Friday, August 22, 2014

Patient Response to Appointment Issues and Priorities

Here's a really insightful comment in response to my post Family Medicine: The Generalist

I'm not sure there's a solution to this problem. As a patient I usually come to the doctor with an assortment of complaints. Often it's hard to summarize everything that's going on in a few short statements on a form or when making an appointment. Issues come and go. New things may have come up since the appointment was made. Also, being an old guy, I think I was trained by the doctor I saw several decades ago to simply talk about everything that is bothering me during an appointment. And I sometimes wonder if some minor problem may contain information that would be helpful to the doctor in understanding the more serious problem...and could actually be connected to it. I come to the doctor not as a symptom, but as a person with a number of reasons to seek medical attention. I greatly appreciate the fact that I can come to a family doctor that way and not have to visit a bunch of specialists who may have conflicting ideas about what's wrong and what to do about it. All that's good...from Dave Levingston

This statement is really helpful to remind physicians of how life really is for our patients.  The era of the Electronic Medical Record adds to the tension of misaligned expectations between patients and physicians.  We don't use ours, yet, but may soon dive in.

My response which didn't show was this:

Thanks, Dave for your comments. We have the continuing creative tension between patients and physicians, trying to figure out the big and little picture at the same time as enjoying a continuing relationship of humans. We might have "little picture" visits and "big picture" visits, to balance focus needs with long range needs. The patient's story remains central to every visit. Both persons stories remain central to the relationship of patient and physician- which we could find a better way to emphasize. Your comments are very insightful and right on.

As we work together on saving the good parts of health care, these considerations are important in designing the electronic connections away from the billing focus of the early EMR's to human focus.  I believe it can be done in Family Medicine as we work with patients and doctors to refocus on what's important.


Sunday, August 10, 2014

The Family Doctor Song

Fellow Family Physicians,

I was humming the "Family Doctor Song" and feeling proud of what I do as a Family Doctor that is so well supported by this song.  The Family Physician author knows about the Myth and the Magic of Family Doctors.  They also understand the Brain and the Heart of Family doctors.  Likewise, the Myth and Magic, Brain and Heart of Family Medicine.

Such insight generating such poetry and translating into such a song is rare.  But, leave it to Family doctors to express the un-expressible in such a way that the imaginations of those who listen to and feel the message, understand it.

Have you heard it yet?  Have you hummed it yet?  Or sung it yet?


Listen to your heart, where the records of thousands of past, present and future patients resonate with human vibrations of meaning.

There is the song.

You are the author.

It isn't finished, yet.


Saturday, August 9, 2014

Family Medicine: Radiation Safety for Patients and Doctors

OK, Family Docs, who is keeping track of radiation exposure in our patients?  (Notice how Radiofrequency ablation adds another pile of radiation onto our patients.)  Could it be...NOBODY?!
How many of your patients have actually signed a consent form for the radiation used in their images?  Could it be...NONE?!
As a Three Mile Island "Alumnus", I remain sensitive about excessive radiation. (Like millions and millions of CT scans, MOST of which seem to be questionable if clinical skills are applied to the patient situation.) How might we get a more organized radiation safety strategy?  What have you experienced in your systems about radiation safety for patients and physicians?  Who has an informed consent form for radiation exposure?   (Especially in Emergency Departments)?

1. Kovoor P, Ricciardello M, Collins L, Uther JB, Ross DL. Risk to patients from radiation associated with radiofrequency ablation for supraventricular tachycardia. Circulation. 1998;98:1534–40. [PubMed]
2. Calkins H, el-Atassi R, Kalbfleisch SJ, Langberg JJ, Morady F. Effect of operator experience on outcome of radiofrequency catheter ablation of accessory pathways. Am J Cardiol. 1993;71:1104–5. [PubMed]
3. Wittkampf FH, Wever EF, Vos K, et al. Reduction of radiation exposure in the cardiac electrophysiology laboratory. PACE. 2000;23:1638–44. [PubMed]

Family Medicine: The Generalist

"By the way, Doctor, what is this spot on my cheek?"    "Oh, there's only one more thing, Doctor."  "While, I'm here, I want to tell you about the pain in my right foot."  "Oh, I almost forgot, I have this lump on my back (left wrist, or right leg, or left eyelid, etc.)"

""Oh, I passed out last month."  "I'm having the palpitations again.  Do you remember that we discussed them before (actually, five years ago)"

Many patients (about 60% by my conservative estimate) add these comments after the family physician has completed the engagement with the patient for the problem for which the visit was scheduled.  They realize that we do lots more than deal with simple problems.  We diagnose and treat thousands of diseases and conditions.  We enjoy it.

It's part of the challenge of being a generalist.  We know a lot and people appreciate it.  They may not appreciate that they have to pay more for additional problem.  It seems that people get excited as they realize how much we can help with their "odds and ends" problems.  We get excited, too, but it's often more because of getting behind on the schedule and having fleeting feelings of disappointment about not staying on time and having the next patients wait too long.

That's part of the Generalist practice.  People and problems.  Problems and people.                                                                                                                                                  

Friday, August 1, 2014

Mentorship Via The Ohio Academy of Family Physicians: Thanks, Tenny

He shook my hand and said "Welcome."  I felt like I was home.  These were my people, my fellow Family Physicians.  This was my anchor- The Ohio Academy of Family Physicians.  It was early 1974 (or late 1973?).  I was a first year medical student at Ohio State.  This was my first committee meeting at the Headquarters on North High Street in Columbus.  They spoke my language.  They talked about patients, education and the Ohio Academy.

Thank You, Tenny, for welcoming me and mentoring me over the 40 years since.  P. Tennyson Williams, MD became President of the OAFP, founding Department Chair of the Department of Family Medicine at Ohio State and , later, the Educator of the Year for the OAFP.  And my friend and mentor.

I hope to see Tenny and many other OAFP leaders, members and staff at the All Members Assembly in Dublin this weekend.  It's important for me to connect and honor the people and the traditions and the innovations of the OAFP.  The whole state wins when the OAFP celebrates.

The OAFP still has the reputation of caring and welcoming students, residents and family physicians to advocate for Family Medicine and good health in Ohio and the nation. I'm happy to be part of the Family of The OAFP and Family Medicine.  "Welcome"

Pat Jonas, MD
48th President of Ohio Academy of Family Physicians

Previous posts about OAFP 2010 and 2011:

Recharging Family Medicine: The OAFP

Naiive Enough to Believe: The All Members Assembly Energizes the OAFP