By Melanie Padgett Powers, writer

In classic literature and mainstream movies, the lead character is often on a “hero’s journey,” which involves adventure, crossing the threshold into the unknown, trials and failures, and temptations. Sometimes there is death and rebirth and eventually a revelation with knowledge, atonement and a return to the ordinary world.

The US health care system has been going through a hero’s journey, said Zubin Damania, MD, at the at the 2023 APHL Annual Conference May 24 “Dr. Katherine Kelley Session.” Damania is a former hospitalist who performs as ZDoggMD, creating music videos, original songs and parodies about health care in the US. His videos have more than a billion views across Facebook, YouTube and Instagram, and he also hosts the podcast The ZDoggMD Show.

Damania brought his comedic wit, rapping skills and videos to the closing session of the APHL conference, as he described the evolution of the US health care system and outlined his vision for Health 3.0.

He started by pumping up the crowd a rap honoring laboratory professionals, while his music video — shot in a laboratory with hospital staff — played on the big screen. Afterward, he shared that his hero growing up was Weird Al Yankovic, the musician who writes and performs parodies of popular songs.

However, Damania is the son of two Indian immigrant physician parents — his dad was a primary care physician and his mom was a psychiatrist. So, in high school, telling his dad he wanted to be an artist like Weird Al was not going to fly. In Damania’s retelling, his dad said, “Being a professional clown won’t put naan on the table. Come to my clinic, see what I do, and then you will see what you’re going to do.”

Luckily, at the clinic, Damania was intrigued by his dad’s interactions with his patients. He now describes this as Health 1.0, a time before managed care when health care was about relationships, taking time to care for patients, intuition and listening.

“This was the cottage industry of health care in that era in the 20th century,” Damania said. “And I really deeply fell in love with it. But it had its downsides, which we all know, right? It’s kind of a fee-for-service mill where supply creates demand. It was truly a patriarchy. … This had a lot of shadow, this Health 1.0, and part of the shadow was this overall repression of the suffering that it was generating.”

Then, the health system went on a hero’s journey, a call to adventure: “We need quality. We need a better electronic health record because we can’t read my dad’s writing, and we need measures to understand whether these things are actually happening in a good way,” Damania said. “That was called managed care and other things, and I call it Health 2.0.”

Those in power decided that using the technologies and systems of business would create an affordable, effective health care system for populations and individuals, he explained. This included “the carrots and sticks of incentives, pay for performance.”

He continued, “Let’s make an electronic health record that can get us to get all the data, analyze it and then do the right thing. How has that worked out for us? … The electronic health record, it turns out, was an electronic cash register that couldn’t talk to the cash register across the street. … We’ve turned the beautiful human relationship of [Health] 1.0 into a commodity, into an assembly line where the inputs are humans and technology, and the outputs are purportedly health, but we’re all turned into commodities.”

The Elephant and Rider

Damania shared the analogy from psychologist Jonathan Haidt about the elephant and the rider. Haidt said human brains have two sides: the emotional “elephant” side and the analytical, rational “rider” side. We think the rider is controlling the elephant, but it’s really the other way around. And this illustrates the challenges with behavior change — including how the health system works (or doesn’t) and how individuals respond to recommendations that would improve their health.

After this realization, Damania secretly created ZDoggMD to try to motivate behavior change through music and humor. The jig was up with his Stanford supervisors, though, after he appeared on the local news for his song “Manhood in the Mirror” about self-exams for testicular cancer, a parody of Michael Jackson’s “Man in the Mirror.”

After singing the hilarious intro to the song for the APHL audience, Damania said, “Joking aside, we’re on to a formula here that in order to motivate people, especially in public health, you’ve got to move their hearts and then direct their consciousness.”

This led him to write a song about speaking to your loved ones about your end-of-life wishes. No humor here. It’s a melancholic, yet truth-filled, song set to the tune of “Love the Way You Lie” by Eminem and Rihanna.

After Damania sang and rapped the song for the audience, he explained how he used the elephant-rider concept to motivate behavior change: Toward the end of the song, he sings, “It always seems too soon, until it’s too late,” which is directed toward our emotional elephant side. Then, he followed that up with one directive: “Talk about your end-of-life wishes now with those you love.

“That’s all. No living wills, none of this stuff,” he said. “Just start with that. So, move the elephant, gently direct the rider.”

Taking the concept further, he explained that Health 1.0 that his father practiced was the elephant side of medicine, while Health 2.0 was the rider. Damania believes that we can bring about a better Health 3.0 by combining Health 1.0 — beautiful relationships, clinician leadership, less politics, less bureaucracy — with Health 2.0 — quality, technology, processes.

“So in the end, the hero’s journey is us waking up, that if all our elephants stampede at the same time, whoa, it would change everything. … We have a lot to do, but it’s happening. We’re waking up. We can do it. We have models to help us do it. We have motivated people who care. The pandemic taught us a lot about what should and shouldn’t be done and why this understanding of human behavior is crucial.”

Damania ended his presentation with a huge thank you to the public health laboratory community: “Thank you so much for everything you have done and continue to do for the health of other human beings and this population of Americans that desperately need you. They need your hero’s journey. They need you to show up authentically as who you are.”

Melanie Padgett Powers is a freelance writer and editor specializing in health care and public health.

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