Change the healthcare paradigm from disease management-centric to preventive/lifestyle-centric. Right now we are in the pattern of naming the disease, suspecting the bug, and writing a prescription. We are hypoing the hyper, and hypering the hypo. There is no notion of seeking balance. There is no focus on discovering the real issue in the patient sitting in front of you. The chemical model is good, but it’s not the whole story. There are so many factors that affect the individual: mental health including attitudes and beliefs, environmental factors, societal support, diet, physical activity.
As a part of my interview series with leaders in healthcare, I had the pleasure to interview Dr. Gil Weiner.
Gilbert Seth Weiner was born into the baby boomer generation in Brooklyn, New York to hard-working middle class parents of Russian and Austrian descent. On the eve of the 1960’s they moved, as did so many, to the island across the city, Long Island.
Fast forward and as an undergraduate at Hofstra University, Gil played football, was in the ROTC fraternity, played guitar in a band, and worked all kinds of odd jobs to put himself through college most notably as a NYC taxi cab driver and as a hypnotist helping people quit smoking, among many other undesirable behaviors. Directly after graduation, he attended and graduated from New York Chiropractic College in 1978. He married his college sweetheart Vicky, who was originally from Cuba and due to the Castro regime, her family was living in exile in the sunny U.S. territory of Puerto Rico. He and Vicky, tired of the cold after the infamous blizzard of 1978 decided to move to Puerto Rico to raise a family and begin his chiropractic career.
It was the classic fortunate case of being in the right place at the right time. Upon arrival on the island, Gil was pleasantly surprised to learn there were only a dozen chiropractors on the entire island and they were older and nearing the end of their careers. Gil opened his first practice in Guaynabo, the island’s affluent “suburb” on the outskirts of San Juan. Being one of the few up-and-comers provided him with many opportunities. He pioneered corporate wellness programs working as an industrial consultant for TII Industries, Thomas & Betts Inc., and Eli Lilly.
The opportunities continued to flow treating members of the Federation of Tennis, Ballet de Concierto, Ballet de San Juan, members of the Puerto Rico Olympic & Triathlon Teams, and the Puerto Rico Miss Universe pageant including Dayanara Torres, the 1993 Miss Universe winner. Partnerships with the major local hotel chains followed and he was called to treat their high profile guests such as Yanni and his orchestra while on tour, tennis great Yannick Noah, among others.
As part of a group of three chiropractors, Gil was instrumental in establishing the first chiropractic department at a hospital in Puerto Rico, and one of the few in the U.S. that performed a new procedure called Manipulation Under Anesthesia.
Gil taught anatomy and physiology at The Interamerican University School of Nursing and with his 6th degree black belt in Japanese Jiu-jitsu, taught for years at a dojo and at Northeastern University upon moving to Boston in 2008.
He had his own local access Spanish-language TV show, “Cuidate” (Take Care) where viewers were introduced to local specialists discussing the health issues of the day and over the years he appeared on various TV and radio programs in Puerto Rico and Boston.
Gil sold his practice when he left Puerto Rico and worked as an associate chiropractor managing a practice in Jamaica Plain, MA until recently. As his final swan song before retiring, he has now launched Humanistic ChiroCare Consultants (HCCC), a multi-service firm offering virtual and onsite consults in Roslindale, MA and Framingham, MA for individual patients, onsite corporate wellness support for local corporations and businesses, as well as insurance claim, independent medical examinations, and patient advocacy support for attorneys and imaging centers.
Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?
I knew I wanted to work in the health field. So while at university I volunteered at a local VA hospital in the physical therapy department. I found that to be limiting. Back then there was no doctorate in Physical Therapy (PT), so the scope of practice was limited. I took a job as a nurse’s aide (an orderly) at a rehab center. I was shocked by the case management. People were over-medicated and actual Occupational Therapy and/or PT was negligible. There was one patient in particular who was becoming very stiff and was declining physically. Discussing this with the attending physician it was decided to increase his exercise activity. After two weeks I advised the physician that due to the medications (Thorazine) the patient was receiving, he could not even get out of his chair long enough to perform exercise. So, the physician cut out the exercises and left the medication. I was disillusioned with the misdirected priorities. The patient being immobile continued to decline. He was dead within two weeks. I was disenchanted with the field until I met the local area chiropractor. I shadowed him around in his office and I saw how he made significant positive changes in his patients’ lives with virtually no side effects. I knew this was the path for me!
Can you share the most interesting story that happened to you since you began leading your company?
At the height of my career, I managed a three office practice across the metropolitan area of San Juan. One that comes to mind of the many interesting stories over the years, concerns a motor vehicle collision case. It is always satisfying to advocate for a patient, but in this case the insurance company was arbitrarily cutting off the patient’s treatment very early on based on a report written by a doctor who was one of their hired pistol. We were able to examine the patient, document the injuries, and explain how the established standards of care apply to the case. We were able to have the insurance company overturn their decision and reinstate the needed treatments to the patient. This allowed for a successful resolution of the patient’s condition. The monetary equivalent of this decision when you include the treatment itself, impact on lifelong wages, and ongoing treatment costs was in the millions.
Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?
Initially like most startups, you cast a wide net and see what sells, so we offered a wide variety of products and services. This opened us up to a plethora of scammers, spammers, and trolls. The funniest mistake was that initially I treated a couple of nuns at no charge and very quickly word got around to the city’s convents. One day my wife walked into my waiting room and it was completely full of nuns! I am still a big fan of veteran and senior discounts, but offering service at no charge to anyone who is not a family or friend is never advisable. We learned the hard way.
What do you think makes your company stand out? Can you share a story?
After conducting some market research, I found that there is an under-utilization of third party evaluations by patients and attorneys, while the insurance companies employ these resources all the time. Another factor that makes our company stand out is our foundational value of humanistic care. The individual is formed and either thrives or is diminished by many factors that affect one’s health. The evaluations I use encompass the seven realms of life; Body, Lifestyle, Spirit, Mind, Environment, Emotion, and Society. All of these factors affect the health of an individual. Some are intrinsic and some are extrinsic. Some are more easily changed than others but all are equally important.
I recall the case of a woman who came to my office complaining of arthritic pain, malaise, and a debilitating lack of energy. She had all the standard lab work done and x-rays performed by specialists. Her appearance was that of an elderly woman; white hair, dull eyes, a hunched posture, multiple areas of pain on examination, and rigidity of movement. We began treating her with a series of chiropractic manipulations. However, on further evaluation we found her to have an extremely sedentary lifestyle devoid of any exercise or movement therapy. Her diet was very limited and seemed to center around Coca Cola and fast food. She had a very good social support system consisting of an understanding husband who appeared anxious for her to get better and she had a church group she participated in that seemed supportive. The patient’s own desire to improve was genuine. We suggested she eliminate all sugar and soft drinks from her diet. She was also encouraged to join a local senior yoga class. The patient returned a month later completely transformed. I almost did not recognize her. She was walking upright with a spring in her step. Her eyes were bright, her skin was healthy looking, she talked with a new excitement about her daily activities. She appeared years younger. Her husband was in tears, thanking me for bringing back the wife he had once known. These changes were profound and life altering.
What advice would you give to other healthcare leaders to help their team to thrive?
The most necessary piece of advice I would give is perhaps the most difficult to implement; embrace change! The medical establishment has an institutional history of being slow to change. There is a rigidity and an attitude of not bucking the system built-in since doctors go through medical school. The healthcare professional needs to stay inquisitive, questioning when interviewing the patient, and when evaluating the patient. This way, by challenging oneself daily, thinking out of the box, one can stay engaged in the process and we would see less doctor burnout and more patient satisfaction.
The advent of tele-medecine and online review websites of doctors are game changers. The consumer is seeking concierge-like services, convenience, and a positive customer experience. The pandemic has forced many industries to go remote. All of these are disruptive changes that are forcing medical professionals to re-evaluate their entire business models. What we plan to offer at HCCC through virtual services to supplement onsite treatment is the future.
Ok, thank you for that. Let’s jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?
This study is very interesting, but it’s nothing new. This has been going on for at least the last 40 years. It gets retreaded every election cycle. The idea that the government can or will fix this is ludicrous. One just needs to look at the waste, overspending, and poor patient care in the Medicare and VA systems to see that the federal government is not efficient. The issue with our private health care industry is that while equipped to do what the government cannot get right, the fact that it is profit-driven means they are not incentivized to be better for the consumer or to solve medical issues, but rather treat them.
The number one reason the U.S. is ranked so poorly is due to the overriding idea within the U.S. government that any problem can be solved by throwing more money at it. We see this in all spheres of government, as well as in corporate and in the private lives of a vast majority of the citizenry. If you are going down the wrong road, changing your hybrid-compact for a Lamborghini will not get you to your destination any faster.
In the U.S. we do not have a healthcare system, we have a disease mitigation system. The modus operandi is to diagnose and label, then prescribe pills or services. This idea is pervasive in our culture. A pill for every ill. There is so very little attention and money dedicated to prevention. We are so forgone that preventative treatment in this country is labeled as alternative treatments or viewed as hobbies for the educated consumers who do seek out healthy lifestyles.
The word prevention has been more prevalent in the zeitgeist more recently, but it’s only lip service serving as good sound bites in the vast ocean of discourse. The concept of prevention itself is still poorly understood among healthcare professionals. Prevention should be all about a healthy lifestyle and that should be the focus of physical education in schools. There needs to be serious attention given to diet and exercise. To lower Cholesterol in the US prevention is considered the early use of statins, the class of lipid-lowering medications most commonly used to lower cholesterol, with very little questioning as to why the cholesterol is high in the first place. Lifestyle is key. The top causes of death in the U.S. and the priciest to our healthcare system are all related to how we eat and how much we exercise: heart disease, diabetes, obesity, and arthritis.
The other biggest issue in the U.S. is the manner in which the healthcare provider is remunerated for service. In other countries when a doctor gets patients to lose weight, stop smoking, or lower their insulin through diet and exercise, they receive bonuses. However, in the U.S. doctors are incentivized with cash, vacation getaways and other goodies for prescribing remedy and saving the healthcare company money by restricting patient services.
You are a “healthcare insider”. If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.
Change the healthcare paradigm from disease management-centric to preventive/lifestyle-centric. Right now we are in the pattern of naming the disease, suspecting the bug, and writing a prescription. We are hypoing the hyper, and hypering the hypo. There is no notion of seeking balance. There is no focus on discovering the real issue in the patient sitting in front of you. The chemical model is good, but it’s not the whole story. There are so many factors that affect the individual: mental health including attitudes and beliefs, environmental factors, societal support, diet, physical activity. Did you know that simply increasing your exercise level will actually change the microbial makeup of your intestines? And those microbes in your gut supply energy to every cell in your body?
We need to change the medical establishment and education in this country to embrace, not ridicule “alternative” therapies to produce forward-thinking physicians. Right now there is a small movement to consider alternative healthcare. However, until this is taught in medical school it will remain an unconventional alternative. There is no real appreciation for alternative care. In most cases alternative or intergraded care means adding some physical therapy to the treatment. In some very few places they will add some mental health counselling, and in even fewer places maybe acupuncture. As long as orthodox treatment frowns on and does not fully buy into acupuncture/meridian therapy, chiropractic, yoga, meditation, cognitive behavioral therapy (CBT), and real nutritional guidance as the baseline self-care daily practice for being a human being, there can be no real intergraded or interdisciplinary treatment. Until very recently for example there was a huge pushback against the use of cannabis as a therapy. There are still physicians in positions of influence, who are more comfortable utilizing heavy narcotics than prescribe a cannabis-related drug. In some parts of the U.S. the physician could lose hospital privileges for such an action.
Change the attitude of the third-party payers of healthcare. Creating a government healthcare nirvana is not going to happen. Medicare, the VA system, and the medical insurance industry need to change from one of patient adversity, to a system of patient advocacy. These third party’s need to see the patient as their reason for existence to be offered help and service. Even the name “Gatekeeper” has a negative connotation as keeping one out. This is where I see us at Humanistic Chirocare Consultants well-positioned. We are dedicated to understanding the cause of the patient’s condition and then advocating for the patient to be sure they get the treatment that they need. My goal is to partner with others across the country who feel the same way I do and acknowledge the issues so that we can consult with private and government entities to enact the change needed.
The change as I mentioned before, must be made in the manner in which the physician is paid. What is he/she paid to do? Perhaps treatment outcomes should be a consideration. Medicare has just begun this system of outcome measures. Not surprisingly, it affects mostly non-medical physician treatment such as physical therapists, chiropractors, and occupational therapists. The medical profession has side-stepped this affecting their own remuneration thus far. Do you have any idea of how many failed lower back surgeries there are each year at 20,000 dollars per surgery? According to a large study from the University of Cincinnati College of Treatment there is a resounding 74% failure rate! It also suggests that you have a 257% better chance of returning to work IF YOU AVOID SURGERY in the first place. These outcomes illustrate the overall issue of pushing surgery when other options abound and preventative measures would likely have avoided the problem from ever developing.
Change must be made in the manner in which the public is educated concerning health. The U.S. is one of the only countries that allows the pharmaceutical companies to advertise in the media and on TV directly to the public. This perpetuates that a pill for every ill is the solution and that health is only a concern once you suffer from an issue. Even worse, over time new conditions have been labeled so that medications could be sold, i.e. restless leg syndrome, sleep issues, etc. How about we teach people that they don’t need to over-caffeinate and should limit their screen time and not use the phone before bed?
Drug advertisements constantly show us that a string of side effects are more devastating in many cases than the original ailment. Our public is not only bombarded by we have a pill for that, but the ads show the person suffering from something and before the 60 second spot is through, she is happy and smiling. What message are we sending or implanting in the minds of the public? The patient is now primed to go to their doctor and request or suggest a medication. When people do not feel wonderful in one day, they are off to a second opinion who may comply with their request.
Ok, it’s very nice to suggest changes, but what concrete steps would have to be done to actually manifest these changes? What can a) individuals, b) corporations, c) communities and d) leaders do to help?
This could be a question for a PhD dissertation, but I appreciate the question. As you now have gotten to know me, you know my entire approach is not just to diagnose a problem but recommend a holistic treatment plan! First we need to identify who the leaders and decision makers are. The politicians in D.C. are not leaders, they are our representatives. They are supposed to do what their constituents want and need. They should not decide what we want and need. Since most are not health professionals, they rely on medical experts which in many cases are not acting of their own volition as they are lobbyists and working for big pharma looking to maintain the status quo. They have voted themselves a great Medical Care system outside of what the everyday citizen has. They have no motivation to push for change, as they say, no skin in the game. We must remove the big money players from the equation. There will probably need to be a grassroots movement as we see the powers that be are too invested in the old system to be trusted to make any significant changes. The youth today are getting involved in the areas of social justice, the environment, and pistol ownership. Police brutality, LGBTQA rights, and school shootings have impacted them and change is coming because of their activism. The problem is that people do get motivated on these causes but as it relates to healthcare, no one is ever concerned with it until they get sick and by then it is too late. For the first time ever, because of the COVID-19 pandemic, everyone is being impacted and we really need to act now to enact any change.
Public health doctors and their patients need to step up. This is their time and move their communities to become more active in healthcare policy. The saying that all politics is local has never been truer than when concerning healthcare. The needs of certain communities and certain areas in the country are different. Costs tend to be different by area hospitals across the country. Certain health issues are more prominent in certain parts of the country. The problem is complex and the best solution must mirror the problem. People and their communities should push the representatives at the local level to institute changes to make the healthcare system more responsive to all the individual health needs. Creating community parks with activities for exercise suited for all from babies to the elderly are needed as well as family fitness programming at community centers need to be funded. Comprehensive mental health treatment needs to be implemented.
The communities can channel the activist momentum from legislating against plastic straws to legislating that donuts, coffee, or a Big Mac and Coke should not cost less than healthy food such as salads and fruit. On the state level instead of boycotting businesses for the way they think, maybe strong action can be taken to persuade local businesses to change the way they act. A large group of people get their healthcare insurance through their place of work and have very little input into what the coverage is comprised of in the plan. These types of changes tend to trickle up. Local and then state policies become national policies.
I’m interested in the interplay between the general healthcare system and the mental health system. Right now, we have two parallel tracks, mental/behavioral health and general health. What are your thoughts about this status quo? What would you suggest to improve this?
Actually, these two tracks have twisted and turned throughout history and have very rarely intersected. Historically, insinuating that a condition was a mental issue, “it’s all in your head” was writing the patient off as a faker or insane. Then all disease became bug-related. Now it has evolved to be bug/chemical-related. The spiritual/psychological/behavioral aspect of the patient is not generally considered until of course, the treatment fails, then it’s the fault of the patient or again all in their head. Only now are there a few institutions actively pursuing a treatment dealing with the entire person as a holistic approach. This includes self-reflection/meditation and behavioral attitudes through CBT. There needs to be an appreciation that a person may be affected by many factors creating a weaker individual thus allowing for breakdown in their biological systems. This happens in the physical realm with posture and mechanical factors but the manner in which one thinks will affect the way one sees the world, and oneself. They are intertwined so as a person with depression might exhibit certain posture and sensory experiences. Studies have shown that when healthy individuals assume these same postures and sensory changes become to feel depressed. The psychosomal connection and continuum is real and demonstrable.
How would you define an “excellent healthcare provider”?
An excellent healthcare provider is like a teacher whose intent is to help the patient attain a healthy, quality life. It should not be to make a lot of money. Any excellent professional who works with the public with a body of knowledge like all the examples above, listens to their “customer”, thoroughly integrates their perception of the problem or what they seek, and with one’s own experience and knowledge, arrives at an all encompassing personalized program in line with their goals and your own ethics and practice of your discipline.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
The most salient quote that might sum up all of my life mantras is from Hippocrates and the Hippocratic oath, “First do no harm.” I have mentioned throughout this conversation how important it is to me to help people without detrimental secondary effects. This is what led me initially to chiropractic, it led me Jiu-jitsu, the style of martial arts I chose to practice because it is defensive in nature and as well has the creed of “no challenge, no resistance, no injury”. It has brought me in the final chapter of my career to start Humanistic Chirocare Consultants. I want to be part of the process on a larger scale to be instrumental in ensuring patients are not harmed by the refusal of treatment, by the wrong treatment that harms them outright, by erroneous treatment by incompetents, or ineffective treatment that becomes, as time passes, an obstacle to the patient’s recovery.
Are you working on any exciting new projects now? How do you think that will help people?
As mentioned before, we just launched Humanistic ChiroCare Consultants in light of the pandemic and in this the last chapter of my professional life as a culmination of my life’s work to attempt to correct the wrongs I have witnessed, offer consulting to individual patients, but also to corporations for their employee wellness, and to fight the good fight against insurance companies by working with attorneys and imaging centers for patient advocacy.
We are talking with people of all walks of life in the industry and hope that with a virtual platform, we can support people in need. The ultimate mission is to switch the paradigm for the medical professional to see the person as a multifaceted organism. The Human Systems Approach, which we employ studies the seven realms of the human being; Spirit, Lifestyle, Body, Mind, Emotion, Society, and Environment.
I am not a religious person, but as a student of eastern philosophies, I agree with The Buddha who said, “If everyone would keep their own little corner of the world clean, the entire world would be clean.” The world may be a mess right now, but it has always been a messy planet and human civilization always continues and evolves to new civilizations. We still have a lot of work to do in the era we find ourselves in. I have great goals with realistic actions. I hope to stimulate conversations first in our own little corner, so thank you for this opportunity with Medium.com/Authority Magazine’s readers. Health is a universal issue. We are living in an extreme situation and it’s not just about fighting this virus or curing it. We need a healthier society, physically and mentally. The seven realms can serve as a roadmap or guideline. At Humanistic ChiroCare Consultants, our long range goal is to influence greater and greater circles of society making healthful changes to help the greatest number of people that we can.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
At the top of my book list are The Tao of Pooh and The Te of Piglet by Benjamin Hoff. These books have always helped me to better understand other people, their natures, and how to accept them for who they are. I shared these books with my son when he was a child as a way to simply assimilate these complex concepts on the level of cartoon paragons. These served as lifelong teaching and coping tools for him. We revisited them as he got older to understand the deeper meaning. During the pandemic, my son started a virtual philosophy club for kids and these books were the first they read.
The Elephant in the Brain by Kevin Simler and Robin Hanson was first brought to my attention by one of my favorite authors, Dr. Jonathan Haidt. He mentioned it in two of his books. The book has given me insight as to the best way to help patients to change their outlooks and behaviors.
Freakonomics and SuperFreakonomics by Stephen J. Dubner and Steven Levitt are two books that reminded me that common knowledge is not so common and that actually so few people possess it that it should be considered a superpower. The books have also opened my eyes as to the proper utilization of statistics and the saying that correlation does not prove causation. Very important concepts when dealing with reality.
Lastly, Made to Stick: Why Some Ideas Survive and Others Die and Switch: How to Change Things When Change Is Hard both are by the Heath brothers. These two books changed the ways I actually communicate ideas to someone and not just talk at them.
You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂
I aim to inspire a grassroots movement for universal intergraded interdisciplinary healthcare. The fruition of such a movement would free up such unimaginable resources: economic capital through saving trillions of dollars on disease that we can control through lifestyle, human capital through having workers miss less days from work due to illness and while at work be more efficient without distractions of pain or fatigue due to health issues, we could greatly reduce physical and mental suffering that stifles productivity and depletes the joy of living, reduce mental conditions to stabilize the fabric of society by supporting the nuclear family and lowering prison populations.
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Thank you so much for these insights! This was so inspiring!