Tuesday, April 30, 2013

Family Medicine Activist: #HAWMC Twitter Review Day 30 of 30

#HAWMC Day 30 Part 2     The Dr Synonymous Show

Here's what you can hear on Dr Synonymous Show for April 30, 2013:

The last day of the Health Activist Writers Month Challenge, health activists celebrated with their final post.  I went to Twitter and commented on several of them (including mine-shamelessly).  Go Activists! 
  1. “Believe in yourself and you can achieve greatness in your life.” ~
  2. Audrey Birt's blog: Day 30 reflections on this "one wild and precious ... on challenges and insights
  3. I'm saving today's prompt until I am done. The next 11 days I'll be catching up w/posts. U can read them here:
  4. Day 30: Congrats to everyone who finished the Health Activist Writers' Month Challenge!
  5. Day29 - Yeah, I'm pretty awesome. - Here are three examples: I am a great, super-supportive friend....
    Day 28
    Go to Twitter.com to read these posts, or click on them here and they will probably work on this post.
    I enjoyed reading these posts.  I hope that you do, too.
    Peace to all.

Family Medicine Activist: "Spendipulous" Health Activist Writers Month Challenge Ends

#HAWMC Day 30!

Today’s HAWMC  prompt was “’Describe your HAWMC experience in one word!”


Peace to All... Until the next Challenge.

Family Medicine Activist: Self Love- Easier Spoken Than Written

#HAWMC Day 29

I’m participating in WegoHealth’s Health Activist Writer’s Month Challenge. This post was written in response to their prompt, “We all know Health Activists are awesome. Share three things you love about yourself, things you’re great at, or just want to share. Don’t undercut or signpost!”

I will look in my mirror daily and say, " In spite of your previous mistakes, I love you."  I admit that if I just say to me in the mirror, "I Love You," I feel uncomfortable.  Using the disclaimer about my previous mistakes makes it doable.

Self love is difficult to write about since it seems to cross a lot of lines in our childhood humility training.  Many religious persons believe what the Bible says about self love:  "Love your neighbor as yourself."  Verses from the Old Testament and New Testament echo the same message.

Leviticus 19:18 (NKJV)
18  You shall not take vengeance, nor bear any grudge against the children of your people, but you shall love your neighbor as yourself: I am the LORD.

Leviticus 19:34 (NKJV)
34  The stranger who dwells among you shall be to you as one born among you, and you shall love him as yourself; for you were strangers in the land of Egypt: I am the LORD your God.

Matthew 19:19 (NKJV)
19  'Honor your father and your mother,' and, 'You shall love your neighbor as yourself.' "

Matthew 22:39 (NKJV)
39  And the second is like it: 'You shall love your neighbor as yourself.'

Mark 12:31 (NKJV)
31  And the second, like it, is this: 'You shall love your neighbor as yourself.' There is no other commandment greater than these."

Luke 10:27 (NKJV)
27  So he answered and said, "'You shall love the LORD your God with all your heart, with all your soul, with all your strength, and with all your mind,' and 'your neighbor as yourself.' "

Romans 13:9 (NKJV)
9  For the commandments, "You shall not commit adultery," "You shall not murder," "You shall not steal," "You shall not bear false witness," "You shall not covet," and if there is any other commandment, are all summed up in this saying, namely, "You shall love your neighbor as yourself."

Galatians 5:14 (NKJV)
14  For all the law is fulfilled in one word, even in this: "You shall love your neighbor as yourself."

James 2:8 (NKJV)
8  If you really fulfill the royal law according to the Scripture, "You shall love your neighbor as yourself," you do well;

 So why  is it so hard to write about self love.  Wouldn't many religions consider it sinful not to follow the Biblical commandments?

"The meek shall inherit the earth," comes to mind as a subtle threat to those with too much self love.  Let's just go with the central message of, "You shall love your neighbor as yourself."  How does this manifest in Family Medicine practice?

I assume that my patients are my neighbors.  I should treat them as I would like to be treated by my Family Physician.  I should listen to them as I would like my physician to listen to me.  I should follow the process of the Human Centered Health Home (HCHH): by Respecting, Protecting, Connecting, Detecting, Correcting and Reflecting both the patient and myself.  (Search this blog site for several posts about the HCHH)

That does afford a better balance in the patient-physician dyad, in which we each may fulfill several roles during our encounters and across our relationship.  OK, I love myself and will manifest an equal importance to that I afford my patients.  It will take some reminding and practice.

Are you able to write about self love?  Does it feel uncomfortable?  Does your mirror or your mother know that you admire yourself?

Let's work on our self love together.

Monday, April 29, 2013

Family Medicine: Rare Disease Frustrations Persist

#HAWMC Day 27
Day 28    What have I learned about being a  patient that surprised me
the most?
"What have I learned about being a patient that surprised me the most? 
I was flabbergasted as I went through the initial process of getting the lyme diagnosis and how many medical professionals chastised, degraded, ignored, and negated me as I asked questions to the get to the bottom of the issue.  
I was shocked by how many physicians threw prescriptions at me and even admitted that they would not look for the source of my pain.  Rather, they would only treat me symptomatically."
 Something failed in the engagements of Ms. Rainey with multiple physicians.  I'm glad she eventually found someone she could work with.  Rare and unusual diagnoses sometimes tax the decision making style of the individual physician and the system of work flow and various incentives.  Interacting with the person with the rare diagnosis may require several visits to systematically clarify what is happening.  The differential diagnosis starts with more common possibilities, working toward less likely diagnoses.

Since we already know that Lyme disease is a major diagnosis, we know it's difficult to arrive at that diagnosis.  We also know that the search strategy can get expensive to test and clarify the options in the differential diagnosis.

I once knew a physician from near Lyme, Connecticut who went into congestive heart failure when she was at a major university in North Carolina to give a medical presentatiuon (not UNC).  She knew a great deal about Lyme disease (surprise) and asked the attending cardiologist if he would order a Lyme test since she lived near Lyme, CT and all her signs and symptoms could be explained by Lyme disease as the diagnosis.  The cardiologist refused to order the test.

They got her heart rate controlled and flushed out lots of fluid with diuretics well enough to get her back home.  On arrival, she went to the county health department, was tested for Lyme disease, which tested positive, was treated and her heart reverted to its normal rhythm and function in a few weeks.  That physician knew some of the frustration that Ms. Rainey felt, but she was A PHYSICIAN BEING DISSED BY HER OWN COLLEAGUES.  Very pathetic, indeed.

Ms. Rainey wisely kept going until she found physicians who would partner better.  Congratulations, Ms. Rainey on your wisdom.

It's true, though, that on our bad days, all physicians or patients may not connect well.  Follow up visits may be needed to best clarify how the relationship may serve the dyad of patient and physician.  Terminating the relationship sometimes is necessary, as in the case of Ms. Rainey and my friend from  CT.

Sunday, April 28, 2013

Family Medicine Activist: Dreams and Realities

#HAWMC Day 28

Just outside of Farmersville, Ohio on Chicken Bristle Road, life seems different.  Slower.  Calmer.  Natural.  In fact, the birds are singing, a squirrel just ran across the yard, a cardinal and bluejay visited the feeder (not together), the pond is smooth and the fields are a moist brown beyond the acres of grassy yard.  Twenty-five acres including the pond adjoining the “family farm” await my wife and I as a potential hiding place and future reality once we hang up our suburban life.
Maybe we should commit to having our ashes spread over the twenty-five acres when we’re deceased since the medical career looks like it’s on a course to reach my 75th birthday before it lets up, and we may never live on the pond-land while alive.  The need for Family Physicians and our current financial trajectory will carry that far before a writing room (or maybe a tent) overlooking the pond calls me to the reality of a writer’s paradise on Chicken Bristle Road.
What about you, persons with chronic health conditions and diseases?  Do you have some choice in your path?  Where you are?  What you do?  What is your dream?   How have you modified it to accommodate your condition?  How will it be affected by normal aging processes on top of your condition?

Many persons are living comfortably at seventy-five, but seem to decline a lot before 80 (men) to 85 (women).  The musculoskeletal system starts to nag folks in their 60’s, drag them down in their 70’s and crush them in their 80’s.  Of course, this isn’t mandatory, but we see a lot of it in Family Medicine.  Knees and hips eventually inquire about potential replacement.  Spines bend, twist and/or pinch nerves as the space for freedom of nerve sheath movement gets less and less.  Tingling and pain descend down the nerve roots into the arms or legs, sometimes associated with numbness, precluding the patient from knowing when the feet hit the ground while walking.

Somewhere along the way we notice what’s happening in our current reality and each decides how to respond to the deterioration.  Your Family Doctor is ready to work with you to clarify your potential for goal accomplishment using the body and mind that you have.  Your body may benefit along the way from prevention and/or therapeutic strategies in addition to care of your chronic condition.  We’re here to help you have your life or understand why you can’t if it’s impacted by medical conditions.

I hope you all have an equivalent setting like our land on Chicken Bristle Road to dream of for a peaceful future, or at least a place to spread your ashes if you get stymied by your current reality and don’t fulfill your entire dream.

Peace to all, whatever your reality (s).

Family Medicine Activist: "All My Patients Die"

#HAWMC Day 26

I was behind a small truck at a stop sign years ago and noticed the words, "All our patients die." Abel Pest Control Doctors was the company name displayed above their slogan.  Quickly I realized that "all my patients die," too.  I am a Family Physician.

Birth to death, cradle to grave I don't stop being their doctor because of a life transition, like getting cancer or a hip fracture, or graduating from high school.  They, and I, eventually all die.  Am I going to take up the slogan of the Pest Control Doctors and put that on a sign in the waiting room, on my business cards or in my directory listing?  No.

Why not market the blunt truth of where all my patients and I are headed?  I think it's because we each know the finiteness of our lives in our own way.  And we like to reflect on our mortality through our own lenses.  Do Family Physicians therefor avoid mention of end of life issues?  Do we hold back on musings about the human condition relating to life span or death?  No

We are blessed with a vision of life and death that whispers an ongoing message of hope.  There is beauty in humanity.  There is truth.  There is a spirit that touches our Family doctor hearts with a sense of thanksgiving for the opportunity to serve and share.

The same vision sometimes delivers individual despair and hopelessness reminding us of a darker side of life and humanity.  How do we relate to these people and these situations?  With a heavy heart, tempered with a broader awareness of how heavy hearts are shared across the human condition and comforted with a part of eternity that is forever at peace.

Will that peace somehow find troubled hearts often enough for Family Physicians to continue to serve, care and share?  Do we still believe that, even though, "All our patients die", being a Family Physician is worth it?  Yes. Yes. and Yes.

Friday, April 26, 2013

Family Medicine Activist: "Doctor, You Have a Call from Hospice"

#HAWMC Day 25

Once or twice weekly, one of our office staff knocks on the exam room door where I'm engaged with a patient and softly says when I stick my head out, "Doctor, Hospice is on line 2 for you."

I excuse myself from the patient and interact with the hospice nurse about one of my patients whom we're caring for.  We talk many times before finally, every two or three months, one of these nurses is informing me of a patient death.  At these times, I reflect on the patient and their life as I knew it, along with their family as I know them.  I may make a note to remind me to continue my grief and mourning my loss of this relationship.  Thoughts about the deceased covering years and years sometimes flood my brain and I have to separate from the sense of loss to see the next patient.

The note, that I'll re-read later, will remind me to continue to grieve after I'm finished with afternoon patients and to reflect on the life of the deceased.  This process helps me to avoid "stuckness" because of unreconciled grief.

The duration of my relationship with those involved seems to determine the intensity of my sense of loss.  Reflecting on the meaning of their lives and getting to continue interacting with family members gives me a sense of continuity and humanity.  Families are amazing, too.

Hospice is a special friend of all, waiting to knock on our door.  We don't have to ask for whom the bell tolls, it tolls for us all. 

"Doctor, Hospice is calling."

Family Medicine Activist: What if You AND Your Doctor are Both Tired?

#HAWMC Day 24

Do your best = A life long challenge.  We want to do our best.  Sometimes we are out of sync, though, but we still have to function.

People with chronic diseases often have fatigue and are less than their best self when seeing physicians.  Especially if they are ill on top of their chronic disease(s).  That's when we see them in our office.  We aren't always on top of our game, either. 

Question:  How can we practice and help people if both of us are misaligned with our best self?

Secret: Doctors get tired, too.  Brain tired, at times.

Answer:  Seek clarification from each other- as often as it takes to understand.  Listen.  Take notes- both patient and doctor.  (I have note pads in each exam room so each of us can jot down items of importance).  Share your uncertainty- both of you patients and doctors.  Sometimes this takes the form of probabilities.  ("There's an 85% chance that this medicine will have no negative effects...",  "Doctor, I'm very likely to have to fly to Denver in three days and stay for a three day weekend...")

Share, Share, Share.  Trust.  Trust.  Trust.  Listen. Listen. Listen.  Clarify.  Clarify.  Clarify.  Take notes.  Take notes.  Take notes.

These are keys to functioning in the patient-physician relationship when we're not at our best.

Wednesday, April 24, 2013

Family Medicine Activist: #HAWMC Day 22-23 Tweets Reviewed on My BlogTalk Radio Show

#HAWMC Day 23

For the third week in a row,  I review several posts from Health Activists Writer's Month Challenge via Twitter.  You may also wish to follow the posts by accessing them through Twitter at the hashtag #HAWMC.

I find the postings helpful, insightful and very human.  These writers are revealing their heart.  I hope you'll read these posts and more.  I read from these and make comments from a Family Medicine perspective.  At the end of the recording, I covered three of my posts from the same time-frame as the other Activists.

These 9 Tweets are copied but not "live" to click on here.  Please go to this #HAWMC section of Twitter if you wish to open the posts and see what Dr Synonymous is reading or talking about.  Thanks.   The Dr Synonymous Show April 23, 2013

  1. The Health Activist’s Writers Month Challenge – Day 23 Technology
  2. Day 23 - A staff member wishes her could be monitored, and corresponding reminders could be sent by her cell phone.
  3. For Day 23 I discuss the functions that I would find most useful in a smartphone/tablet app:
  4. New blog on from yours truly: What device or app do you wish helped track your condition?