Saturday, November 22, 2014

Chicken Pox, Vioxx and Goldilocks - The Song

Healthcare Healthcare Everywhere                     by Pat Jonas, MD

Chicken Pox, Vioxx and Goldilocks- Healthcare Just for you
A shot, a drug and a fairy tale, it’s just like a zoo
And if you have insurance, you won’t pay the bill
Just go into CVS, you can get your fill

     Healthcare, healthcare everywhere, more than what we need
     Cat scans, ER’s, MRI’s, Chemo used like tea
     More is better, “Let’s be sure”, “You’re a friend of mine.”
     Let me see your wrist ID to bill you one more time.

Barcode reader in my hand leads to good health care
Patients lying in the bed will notice that I’m there
“Yes! A nurse someone who cares, perhaps I won’t be killed”
“OK, I can hear your cares, after you’ve been billed”

Family Doctor, what is that? Someone we don’t need.
ER, that’s the place to go when I start to bleed
Just bill my insurance, please, for more and more health care
Co-pay’s all I need to pay for everything that’s there.

I recently gave a talk titled "Chicken Pox, Vioxx and Goldilocks:  Avoiding Avoidable Care" at the Institute of Holistic Leadership Annual Symposium (see previous blog post with that title).  Included was this song which we sang together.  Just a spoof on some aspects of healthcare.  The tune is similar to the Mr. Clean song (but not quite).  Enjoy.

Friday, November 21, 2014

Family Medicine: Compassion Equals Vulnerability

"Long term relationships lead to a build-up of particular knowledge about patients, much of it at the tacit level.  Because caring for patients is about attention to detail, this knowledge of particulars is of great value when it comes to care....On the whole, our tendency to think in terms of individual patients more than abstractions is a strength...but can make it difficult for us to feel comfortable in the modern academic milieu, where diagnosis and management are more usually seen in generalizations than particulars.  The risk of living too much in a world of generalizations and abstractions is detachment from the patients experience and a lack of feeling for his suffering."
The ideal for all physicians is an integration of the two kinds of knowledge: an ability to see the universal in the particular.
     The most significant difference between family medicine and most other clinical disciplines is that it transcends the mind/body division that runs through medicine like a geological fault line". ...Ian McWhinney, A Textbook of Family Medicine

I love that last sentence more every time I read it.  But it is also sad that most of the rest of medicine employs, as Dr McWhinney notes:  "a clinical method that excludes attention to the emotions as an essential feature of diagnosis and management.  Another is the neglect in medical education of the emotional development of physicians."

Important to Family Physicians is compassion.  We care enough to hurt.  When we hurt for our patients or our relationship with them, we show our vulnerability as humans.
Compassion = Vulnerability.
When we celebrate with our patients, our enjoyment can equal our caring.
Enjoyment= Caring.

It's fun to transcend the mind/ body fault line and be a Family Physician, vulnerable and caring..

What do you think?

Wednesday, November 19, 2014

Family Medicine: Life is Not Medical, It's Human

So many initiatives make up the current healthcare transformation.  Many are fad-like IT adventures that appear exciting on the surface but detract from health care, especially as it applies to individuals.  The life of the individual is being sucked into a medical abyss by some of these initiatives such as "Meaningful Use"  which measures "measurables" and calls them "quality".  These initiatives are billed as vital and may lead to bonuses for physicians (or their employer) or labels for patients as "non-compliant".  Overall, they are leading to the Medicalization of life and a denial of the Humanity of life.

Is life just Medical?  Are we Human Beings or Medical Beings?  Is managing cholesterol the essence of Family Medicine?  Is a good Hemoglobin A1c the measure of the patient-physician relationship?  As Peggy Lee once sang, "Is that all there is?"

The Direct Primary Care DPC) movement says, "No!"  There is more.  There is the power of the patient-physician relationship to validate the humanity of both patient and physician while identifying and treating medical conditions.  There is the shared wisdom of patients and physicians that clarifies the meaning of the illness and the beauty of life.  DPC offers new freedoms and challenges to Family Physicians via more time with patients and family. The time factor allows for richer differential diagnoses and clinical decision making.  It also allows for a deeper understanding of what it means to be human.  It's not perfect and it's definitely not for everyone.
What do you think?