The film Escape Fire explores what's fanning the flames of the health care debate. Credit:

By Ashley Yeager

Imagine lighting a match to protect yourself from the flames of a fire.

It’s probably not the first thing you would think to do to stop from being burnt. But when there’s no other escape, the technique works. In 1949, Robert Wagner Dodge became living proof when he lived through the Mann Gulch fire by setting his surroundings on fire.

Now, his actions have become a metaphor for drastic ways government and industry should change U.S. health care before it too burns everything in its path.

Escape Fire: The Fight to Rescue American Healthcare showcases the health care system’s metaphorical blaze. The award-winning documentary, described as the “Inconvenient Truth” of the health care debate, opens nationwide in October. But members of the Duke community saw it for free on Wed., Sept. 19. They were also able to participate in a post-film panel discussion, which fleshed out a few potential escape fires for the health care industry.

“I think working with one patient at a time can help everyone become healthier,” said Annie Nedrow, a primary care physician and the associate director of Duke Integrative Medicine, which sponsored the event. But as the film points out, the current system rewards doctors for the number of patients they see, not the amount of time they spend with each person or the plans they may develop to help that patient prevent and manage disease.

Ironically, almost 75 percent of health care costs are spent on preventable diseases. The film, directed by Matthew Heineman and Susan Froemke, illustrates this statistic through anecdotes, where a band-aide, pill or even invasive surgery, such as inserting a stent to relieve heart blockages, provides immediate relief but does nothing to address the underlying causes of illnesses – typically diet and lifestyle.

Preventable diseases are 75% of our health care costs. Credit:

“There’s got to be a shift in our culture, one where we actually have access to safe parks to exercise, healthy food, and the time to eat it,” said Adam Perlman, Duke Integrative Medicine’s executive director. He also agreed with Nedrow that a new system should invest more in primary care and health promotion, rather than disease treatment.

To set an example and test the feasibility of such a system, Duke Integrative Medicine has opened a primary care practice that limits the number of patients each physician sees so the doctors can spend more time with each patient and create a more holistic approach to that person’s health.

Perlman said that health coaching could be another important aspect of correcting the healthcare system. He explained that doctor X might tell a patient to lower his blood sugar, doctor Y then tells him to lower his blood pressure, and all the patient really wants to do is dance at his daughter’s wedding. “A health coach helps the patient reach those bigger goals by connecting the dots and helps them execute the plan to get there,” he said.

The film and remarks prompted many audience members to question what it would take to change the current system. Nedrow, who said she has been inspired by books on creativity and innovation, suggested that it was dialogues like the one they were having that could ignite change to repair the broken model of health care or create a new system.

More innovation, however, may mean that more people need to step into the fire and strike a match, rather than run and try to dodge the flames.