I Don't Speak Medicalese

I tell people early that I don't speak medicalese. I lead a coalition of physicians, nurse practitioners, and other clinicians across the islands, and I am not a clinician. When the conversation turns to dosing or imaging protocols, I get quiet and I take notes. I don't see myself as a clinical expert. I see myself as a systems builder. The clinicians bring what they see in the exam room.

I came to healthcare the long way. Supply was one of my first jobs in uniform. Later, in supply and logistics with the 297th Air Traffic Control Squadron in the Hawaiʻi Air National Guard, I had to justify the squadron's spending every October, and I learned how much it hurts to defend every dollar you need. After the Guard I ran parts for a fleet of passenger jets. Anything those aircraft needed to be airworthy, nose to tail, was my responsibility. If my birds could not fly, I could not work.

Then COVID grounded the fleet. I had a baby on the way, and I took a human resources job inside one of Hawaiʻi's large health systems. It was business as usual without the uniform.

That job is where I learned healthcare from the inside. Through a merger of two workforces, a union negotiation, and the vaccine months, I sat between the front line and the executive suite. I was in front of the people and in front of the executives at the same time. I heard the patients' frustration through the staff, and the staff's frustration through the patients. Nobody in that building was the villain. The system was doing exactly what it was built to do.

The numbers on paper, and the care you can reach

The first thing a systems person notices about Hawaiʻi healthcare is that two sets of numbers have split apart.

On paper, we look fine. Only 3.5 percent of Hawaiʻi residents are uninsured, the second-lowest rate in the country. Hawaiʻi has the longest life expectancy of any state, 80 years at birth.

Now look underneath. Hawaiʻi holds 12,688 physician licenses. The medical school's 2025 workforce assessment counts 3,647 physicians in active patient care here. More than 600,000 people live in federally designated primary care shortage areas.

More than 9,000 of those license holders are not counted as seeing patients here, and that is the point. A license is not a doctor in the room. Insurance is not access.

Why a non-physician

When everybody in a room is smart, everybody knows how to get things done, and no one knows how to put it together. Physicians are trained to solve the patient in front of them. Hawaiʻi's trouble sits between the patients: the license file, the insurer's directory, the federal shortage designation, the payment schedule, and the plane ticket from Molokaʻi.

Each agency brings true numbers to the Legislature. Lawmakers end up seeing the trees and not the forest, and when they make a bad call, it is technically not their fault. So I spend my time building the forest: one place where those numbers meet, so we can stop arguing about the problem and start measuring it.

One night I recorded a short talk for myself about people who work across disciplines. I said that knowledge is becoming abundant, but integration remains rare. I still believe that. Healthcare isn't just medicine. Leadership isn't just management. Where other people see separate fields, the job is to see the bridges.

The line I don't cross

The integrator's danger is thinking he knows the work because he can see the whole board. I can't. When I was helping turn a mailing list of frustrated clinicians into a real organization, I told them I had to give them the room to be the physicians. I run the organization. They are where the rubber meets the road.

That is how the work actually runs. A doctor says something is wrong. I run the numbers. Most of the time, the doctor was right first.

If you are a clinician reading this: what is the one number you see every day that never reaches the people who decide? Send it to me. I will find where it lives.

David Isei is Executive Director of the Hawaiʻi Healthcare Task Force and a U.S. Air Force veteran.

Truth in the data. Care in the community.