Opinion | Spread ‘Aloha’ in Healthcare

I spent most of January 2024 in Honolulu — writing, working, and vacationing. With its high cost of living, scarce affordable housing, and homelessness problem, Hawaii is far from perfect, but the vibe is mostly better in this island state than on the mainland.

While ordering shaved-ice (a local favorite) at Uncle Clay’s House of Pure Aloha (HOPA), I came across the following “oath.” It was written by Clayton “Uncle Clay” Chang and his nephew Bronson Chang in 2008.

“I solemnly promise

To live every heartbeat of my life

From this day forward

With pure Aloha.

Every single word that comes out of my mouth

And every single action, be it large or small

Must first come from my compassionate heart

And be supported by my thoughtful mind.

With an open heart and an open mind

I will unconditionally love

Every person who crosses my path in life

As a fellow member of our one world ‘ohana.

If I truly do my best to do all these things

I will become the person I was born to be

Filled with inner peace and complete happiness.

Living every heartbeat with Pure Aloha

I can bring love into the hearts of others

And make our world a better place.”

The spirit of Aloha is all encompassing, including the core values or virtues of unconditional caring, personal inner peace, passionate self-discovery, courageous belief, humble collaboration, and the pursuit of excellence.

If we could live Aloha by conforming to the HOPA oath while also honoring the tenets of the Hippocratic Oath, just imagine what healthcare might look like today. The following changes could be observed:

1. Patient-Centered Care: Every patient would receive personalized, patient-centered care. The focus would be on understanding the patient’s needs, preferences, and values, and involving them in decision-making processes.
2. Preventive Medicine: There would be a significant emphasis on preventive care rather than just treating diseases. Regular screenings, healthy lifestyle promotion, vaccinations, and early detection of potential health issues would be prioritized.
3. Universal Access: Everyone would have equal access to healthcare services, regardless of their socioeconomic status, race, or geographical location. Patients and doctors would be better matched. There would be no disparities in the quality of care received.
4. Holistic Approach: Care would not focus just on treating the physical symptoms but also would consider mental, emotional, and social factors affecting health. Integrated care involving psychologists, social workers, and other professionals would be standard.
5. Technological Advancements: Advanced technologies would be fully integrated into healthcare. This includes telemedicine, artificial intelligence, electronic health records, genetic therapies, advanced imaging techniques, and personalized medicine.
6. Efficient Administration: There would be streamlined administrative processes that would reduce paperwork and allow physicians to spend more time with patients. Billing would be transparent and straightforward. Medical scribes would be commonplace.
7. Continuous Learning and Improvement: Medical professionals would be engaged in continuous learning, keeping up with the latest research and innovations. Healthcare professionals would stay abreast of the latest scientific developments and incorporate evidence-based treatments into their practice, yet still embrace the “art” of medicine. There would be a culture of feedback and improvement, with reduced medical mistakes and, in the event of error, sincere apologies to families without legal ramifications.
8. Interdisciplinary Collaboration: There would be effective collaboration and communication among healthcare professionals across different specialties for comprehensive patient care. Internecine wars between various disciplines and practitioner types would not exist.
9. Global Collaboration: Healthcare providers and researchers would collaborate globally to share knowledge, resources, and best practices. This would accelerate medical advancements and ensure that breakthroughs benefit people around the world.
10. Emphasis on Mental Health: Psychiatry would not be a stepchild to medicine. Stigma associated with mental health disorders would be eliminated, and mental health services would be routinely integrated into practice. Adequate mental health and substance use resources, funding, and services would be available for all.
11. Ethical and Transparent Practices: Medical professionals would adhere to the highest ethical standards, with transparent communication about treatment options, risks, and costs. Open and honest informed consent would be a cornerstone of medical practice.
12. Patient Empowerment: Patients would be empowered with information and involved in decisions about their care. This would involve effective communication between healthcare providers and patients, ensuring that individuals have a clear understanding of their health status and treatment options.
13. End-of-Life Care: There would be compassionate, respectful end-of-life care ensuring that patients can spend their last days in comfort and dignity. Treatment spending in the last 6 months of life would significantly decrease.

While achieving such an idealized vision may be difficult, ongoing efforts in healthcare aim to move closer to these principles through research, policy changes, and advancements in medical technology and practice.

What’s missing is Aloha. An infusion of Aloha is desperately needed to overcome challenges such as financial constraints, workforce shortages, and systemic inequities that often make it difficult to fully realize an ideal health system.

It’s important to note that many healthcare systems around the world strive to achieve these goals and have done a much better job than the U.S. without incorporating Aloha into their strategies. Can you imagine how differently medicine would be practiced today if the U.S. were to incorporate the power of Aloha?

In 1962, Aunty Pilahi Pakī (1910–1985), a beloved native Hawaiian poet and spiritual guide, shared a bold prophecy that in the 21st century, “The world will turn to Hawaiʻi as they search for peace because Hawaiʻi has the key; and that key is ALOHA.”

Aunty Pilahi’s life’s work and desire was to spread the true meaning of Aloha to Hawaiians and non-Hawaiians alike.

Emulate people like Aunty Pilahi and Uncle Clay, and help spread the meaning and spirit of Aloha. The future of the U.S. healthcare system depends on it.

Arthur Lazarus, MD, MBA, is a former Doximity fellow, a member of the editorial board of the American Association for Physician Leadership, and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia. He is the author of Every Story Counts: Exploring Contemporary Practice Through Narrative Medicine and Medicine on Fire: A Narrative Travelogue.

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