Monthly Memos

Health-Care Costs And The Relationship 'Virus'

Charles I. Mundale
Executive Director of MCCR

August 1992

"When the file gets two inches thick,
we know we aren't dealing with the real problem."
--Twin Cities health-care official at MCCR seminar.

When a person goes to the doctor, symptoms are the focus of attention -- and often the target of treatment. Yet, doctors in increasing numbers are concluding that many of the physical symptoms they see are the result of problems their patients are having with other people in their lives. In one study, family practice physicians and pediatricians estimated that 60 percent of their patients have relationship problems -- more often at work than at home!

The symptoms of these relationship problems are varied and sobering: chronic digestive disorders, headaches, loss of weight, obesity, chronic fatigue, sleep disorders, susceptibility to colds and low-grade infections, and depression. In cases where violence is involved, bruises, black eyes, cuts, and broken bones. When such problems occur, the bottom line takes a double hit: lower productivity and higher health-care costs.

Under the country's present health care system, doctors are paid to deal with these symptoms. They are not paid to treat causes and, in most cases, are not in a position to do so. Like any system, our health-care system provides incentives to continue present practice, to perpetuate itself.

Recent surveys in the Twin Cities reveal that the workplace is a major source of relationship problems. The stress resulting from such relationships is a direct cause of the physical symptoms that show up in the doctor's office. The doctor can treat the symptoms but under present arrangements cannot affect the cause. So the file grows slowly toward the two-inch "epiphany" point, and the bills add up.

In all the discussion about this country's rising health-care costs, very little has been said about the current system's costly clumsiness in dealing with link between stress and physical disorders. Why the silence?

Evidence presented at MCCR's seminar on "Counter-Productive Management" in late June strongly suggests that we are silent because we fear to speak the name of the root problem: abuse. To characterize a significant portion of what passes for management and supervision as abuse is to pose a blunt threat to those involved -- a threat made all the more ominous by the protocols of hierarchy.

"It doesn't happen here!" is the immediate, reflexive response. Maybe not. But the accumulating evidence counsels every CEO worried about the company's health-care costs to take another look. The "virus" is often in the organization.

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