Monday, April 28, 2014

Family Medicine: Celebrating the Uniqueness of Each Patient

Sixty trillion cells, each of which has 100,000 chemical reactions per minute (who counts these things?) are the basic material in humans.  As a Family Physician, I am ever mindful of the complexity of such a system. Unique is a word that comes to mind as I think of each patient.  Amazing is another one.

Each patient makes about five billion new cells daily.

Along comes the electronic medical record and "Bonus Based Medicine" and the patient is pushed aside into a "Payment Centered Medical Home" or stumbles into a hospital where nurses greet them with a barcode reader to bill them multiple times daily.  We have guidelines such as, "All humans should be on a statin drug unless they have died".  "All patients should be on a low fat diet"  (known to make people fat).

Wait a minute!  What about the "Meaning of the illness" to help the patient with their evolving humanity?  What about helping them to find the meaning of the illness in their life?  What about the Human Genome Project which gives us the potential for massive differential diagnoses for each symptom or sign?  Are we to ignore over 20,000 single gene disorders that are beautifully documented on the OMIM site?

I love the uniqueness of each patient.  I love their quest for meaning.  I believe they value their evolving humanity and its meaning in their lives.  Let's celebrate it.

Let's allow the EMR or EHR to align with the uniqueness of each patient.  Let's redefine quality so it's connected to mutually agreed to goals between patient and personal physician.  Let's allow physicians to use our "mutant brains" to think about helping the patient to align with their values, goals and dreams.

OK, you might say- they eventually all die.  True, even with the best medical care on earth- they all die.  We can help them to define their end of life goals and enhance the meaning of their life or its end resulting in end of life "quality".

Let's back off on the phony quality initiatives and excessive use of nurses and physicians as billing agents. Let's dive back into the amazing complexity of human life and human biology and celebrate the uniqueness of each patient.  It's fun.

At the same time, let's celebrate the education and training of our physicians and allow them to redefine quality- one patient at a time.  We're unique, too.

What do you think?

1 comment:

  1. I think you are exactly correct. We should define quality.