WORKWEEK

The general rule of thumb is not to talk politics at the Thanksgiving dinner table. But what about healthcare?

Rule #1: There must be more than one person participating in the discussion.

Healthcare is inherently political. So, any discussion about a healthcare topic can get quite heated. I remember last Thanksgiving. I had one heated argument about the pros and cons of universal healthcare coverage. However, I realized after 10 minutes it was just me talking to myself…

Rule #2: Find a transition point in the conversation to discuss healthcare.

Make sure you catch the vibe when you’re at the dinner table. This year will be particularly interesting because of the current events: the House is now red, Trump announced his presidential candidacy, Elizabeth Holmes is going to prison, RSV/Flu/Covid are spreading through communities like wildfire, Musk took over Twitter, etc, etc.

I know this may be obvious, but it’s worth reiterating: if everyone is chatting about how Elon Musk is destroying Twitter, don’t barge in saying, “can we please discuss the efficacy of patient satisfaction surveys as a measurement of high-value care?”

Instead, find a way to direct the conversation to the healthcare topic you desire to discuss. For example, “can you believe Musk fired 50% of the Twitter staff? It’s kind of like how all these health tech companies are laying off 20% or more of their workforce.” Boom. Smooth transition into how health tech companies were overvalued and over-hired in 2021.

Rule #3: Don’t choose a boring healthcare topic.

No matter how excited you are to bring up a healthcare topic, please keep in mind that no one in the family wants to talk about something boring. While the work being done on the ACO REACH model may be exciting to you, talking about it will put your family asleep. So, make sure you have a compelling topic in mind to guide the conversation.

Perhaps the most boring things in healthcare excite you, but you’ve lost touch with what healthcare topics excite the average family member. Here are five topics to avoid talking about:

• Any payment model (FFS, ACO models, MSSP)
• The latest digital health funding trends
• The insolvency of the Medicare Trust Fund
• Why your pre-seed mental health startup is going to revolutionize healthcare
• Inflation

Here are five topics to consider talking about:

• Pros and cons of universal healthcare in America (must have one college student involved in the discussion)
• Do high drug prices offset innovation costs?
• Why CMS is decreasing physicians’ reimbursement despite rising inflation
• The efficacy of continuous glucose monitoring in people without diabetes
• Is Pfizer right to 3x the price of its Covid-19 vaccine for private insurers?

Rule #4: “I did my research”

If a family member challenges your stance, repeat the words “I did my research,” even if your research was reading one of my Twitter threads.

So now you have the hot topics to bring up and the boring topics to avoid at the Thanksgiving dinner table. There’s always a tiny chance that someone like Uncle Joe, a fitness freak, catches you off guard with his continuous glucose monitoring knowledge. Stay calm if he challenges you.

Rule #5: Is it getting heated?

Pay attention to how heated the conversation is, and divert to a more neutral topic if possible.

Sometimes, the conversation gets heated, but you may not notice since you’re so fired up. You should, therefore, know how to recognize a conversation is getting heated. The most specific test (tested and validated by the Dashevsky household) is table occupancy. If your table occupancy decreases by two or more during the course of the conversation, then it’s getting heated. Those two people left the table because they were uncomfortable or bored by what you and Uncle Joe discussed and argued about. When this happens, you must divert to a more neutral topic:

• Healthcare spending is out of control.
• Why does it take so long to see my dermatologist?
• Can you believe how long Aunt Sue sat in the emergency department?
• Why is cousin Sarah working so much as an internal medicine intern?
• Who is Hasbulla Magomedov, and why does he look like a baby?

Rule #6: There will never be a resolution to an argument about healthcare.

Since no healthcare problem will ever be solved in our lifetime, considering how slow things are to get done, there will inherently be no resolution to the argument/conversation you’re having. “Was this a waste of a conversation?” you may ask. No, not at all. Even without a resolution, there’s high value in discussing essential healthcare topics.

Rule #7: Do not send a follow-up email

At this point, dessert is being served. Your siblings and parents are now uninterested in discussing healthcare, no matter how provoking the topic may be. You may be tempted to send a follow-up email to your family tomorrow morning, recapping the topics discussed, who said what, and what the final outcome was.

Please don’t do this.

Instead, tell your family members—especially the physicians—to join Healthcare Huddle.

So there you have it. Seven rules to follow to have a pleasant conversation about healthcare at the Thanksgiving dinner table.

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