Saturday, June 6, 2020

Family Medicine: Human Centered Care in the Modern Era

Respect:  Myself, my office staff, the patients and their families, the system in which we are allowed to engage, the community in which we live and work, the nation in which we reside, the world with which we exist and interact, the biosphere which is amazing, God who is beyond understanding.

Protect:  The patients and persons involved in patient care in and through my office today; their time to express themselves; the objects, air and persons from toxins and pathologic microbes.

Connect: Via an appropriate medium to the patient and their values, goals and dreams.  Our humanity through our respective roles that support exploration via communication.  Our hearts as necessary during our interactions.

Detect:  Our individual and mutual alignment or misalignment with our values, goals and dreams as it relates to the purpose of the interaction today. The "Chief Complaint" and other issues to be considered during the visit and later.  The context in which the patient raises the "Chief Complaint" or purpose of the visit.  The differential diagnosis using a simple and complex model that expands the list of considerations for the cause of the patient's Chief Complaint and other problems/issues.

Inspect:  Information that is available and the patient to clarify the search/ testing strategy that will best explain the patient's problems and possible solutions.

Correct:  The phenomena that cause the patient's misalignment with current or future values, goals and Dreams.  The perspective of me and/or the patient about the context, information, processes, values , goals and dreams of both of us.

Reflect:  On the above in thought and by preserving a record of the interaction in appropriate media and form as desired/ required.  On the continuing connection between the patient and the process of health/ care.

Thursday, June 4, 2020

Thursday in Family Medicine 2020. Technology and People

Wash hands, temperature taken, select mask for the morning, liberal use of hand sanitizer.
Check patient schedule (again, having checked it at the end of yesterday):  Who, What type of visit (video, phone, office), Why are they scheduled? Acute, chronic, preventive focus (although, since I'm a Family Physician, often we cover all three in one visit).  Set up context for the day and first visit.  Make space for two laptops- one for video visit, one for EMR- ,forms/paper space (since I'm a "Geezer", I still write in a paper record as the patient tells their story- suitably illegible at times, but meaningful to me) telephone, and a bottle of water or cup of green tea.

I don't yet have a green screen behind me or a variable background that I noted on a Zoom feed with one of my sons, an academic physician at the University of North Carolina, last week.  Geezers take a while to catch up to cool trends.  I don't have the headset that I would like yet, but the mic in the computer is incredibly good.  It's a start.

Connection difficulties arise with about 20% of patients, especially with the video visits, about issues with sound usually.  Sometimes they can't get the video connection.  There is a software download factor that is a stumbling block for some phones or computers.  My office had some WiFi problems til finally getting a new WiFi and new router.  We're making progress.

The video visits are especially informative about the life of the patient.  Sometimes family members show up as well as pets, art, memorabilia, etc.  We're learning.

More later.

Sunday, April 21, 2019

Wellness and Integrative Health Coaching: Why and How - interview with Doug Newton

We'll update our previous session with Doug Newton which was our February Chat with Dr. Pat, but didn't record well.  This broadcast will occur April 22 at 9 PM as a live show then will be available online at The Dr. Synonymous Show.

Doug is an integrative health coach among other skills that help people to enhance their health.

With increasing knowledge about epigenetics and moment by moment genomic “adjustments”, Ben Lynch, ND has authored a book titled, Dirty Genes.  In it he explains how to use our daily and leisure activities and food to improve the functioning of our genes.  It comes down to Wellness, which does have many definitions and approaches.

But, should Wellness be considered to be "Medical"?  Concepts of wellness may benefit from being distanced from medical care, which has a way of increasing the price of most issues related thereto.  We'll discuss this a bit, too.

A recent editorial in JAMA poked seriously at this issue in a discussion of "Wellness Genomics" : 
"If the paternalistic emphasis of precision medicine, the essentialism of precision prevention, and the perfectionism of wellness genomics go unnoticed and unchecked, precision health risks becoming merely another step on the road towards a new eugenomics that society could come to regret."

Doug Newton who most recently was Program Director for Wellness at WSU will provide a definition and expound on wellness for individuals, colleges, businesses and communities.
Dr. Jonas, your host on the Dr. Synonymous Show and Blog,  will comment on the book by Dr. Lynch and some genomic concepts that reaffirm what Doug is saying about Wellness.  #Wellomics might be coming next!


This will be broadcast on Dr. Jonas internet radio show live and stored as a podcast on BlogTalk Radio at The Dr Synonymous Show and reachable via Dr. Jonas Blog www.DrSynonymous.blogspot.com

Tuesday, March 5, 2019

Healthcare Transformation: What is New That Might Help You?

Dr Jonas, aka Dr. Synonymous delivers 15-20 holistic health presentations each year, most of which are written about in blog posts on this site.  Here is part of a post on the Beavercreek Women's League web site announcing one of his talks:

"Dr. Pat Jonas, a holistic-minded family physician in Beavercreek will engage the Beavercreek Women’s League in a discussion about current trends and issues in health care. 
How might all the advances in: 
• genomics (DNA sampling),
• pharmaceuticals (direct marketing),
• medical technology (wearables & implanted monitors),
• nutriceuticals (dietary supplements), and
• individual wellbeing
add up to lower cost and higher quality health care? What role might direct pay or concierge practices play in health care transformation? "

The healthcare quadruple aim is "The Triple Aim is an approach to optimizing health system performance, proposing that health care institutions simultaneously pursue 3 dimensions of performance: improving the health of populations, enhancing the patient experience of care, and reducing the per capita cost of health care" PLUS ONE More Aim:  improving the work life of health care clinicians and staff."  from The Annals of Family Medicine Nov/Dec 2014

Forty-three percent of physicians surveyed in 2014 reported spending over 30% of their day on administrative tasks.9 Physicians spend more time on non–face-to-face activities (eg, letters, in-box management, and medication refills) than with patients.10 Even when in the exam room with patients, primary care physicians spend from 25% to 50% of the time attending to the computer.

Individual Wellbeing:  For both patient and physician with human centering instead of patient centering.
              Context is everything.  Personal values, goals and dreams make a difference.
              Stories matter
              You matter
              We Matter
              Money matters
              God matters

 Genomics from DNA to health food store or garden
                    Pharmacogenomics  e.g., Genesight test 
                    Nutrigenomics        from 23andMe, Genetic Genie, Promethius
                    Microbiomics
                    Epigenomics   

Genealogy from Ancestry.com, etc.
                    Could be a basic element of IHR that patients may store and deliver into the healthcare system for engagement.  etc,
More later      



Saturday, February 2, 2019

Wellness: One Way to Clean Your Dirty Genes


Breakfast Chat with Dr. Pat, “ Wellness:  One Way to Clean Your Dirty Genes”

Guest Presenter:  Doug Newton, MS  former WSU Wellness Program Director

February 6, 2019 at 9:15 AM Hosted by The BellHOP Cafe

With increasing knowledge about epigenetics and moment by moment genomic “adjustments”, Ben Lynch, ND has authored a book titled, Dirty Genes.  In it he explains how to use our daily and leisure activities and food to improve the functioning of our genes.  It comes down to Wellness, which does have many definitions and approaches. 
Doug Newton who most recently was Program Director for Wellness at WSU will provide a definition and expound on wellness for individuals, colleges, businesses and communities.
Dr. Jonas, your host on the Dr. Synonymous Show and Blog,  will comment on the book by Dr. Lynch and some genomic, nutrigenomic and epigenetic concepts that reaffirm what Doug is saying about Wellness.  #Wellomics might be coming next!


This will be broadcast on Dr. Jonas internet radio show live and stored as a podcast on BlogTalk Radio at The Dr Synonymous Show.  www.BlogTalkRadio.com/DrSynonymous and reachable via Dr. Jonas Blog www.DrSynonymous.blogspot.com