Podcast: ‘We have to do better for our veterans’

Dr. David Shulkin on veterans' benefits, mental health care and his new book

David Shulkin speaking into microphone in podcast studio

Episode Transcript

Jacqueline Palfy (Host): Hi, I’m Jacqueline Palfy and I’m here with Sanford Health News. Today we’re talking with Secretary David Shulkin. Thanks for coming out to Sioux Falls, South Dakota to talk with us. You’ve been working for Sanford for about a year now, is that right?

Dr. David Shulkin (Guest): Yes.

Host: Tell me a little bit about how you came to come to Sanford.

Dr. Shulkin: Well, when I was in Washington, in the role of Secretary, I had the chance to get introduced to Sanford and hear about the work that they were doing primarily with genomics and their desire to help veterans and of course, that’s a passion of mine. And making that connection and being connected with such a mission driven organization like Sanford Health was really something that I didn’t forget. And so, connecting back with them and helping them continue to improve the health of people particularly in rural settings like where Sanford Health is located, but also their commitment to veterans and the military was really important for me.

Host: You have a long history of working with veterans all the way back to your dad was an Army psychiatrist. Is that right?

Dr. Shulkin: Yes, I was born on an Army base.

Host: Absolutely. So, you have been around this for a long time. And you have a book coming out October 22, is that right?

Dr. Shulkin: That’s correct.

Host: Called “It Shouldn’t Be This Hard to Serve Your Country.” Tell me a little bit about that book.

Dr. Shulkin: Well, the title of the book, “It Shouldn’t Be This Hard to Serve Your Country,” really has two meanings. The reason why I agreed to go to Washington in the first place, is because I believe that we owe our veterans, those who have put their lives on the line for all of us, the very best that this country can offer. And in too many cases, I think we’ve all seen, it’s just been too hard. It’s been hard for them to access the best health care. It’s been hard for them to access the benefits that they’ve earned, and I really believe that we need to do better than that. And so, the first meaning being that we have to do better for our veterans, and we have to make this an experience where they feel the support and the benefits that they’ve really earned.

The second meaning of it is was really my own personal experience coming from the private sector and raising my hand when first President Obama asked me to help fix the VA and then President Trump asked me to stay on and be his Secretary for Veteran Affairs. I was a private citizen and said I believe in public service and believe that I owe it to the country to be able to give what I can offer. And it’s not always an easy experience and quite frankly, I worry about the willingness to go and to serve in public service. And I believe we need that to have a strong country. The people that are most competent to go and to lead these organizations. So, I believe that we need to make public service a more welcoming environment and one where people can succeed and do well for the country and then return to the private sector and go back to their normal lives.

Host: And that’s sort of exactly what you’ve done. You are back in the private sector now with Sanford and as you said, you came in partly because of this interest in genomic medicine. You know when you go into public service, you bring the lessons you learned in the private sector and now you are back in. What did you learn from being in the public sector that is able to help you help Sanford?

Dr. Shulkin: Yes, surprisingly I thought it was going to be all the lessons from the private sector I’d bring to the public sector. But I learned a great deal being in the Department of Veteran Affairs that now I think is very applicable to those that are working in health care in the private sector. And I think primarily, it is looking at a person’s health in a much broader view than I ever did as a private sector CEO and as a physician. I looked at the physical needs and the physical concerns of my patients. And in the Department of Veteran Affairs, it was a much broader view, where it was not only the physical, but it was the psychological, the spiritual, the economic, and the emotional aspects of being well and healthy.

And I think it’s that broader comprehensive view of looking at a person’s well-being that really is so impactful. And that brings you to looking at not only the healthcare system but really what we now call the social determinants of health and the environment and the community that people live in and whether they are connected with other people. And whether they have the right food sources and transportation and feel secure in their housing. Because it really takes that whole combination of looking at this in a comprehensive approach to really impact people’s lives.

Host: And you might see that as a physician if your patient can’t get to appointments or is struggling to pay for a medication. But once you are in the public sector and you can see all the different ways that you can influence that, right, so, when you come back, you can help sort of drive that conversation in a different way.

Dr. Shulkin: Yeah, I think that unfortunately, when you are in the health care system in the private sector, you’re very limited by what you are reimbursed for by this insurance system and it keeps you very focused in this physical silo. And I think that what we really need to do is to understand the interconnectedness between all of these systems and still today, when you look at what’s the strongest predictor of whether a patient is going to do well or not, if they have an illness, it’s their zip code.

And so what that says is, is that it’s not just the science of medicine, it’s really the environment that people live in. And when you think back to veterans and you think about what they’ve gone through and the situations that they’ve had to endure in some cases; you can begin to understand how complex it is to improve their lives.

Host: And how each one would have different needs based on where they are.

Dr. Shulkin: That’s right.

Host: Where they are as people and where they are geographically can have a huge influence on that.

Dr. Shulkin: Yeah. And of course the military is a very diverse environment. Forty-five percent of veterans live in rural areas. And it’s made up of really who this country is. It’s a complete reflection of the diversity of our country.

Host: With such a huge segment made up in rural areas, that’s the great opportunity for Sanford Health to really, as a large rural healthcare organization, to focus on, on veterans and one of the things we’ve done is with the Sanford Chip is pharmacogenetic testing. I know that you have talked a lot about reducing the stigma around mental health for veterans and we know it’s a common statistic that 20 veterans and one active service member die each day by suicide. Is that something that the Chip is able to help a little bit with, we hope right? Testing for which antidepressants will work best and how to help people feel better faster.

Dr. Shulkin: Yeah, the statistics that you talked about with so many veterans and active military taking their life through suicide is really staggering and alarming and it was my single highest priority as Secretary to begin to address that. And the Department of Veteran Affairs still has that as one of their highest priorities.

If there was a simple solution to this, it would have been done before. So, it’s not a matter of necessarily just finding what drugs work; unfortunately, so many people who take their lives are isolated and don’t reach out and get the help that they need. So, the first priority is really connecting people that are experiencing emotional distress, connecting them with people who care and help. And the Department of Veteran Affairs is certainly always there to be helpful, but of the 20 veterans a day that take their life, just six are getting care in the VA system. So, you have 14 a day who are out in the community and my fear is that they are not connected at all.

So, we have to work with organizations like health systems like Sanford Health but also community organizations and churches and veteran’s service organizations all working together to identify how do we connect people who need the help.

Host: Absolutely. What have you been doing with Sanford to try to drive some of those conversations?

Dr. Shulkin: Well I think Sanford Health has had a very strong commitment to the military and to veterans. Since 2016, Sanford has seen 55,000 veterans in their facilities and in their clinics and that’s making a big impact for this part of the country, no doubt. But the commitment is to do more. And so as you’ve said, Sanford has reached out to the Department of Veteran Affairs and is now offering it’s genomic chip, the Sanford Chip to veterans to help them get the very best personalized medicine that they can. A lot of that is around finding the right drugs and which medications are going to be the right fit for an individual veteran.

But there’s a much larger commitment in terms of its research program, trying to help on those areas that are important to veterans and active military as well as being a good employer. Because when veterans get out of their active military duty, finding the right successful career and job is so important to making sure that they have a good transition back into civilian life.

Host: And Sanford has I know worked really hard in the past few years to recognize that veterans on staff — we’ve opened a veterans lounge for members in the hospital and then even just you’ll walk around any of our buildings and you’ll see folks with their ID badge on with a tag that says veteran and it’s such a wonderful way to be able to look at your coworker and recognize them and have them know that you are grateful.

Dr. Shulkin: Yeah, these are really relatively simple things to do but they do reflect as you suggest, a respect and a welcoming culture to those who have served, and I think that that’s so important and people know when they experience that type of culture.

Host: And as you said, one of the things is to make sure people feel less alone and that they feel connected and letting people know, maybe there’s another veteran here if I’m feeling lonely I could talk to or having that sort of front and center may help someone reach out or a patient reach out and say to a staff member, I see that you are a veteran too.

Dr. Shulkin: That’s right.

Host: Your trip to South Dakota is almost over here and I know that we’ll be hearing a lot from you especially about the book you have coming out in October.

Dr. Shulkin: You know I’m not so focused on that. I’m focused on making sure — I wrote the book primarily for two reasons. One is that I believe so strongly that we need to continue the momentum that we’ve seen in the last couple of years to improve the system for our veterans and this is a book about the progress that we’ve been making but also a plan for the future and how we can continue to make sure that the Department of Veteran Affairs is a sustainable department that’s meeting its mission to help veterans.

And then secondly, to encourage people to understand the importance of public service and why we need people who are willing to raise their hands and go and help the country in important areas all throughout the administration and throughout the government.

Host: Well, I think that it’s important to have the conversation and to have it out there in the public and we are looking forward to hearing what you have to say about that and working with you in the future.

Dr. Shulkin: Great, thank you so much.

Host: Thanks for coming.

Dr. Shulkin: Thanks.

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Posted In Innovations, Veterans

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