if we can better humanize one another…
Deb: Yeah. I do coaching with physicians and one of the main things that comes up is “Deb, I don't know how to do all of this work and have a life. I get home, I bring it all home. On a day that I have time off, I'm doing the charts, I'm calling people back. The demand needs to be addressed.”
And the work that we've done in physician burnout, the researchers are very clear that this is not about resilience of the physicians. We're inherently resilient or we wouldn't be here. It requires a form of resilience to be able, and they've done studies on that. So I don't just say that to say that. It requires a perseverance and a resilience to even get to be a doctor. And that's true in other fields too. I don't live in a hierarchal world where I think anyone's better than anyone else, but that's just the nature of that work. The studies are very clear that 80% or more of this is a system level issue. That the system itself, and we talk about this a lot in nonviolence, right? That the system itself is not working.
And so then the question, which is really an important question becomes how do we navigate in a system that's dysfunctional and still stay aligned with our values? They talk about moral injury among physicians and it's in other fields too. Right? I can see you shaking your head, Michael. The moral injury of not being able to do what you know is needed when you know what to do, but the system will not allow it. That's crushing. How do we navigate a system that's broken while we're still trying to fix it? And we've done a lot of work in our community, so many wonderful people to address the system level issues, but they're not fixed yet.
But we still have to get up every day. And how do we do that without a broken heart? How do we do that to show up for a patient who is struggling? I just got off the phone with a patient right? Two minutes before I jumped on here. Who's struggling so much, right? And I know so much. She needs my time today. and she will get it. She will get it. But I also have to be sure that I am present and I feel nourished to do that.
And that's the big question. How do we deal with a system that's not working and still show up capable of seeing the possibilities, capable of supporting each other, capable of having the vulnerability to reach your hand up and say, “I'm not okay. I'm not okay today.” We have a thing where we write SOS on our texts, that means, “I'm not okay.” It doesn't mean “call me tomorrow.” It means, “I need someone to kind of hold a space for a few minutes because it's overwhelming.”
You know, the physicians that we're losing in our state, we lost 43% of our OB-GYNs who are practicing obstetrics. We brought in some, so the net is about 35%, but that's a huge number of people. Those people did not want to leave their work. They've been doing this for 30 years, some of them. They are so connected to their patients and their community and their peers, and yet some of the demands are causing that moral injury and that depression, that hopelessness that are saying, “I need to make a shift here.”
And you know, another piece I really do want to articulate is that it's just as difficult for our patients, right? This is a circle, and our patients are being injured too, because, if we're hurting, they see it. If we can't show up for them in our wholeness, they know that. And if they don't have access to healthcare professionals who are available to them, it's really tough for them. They don't want to wait a week and a half to get a biopsy report. They're not going to be able to sleep. They want someone to call them, but if there's not enough people, it's difficult.
So I think sometimes there's this perception, that doctors, they're all rich and they all have all these things and they're kind of complaining. I really want to address that most of us are not rich, number one. Many of us work on sliding scales, we do it different, right? And we care deeply about the work we're doing and the people we're caring for. And so these interruptions in that circle are, they're heartbreaking for us and we're trying to figure out how to make our way forward and like you said, Stephanie, to create something that's life-generating or to even just illuminate that which we know already is life-generating. It's always been here, so how do we make sure that that's at the forefront?
Michael Nagler: Deb I come from a family of educators, down to my generation; and then with my daughter on down, it's a family of physicians.
I've had this same conversation with my brother-in-law who teaches family practice medicine. He was really, really good at it. And the conversations always came down to we're both being inhibited, to say the very least, compromised by the systems in which we have to operate. But I used to say to him, “Rick, you guys have a lot more power than we have. Because if we withdraw our support or we threaten to go on strike, nobody cares. But if physicians threaten to pull back, the world would be panic stricken.” And so I'm encouraging you as I encourage him, which is probably quite unnecessary in both your cases, you know, to use that power that you have to get this story out. And I'm glad that in this tiny little way right here, we're helping to get the story out of what is happening to helping professions in a cruel world.
Deb: Yeah, it's a really interesting piece. I really appreciate what you're saying. I kind of want to play with this with you because I think it's such an important piece. We've thought about that and we talk about that; there is the potential to influence what happens by stepping back. There's several layers to that. One is that we've always been taught that we're there for the patients. And we are. We are there for the patients. But we're also recognizing that we need to be there for each other or we won't be there for the patients. So that's a big piece of that, right? Many doctors feel uncomfortable stepping back because they worry what will happen to their patients. I will tell you that in my opinion, the system encourages that thinking to discourage us from speaking up. There is that too. In this world, there is a risk of speaking up, post-COVID politicalization. It's… there's a risk. So it's not just about what you're thinking, you know, personally, it's that there's a chance that you'll be attacked for those things, right? So there's other variables.
The piece I want to explore with you guys if I can is the nonviolent way to approach this and one of the pieces we talk about a lot is that no one's the bad guy here. The administrators are trying to do what they do. The CEOs are doing what they do. How do we expand the conversation so that everyone can be seen as a human being who's trying to figure this out too? We all can find some place that allows us to move forward together. And this idea of going on strike, which has been definitely, we've talked about it a lot, honestly, and there are ideas about that. I'm not saying it's right or wrong, but how do you do that, let's say, even if you just decided to do that, how do you do that in a nonviolent frame? Because it can be a violent thing as opposed to bringing forth the idea that you're really doing that from a place of love instead of a place of “I'm trying to make you suffer.”
We have found, let me just say it this way, that one of the more valuable things, rather than immediately going on strike; “How do we connect with all the people of influence who are creating the system, supporting the system of which we all are in certain ways, right?” I have to call myself to task, how much am I supporting a particular system by my behavior, right? We all do it. How do we facilitate conversation and understanding and connection that would allow us to find a way forward together? That doesn't mean that there wouldn't be a place for a strike or for some other form of nonviolent resistance, right? But I think what I'm trying to parse out is that, John Deere talked about this when we had a talk. Like he said, there were lots of protests in the 1960s that were violent, but not just violent in terms of someone being hurt physically, but mentally. The mindset that was going into that is that “You are bad, I'm good.” That's what I'm trying to grab. It's like that piece, that element of “Are we doing this to support everyone and to bring us to a place of understanding or are we punishing?” Does that make sense?
Stephanie: Oh, yeah, absolutely. It is a question of our intention and our placement of power. Protests absolutely have their place. And if there can be consciousness-raising about the message and why we're there and have a really good PR media side to be the ones talking to the media with that message, it's really important. You have to get in charge of the narrative of what's taking place, because if you don't, it goes passive and then the media will interpret it for you, and then turn it into even a greater power struggle. I've found that in the most beautiful nonviolent moments that happen, it's not happening in protest situations. It's happening because somebody sees the humanity in the other, and that you have differences. And then one of you gives the other the benefit of the doubt in some way and allows them the space to change, and it kind of happens in a quiet way.
Deb: I love that.
Stephanie: And to allow for that to happen, I think, is really important. And also to know that that's really where change is possible too.
Michael: We have a concept, Deb called the escalation curve, which lays out what different strategies you need to use at different stages of the dehumanization. And, my impression is that you have taken the first step very well in this document that I just read about where 800 physicians registered in effect a complaint with the health secretary, explaining very carefully why things are going wrong.
Those statements are often effective in themselves, but when they're not, we have to be ready with some kind of escalation. Not saying necessarily a strike. I didn't really mean that. And I understand they're even ethical and emotional issues involved that would make that not appropriate for you. But we should be thinking about, “what will we do if our very rational proposition that we've just registered is ignored?" and I don't have an answer off the top of my head, but I think there must be a lot of creative resources if we can get together and discuss this in an open way.
The other little detail I would add is that it's extremely helpful, whenever we're dealing with someone with whom we are in an oppositional framework, to start off by acknowledging them. “We know that you want people's health just as much as we do; we have something that we can offer from our perspective.” And because of the passions that are involved and the importance of what's involved, we can lose sight of that. So it's important to be able to hold onto our own emotional distress. And, this is just repeating back to you something that you just said, acknowledge the humanity and the goodwill of the other person, then you can go on and really say, “we think, however, you've made a mistake in your interpretation and we're in a good position to tell you what's going wrong and how to fix it.”
Stephanie: And in a way it's taking the medical framework and looking at nonviolence and direct action. I think you've been talking as well about the importance of relationship between the professionals within themselves, with each other, with the patients, that this is all a collaboration. It's an invitation of that spirit, which is really starting in that right way within oneself, with others, with the patients, and with the system itself, that it needs to be a relationship.
Deb: A hundred percent.
Stephanie: You're teaching us this in this conversation. You're bringing it up.
Deb: I think you already know that we started a group of people to start dealing with system level issues. But what we did first was we said, let's call our friends who might want to come to this conversation, right? So these were people that we already knew. John Paul Lederach talks about that. Who do you know? Who do you know? Bring them to the table even if their views are very different than yours.
We made sure we had good food. Always have to have chocolate. Definitely do not do anything without chocolate. And, the first conversation that we had with this group of all kinds of people, from the payers, to the physicians, to the system leaders, was a bit adversarial, right? “You are wrong. I'm right.” We were working with prior authorization as a starting point. So what we did was we called the people afterwards. “Joe, how did that go for you?” “Not so good. I felt like the bad guy.” That's not going to work. And so by our second meeting, we really, really addressed that. “This is about our friends. These are our friends. We may not agree about something, but we will always agree to be friends.”
And that's where the relationships started. We didn't go into “How do we do this?” We went into “How do we see each other? How do we honor each other? How do we value each other and ourselves?” And sometimes the conversations had to go to something very different first, like fishing or cooking or something else that wasn't quite so charged, or music, and that was our connection, right? Then we could see each other clearly. As soon as we bring up the other thing, things kind of blind out, so we had to start there.
And even then once we started doing our work, it became very fluid then because we were just working as people, to your point, Michael, who value the health of everyone, right? We all value that. We want our families to be healthy. But a big piece of it, if I can just offer a thought, is the personal work. We really had to look deeply into ourselves and say, “Am I being biased? Am I creating space for someone else to be themselves?” and not in a judgmental way against ourselves, but to say “What am I struggling with that I have to navigate first and kind of get in touch with and allow to move through me so that I can show up that way?” So it was a lot of personal work. and Michael, you've talked about that nonviolence, right? Gandhi spoke about the personal work. That became very important too, is, “How are we showing up?” and then “How are we all showing up together?” And then the conversations just seemed to come.
And one other piece we did with that a lot too, and I mentioned earlier, is we constantly checked in with each other, and we didn't use hierarchy. It was all first names, you know, whether you're a physician, whether you're a CEO of the corporation, whether you're a physical therapist, whatever your work is. I'm Deb, right? People would say, “Dr. Roman,” I'd say, “No, I'm not working.” In fact, many of my patients call me “Dr. Deb,” so I don't hear it even then to tell you the truth, which is fine with me because that's not necessary. There's no reason that has to be that way.
Stephanie: Sometimes I think it has its value in medicine, so that people do what you encourage them to do; sometimes you need people to follow through.
Deb: My personal feeling about that is that I've been trained to provide some ideas for people and I hope to give them something of value. But I always say to patients, “If you go home and you haven't done any of the things that we discussed that you seem to feel like were comfortable for you, then they weren't the right things. Come back, let's talk again. I want to be sure I'm hearing you clearly to see how it's going to work in your world. This is not about me having the answers for you. It's about me listening carefully enough to say, ‘what is it that you need and how can I serve you?’” You know? So just a response to your comment.
Stephanie: Appreciate that, yeah.
Michael: Deb, there's a time-honored method for overcoming adversarial attitudes and conflict, and that is to find a common problem that you all have to work on. And it seems to me that we can all come to agreement, we don't all agree right away, but we can come to agreement that there are unhealthy elements in our culture, in our civilization, e.g., you know, the violence in the mass media, for example, which of course would not bring them in, it would be adversarial toward them, but there are a lot of things that we could all agree to do together. And there's a famous experiment that took place in a summer camp in Canada where kids were very much in two opposite camps and they developed strong animosities against each other.
Stephanie: It was a camp run by psychologists.
Michael: Yeah. Okay. This is a phony, put-up situation. So I mean, it was getting serious. There were fights that broke out. And what they did was, the truck broke down that they all needed to get into town with, and they had to collaborate to fix the truck. And lo and behold! So it's looking for that common issue that contextualizes and diffuses the conflict. And I think we've all got one. We all know that we've created a culture which is unhealthy for people to live in because they don't have a sense of meaning and a sense of dignity. And if we all got our heads together in a way to resolve that even, you know, stepwise very incrementally, we would be on a very different wavelength.
Deb: No doubt, no doubt. We started a group called the Compassionate Communities Healthcare Movement. And we started that with the idea that “How do we inspire compassion?” But very much based on this idea of what you're saying, Michael, based on health. I think most people can agree that they care about the health of their families. They care about their health. They care about the health of their communities, hopefully. So it's a landing place for us, that maybe we can agree on, to your point.
My greatest teacher on that has been my father, who has always, always said to me, “Honey, what about common ground?” And such a beautiful, you know, reminder, “What about common ground?” And he's 94 and I've told him he needs to stay around a lot longer because I still need him to teach me that wisdom because he…. Oh just so much insight that he has had over the years and his ability to create spaces where people feel seen. I wonder, you guys, this is what comes up to me a lot lately, is if we can just create spaces where people feel seen and heard, I think we can find peace in the world. Honestly, I think people just want to be seen and allowed to show up as they are, and shown how beautiful they are when they show up as they are, and then we'll figure the rest out. We won't want to hurt each other. We won't want to hurt ourselves.
There's a wonderful story that I just heard the other day from a meditation teacher and she said there was a meditation teacher that was walking down a dark alley and someone came up to him and said, “Give me all your money.” And this, I think, was a homeless person potentially who had a gun. And he said, “Not a problem. Not a problem.” And he took out his wallet and handed him $600 and the guy looked at the $600 and, and he grabbed his gun and he said, “I'm going to shoot you.” And the guy said, “You don't have to do that, you don't have to do that,” he said, “Here, take the whole wallet. You have all my credit cards, can use all those.” And the guy looks at the wallet and he takes his gun and says, “I'm going to shoot you.” And he said, “You don't have to do that. Take my watch. Super expensive watch. You can sell this for a lot of money.” Hands him the watch. And then the guy turns to him and says, “I'm going to shoot you.” And he says,”You know what? Hold up,” he says, “look what you got from me: $600, my whole wallet, and you got my watch. When you go back to your friends and you tell them what you did, they're going to say, ‘You did good. You did really, really good.’” And he looked at him and he put down the gun and the guy said that as he was walking away, he heard him say, “I did good. I did good.” And maybe no one had told him that in his life. No one was willing to say, “You are good. You are good. And I honor you and see you.” Imagine if we did that.
Michael: You know, if we did that as individuals, it would be very powerful, but in order for it to really sink down into the mental infrastructure, it would have to change the culture as well.
Deb: Exactly.
Michael: Because the advertising is all based on the assumption, “Your pain is my gain,” and vice versa, in fact. We have a photograph of a billboard that I stopped and took a picture of on the way into town one time. They're just trying to sell real estate, but across the top of the billboard it said, “Our pain is your gain.” Causing so much harm for such little benefit. When I was in literature, back when I had a real paying career, as far as that can be done in literature, we often talked about what we call the subtext, that we're giving you a message underneath the words, there's an implication. And the implication of those words is “We are radically separate, if you suffer, I benefit.” And if you know, we pay no attention to that. That is, we pay no conscious attention to it. But people who need to feel that they dominate, they don't pay attention to that subtext, they don't take responsibility for it. Through that subtext, they manipulate us.
Deb: So how do we change that?
Michael: Well, what we think is the way to go about it is to start with something that will be not confrontational but which will build an infrastructure that makes our work possible. And that thing, our opinion is, and you alluded to this, is a new, accurate, inspiring image of what a human being is.
Deb: Exactly. Right?
Michael: And of course, you are in a favorable position as a physician to do that. You have your angle, which people will respect, you know, and we have ours. And if we all kind of collaborate on this one big effort to create a better image of who we are, I think that would lift all boats.
Deb: No doubt about it, and I'm not even sure it's new, right? It's kind of who we are, right? It's just illuminating that piece, and that the culture starts to change. That's why with our Compassionate Communities, we were like, we have to inspire compassion. You can't legislate compassion.
You can't make someone do that. You have to kind of inspire something inside them that awakens to say, “Yeah, this is who I am and this is how I want to show up.” And it really takes a lot of work. It takes a lot of courage. It takes a lot of insight looking at ourselves, you know, and being willing to commit ourselves to that vision of the future or of the present. I always think of nonviolence, to me it's revolutionary. Like, it's a radical thing. It shouldn't really be that radical, but to say to people, “Can you see your own goodness and can you see the goodness in others?” is not something we often talk about.
Stephanie: Deb, in the meantime, how can people get in touch with you if they want to learn more, get involved, study with you, understand how you're going about the work?
Deb: My website, it's Finding-Health.Com. So again, the focus on health, right? Not on disease, not on things that are not working. And my email is DrDebRoman@finding-health.com. So, people can feel free to reach out to me anytime. I think I really want to say that with all openness and sincerity that these conversations are so important and if there's somebody that wants to have a conversation, they can email me or I'll give them my phone number and we can have a conversation and talk more about these things. Happy to do that.