Sunday, March 25, 2012

Family Medicine: Present for Duty

We're still seeing lots of patients.  They have a wide variety of situations, needs, conditions and diseases.  We respond.  We also discern things about their values, goals and dreams over time.  Over time, we validate their sense of worth.  Oh, we also consider the context of their life to help our therapies to align.
Day after day, seeing lots of patients and caring.  They (You) matter.

Friday, March 16, 2012

Family Medicine: Reconciling our Wounds

"What are cows for?  To the bioengineer and corporate manager, they are machines; they are units of production."....David Loxterkamp, MD from "A Vow of Connectedness:  Views from the Road to Beaver's Farm" in The Country Doctor Revisited pp.80-86, Edited by Therese Zink, MD.  Kent State University Press 2010.

Doctor Loxterkamp eloquently expounded on the meaning of cows to the farmer, making a further point about the meaning of the Family Physician.  "the family doctor is rarely an agent of meteoric change.  But, every day and closer to the earth, we are its vehicle and eyewitness.  Doctors who remain deeply connected to their patients will know this privilege.... In modest ways, we accomplish the utterly profound, long before the prescription is filled or the blood test is taken.  We profit by the patients' periodic return and by the mutual exchange of friendship, intimacy, and trust."

I enjoy reading those words, but flinch at his lasting message about our frailty, humanity,  and vulnerability in another section of this piece:  "We realize that patient care is not portable and that the doctor who lives among his mistakes and prejudices becomes a healthier person less prone to severity in the judgment of patients or peers.  Lastly, family doctors are inevitably changed by the patients they serve.  The merely responsible physician, tempered by mercy and groomed by grace, adds to the stock of moral credibility that has sustained our profession over the milennia."

I was paused by the phrase "Lives among his MISTAKES and PREJUDICES", suddenly reflecting on, and again thankful for, the small town Family Physicians who trained me in the night clinic at Ohio State (Pete Dils, MD stands out since I later became his partner) and in my Family Medicine Residency at Hershey, PA. (Tom Leaman, MD; Hiram Wiest, MD; Doug Chervenak, DO; Bill Hakkarinen, MD).  These were sturdy Family Doctors, but with a certain, humble respect for patients and their stories.  All were willing to share stories of their humbling moments in patient care in the most genuine of ways, maybe hoping to help younger learners to avoid similar situations, but I think it's more likely they were preparing us for membership in the guild of Family Practice, where all have been wounded.

Vulnerability springs from compassion, and the wounded physician humbly carries the scars of living among their mistakes, quietly avoiding their duplication.  Over time, the wounds are reconciled into the essence of each Family Physician.  I'm comforted to know that so many of us quietly allow our reconciliation to happen, "tempered by mercy and groomed by grace, add(ing) to the stock of moral credibility that has sustained our profession..."

My deep appreciation to David Loxterkamp, MD for recording his reflections and insights so others may better light the path to reconciliation.

Sunday, March 11, 2012

Family Medicine: They Are Closing Us Down Coast to Coast

Across the nation, random attempts to close Departments of Family Medicine and Family Medicine residency training programs are continuing to bubble, fade, succeed, fail and surprise those who thought more Family Physicians are needed to "bend the cost curve" of healthcare.

It's all about the money, folks.  Family Physicians decrease emergency room visits, admissions and re-admissions to hospitals and over-all cost of health care. That loses money for several entities, but saves money for employers and patients (and governments, aka tax payers) .

Watch in your area to see where the cuts occur that decrease your access to Family Physicians.  You may be surprised.  I was.

I remember surprising moves over the years by the University of Iowa, Ohio State University, Penn State University, Duke University and numerous Community Hospitals that evicted, closed, reduced or merged Family Medicine Departments or Residency Training Programs.  Rumors about the University of Minnesota were the most recent example of University versus Family Medicine.

I trained in the Family Medicine Residency of the Department of Family and Community Medicine of the Milton S. Hershey Medical Center.  My training program was evicted years later and picked up by the Good Samaritan Hospital in Lebanon, PA which picked up an expanded Penn State relationship in the process.

Both flagship hospitals of the two surviving hospital networks in my area of Dayton, OH have closed their Family Medicine training centers within the last three years.  Who is training the Family Physicians needed to serve the Greater Dayton area?

I'm worried about the Future of Family Medicine and access to care for Americans as we are about to add 30 million people to the ranks of  "the insured".  I fear that they and millions of others will find that an urgent care center or emergency room is their Family Doctor.  The costs of care can only to continue to bankrupt America unless we get together about a better vision for health care.

Medicare is paying much of the costs for Family Medicine training via subsidies to training hospitals.  As this money is decreased with various government policies, the hospitals may lean toward training specialists who make more money while in training such as cardiology fellows who do procedures and order lots of expensive tests routinely.

Various legislative efforts are being initiated such as H.R. 3667 to find ways to continue the training of Family Physicians and other primary care physicians.  You may wish to read more about this bill and its background and sponsors by double clicking on the link below.  More later.

H.R. 3667

What have you heard about reductions in training Family Physicians and other primary care physicians?

Tuesday, March 6, 2012

Fibromyalgia Update on Diagnosis and New Statin Warnings

Dr Synonymous show March 6, 2015 features comments on the latest diagnostic criteria for fibromyalgia and a discussion of the new warnings the FDA has placed on statin drugs.

We'll review patient blogs, physician  blogs and Dr Synonymous blog along with some tweets and other medical trends.

Tuesday from 8-9 PM ET on Blog Talk Radio (  Listen in live or later to a podcast of the show.

The Dr Synonymous Show March 6, 2012 8-9 PM ET