Thursday, August 30, 2012

Family Medicine: Promoting Civil Discourse

With the start of the Republican National Convention in Tampa, political intensity is rising.  As Family Physicians, we repeatedly communicate in a mutually beneficial way with patients.  Can we demonstrate and promote this in the political arena.  Let's role model our engagement with, and respect for, patients skills in other venues, to show people how to engage and listen to others.  Let's lead the way to demonstrate and promote civil discourse during and after the campaign season.

What do you think?

Wednesday, August 29, 2012

Dr Synonymous Blog Talk Radio Show August 28, 2012

Here's the overview for the content of the Dr Synonymous show on August 28, 2012.  

Health Care blog, tweet and medical review and discussion, starting with patient blogs including Dr Fatty, Medical Mojave, Brass and Ivory:  Life with MS and RA and Rheumatoid Arthritis Warrior.  Resident physician blog post in The Future of Family Medicine.  Tweets from Molly Tally of PAFP and Mike Sevilla, MD.  Lastly, Dr. Synonymous blog posts:  Family Medicine:  Superhero Needed and Healthcare, "Obamacare" and Vietnam.

Click here to listen  Dr Synonymous Show 8/28, 2012

Sunday, August 26, 2012

Health Care, "Obamacare" and Vietnam

I'm a Family Physician, at, what many would call, the "front lines" in health care.  I'm also a Vietnam Veteran, former Army officer, helicopter pilot and a graduate of West Point, Class of 1968.  My reflections on health care cause me to reflect on Vietnam.  How do the two relate?  Both were non-declared wars.  We won the major battles in both.  We lost or are losing both wars.  Why?  How?

In Vietnam we were confused about the overall strategy, but our tactics won every major battle.  One could say the same about health care.  We have no overall strategy, but our weapons to fight disease are superb.

Morale in Vietnam deteriorated when front line troops were instructed to become killers instead of soldiers.  Body counts replaced mission accomplishment as the focus.  The troops found a way to hide from their role as "killers" in illegal drugs, from marijuana to heroin, and mental health problems such as PTSD.

Health care is starting to fade into numbers instead of patient care.  Misguided quality initiatives follow IT installations in which billing software is modified into Electronic Medical Records (EMR)for clinical use, resulting in patients and their narratives being ignored into a sea of numbers.  Nurses hang onto bar code readers instead of holding onto patient hands and hopes.  Caring professionals are becoming despairing professionals.

Patients are being turned into numbers and bar codes.  Their hopes and dreams, which should be the basis of "Quality" measures, are being ignored.

Robert McNamara, Defense Secretary for Presidents Kennedy and Johnson was the leader behind the Vietnam body counts which devastated troop morale.  The Patient Protection and Affordable Care Act (PPACA), also referred to as "Obamacare", has now taken the lead with numbers-oriented policies and protocols that will move us closer to the demise of health care. 

"Meaningful Use" (which I sometimes refer to as "Meaningless Use") is the term used to refer to the government mandates for approved Electronic Medical Records, which may reward primary care physicians with taxpayer dollars (up to $56,000 per compliant physician).  The numbers game is polluting the push for developing the Patient Centered Medical Home (PCMH), which is supposed to help patients, into the development of, what I refer to as, "Payment Centered Medical Homes", with over-emphasis on physician reimbursement to try to "buy" medical students into Family Medicine and other primary care specialties.

Family Medicine is a relationship focused medical specialty.  The patient-physician relationship is the heart of Family Medicine.  It is our essence.  It is being ripped out by the current direction of health care.

Is health care becoming another Vietnam, with massive expenditures and worsening outcomes?  It feels that way to someone who's been involved in both wars.

What do you think?

Family Medicine: Superhero Needed

I still remember the excitement I had when Robert Rakel, MD, Chairman of Family Medicine at the University of Iowa (and, eventually, editor of one of the top two texts in the field of Family Medicine) spoke at the National Rural Health Annual Meeting in Detroit in 1974 to medical students attending the meeting.  He introduced the relatively new specialty of Family Medicine with a charismatic presentation which included the Kerr-White diagram, showing that almost no-one who gets sick goes to a university hospital for their diagnosis and treatment.  They were going to Family Physicians.  They still do.

We are America's specialty:  A group of generalists who relate to patients regardless of their problem or need.  Family Doctors are doing well at taking care of much of America.  I'm still proud to be a Family Physician after more than 170,000 patient encounters, but things are changing.

I'm worried about Family Medicine now.  We need 30 % of medical students to select our specialty in order to have enough of a workforce to care for an aging population and to prevent premature demise from preventable or treatable diseases.

An over-emphasis on numbers is leading to increasing patient dissatisfaction with their care.  An  over-emphasis on money is leading to "Market Medicine", ethically insensitive business practices that lean toward profits instead of patients.  An over-emphasis on technology is leading to overuse of expensive technology instead of efforts to balance "High Tech" with "High Touch".  The money that follows the over-emphasis seems to pull medical students away from Family Medicine.

Bob Rakel, who was sometimes referred to as "The Rakel of OZ" was like a Superhero to me.  Family Medicine could use a Superhero to "fight for truth, justice and the American way of life", or at least the patient-physician relationship.  Be on the lookout for a masked someone with a big "FM" on their Superhero shirt.  We need them.

Thursday, August 23, 2012

Male Wellness, Leg Cramps, Limb Movement, Human Trafficking

Here's a summary of the main elements of my BlogTalk Radio broadcast August 21, 2012.  The show covers a variety of health care blogs, tweets and medical review articles with some discussion.  Starting with an introduction and disclaimer, Dr Synonymous (A. Patrick Jonas, MD) notes an exception to the usual show format.  Sea Spray's patient blog about children, a dog and POOP is the only patient blog tonight.  Medical articles from American Family Physician and The Journal of Family Practice are the main focus, starting with an AFP overview of the "Adult Well Male Examination".  Discussion moves to Nocturnal Leg Cramps, then to Periodic Limb Movement Disorder and their diagnosis and treatment.  Brief comments about a Food Allergy slipped in to introduce a topic that I'll cover in a week or two.

Dr Jonas lastly comments about Human Trafficking, a modern slave industry with shocking dimensions.  Motivated by Pastor Terry Heck of Bellbrook United Methodist Church who is active in trying to eliminate this human disaster, Dr Jonas reviews the definition of Human Trafficking and gives an introduction to the topic.  I believe that Family Physicians have a role to play in prevention of Human Trafficking, starting with awareness. Addressing the issue of pornography, especially on the internet is another prevention strategy.  Human Trafficking in the sex trade leads many to become trapped in chemical dependency, prostitution and depression.  What do you know about the problems we have in Ohio and the rest of the nation in Human Trafficking?

More will follow.

Dr Synonymous on BlogTalk Radio August 21, 2012

Wednesday, August 15, 2012

Health Care: Radical Innovation Needed

I looked at the pile of reports about my patients at the end of the patient encounter schedule. Twenty or so patients are represented in the information that I review and direct for action or filing.   While working through the schedule of 15-20 patients each day, I also process information about six to ten other patients by responding to questions, signing prior authorization forms so patients with drug allergies might be authorized to get a medication that won't make them sick, evaluating and signing referrals, interpreting crisis lab values, responding to power company intentions to turn off the power of patients who were unable to pay their bill with a waiver form if they are dependent on electrical devices for their medical care, and responding to calls from hospice nurses and emergency room physicians.  

The intrusions that might distract me from focusing on the patients in each exam room have been increasing as "administrivia" increases in medical care.  Family Physicians are tiring as unfunded mandates pile up on the specialty with the broadest array of response repertoires to patient needs.  How do we get around the "sludge"?

Innovation.  Innovation.  Innovation.

Human Centered Innovation-  Not Payment Centered!  Not Physician Centered (Not even Patient Centered which leads to dehumanization and disrespect for physicians).

Radical Innovation- Not Incremental- Not Predictable.

How?  Start with a human perspective.  Stir with some IT.  Fold into apps.  Give them to humans.  Launch and leap ahead.

Check out IFG Health ( and their apps that "protect people's humanity as they navigate the healthcare system."

Human centering starting on the patient side of the patient-physician dyad delivers a radical strategy to level the healthcare playing field.  The context of the patient's life may connect to the context of the physician's situation better with the IFG Health approach.  

Steve Deal, CEO of IFG Health has an array of skills and experiences as a systems engineer with an aggregate 14 years experience- eight years in satellites and simulation, six years in human systems.  He and I published a human systems article about the HCHH and another for The Ohio Family Physician.  I add 39 years of medical experience including 13 with the Center for Innovation in Family and Community Health and serve as the medical innovation advisor for IFG Health.  

Co-founder Rene Rafael Vogt-Lowell serves as chief technology officer.  He has a combined 14 years of service in many sectors of IT including management of emerging technologies for Sinclair Community College’s Distance Learning department and development of eLearning software applications and simulations for both mobile and desktop platforms.

OK, my piles at the end of the day won't disappear this week from one  innovation company.  No one strategy or company will solve the healthcare dilemma, but IFG Health is a radical innovation that feels right.

Saturday, August 4, 2012

DOC (Direct Ohio Care) Launches Soon

Direct Ohio Care (DOC), an Ohio based network of medical practices, will enable Ohio Family Physicians and other Primary Care Physicians to offer Direct Primary Care (and what I like to call Direct Family Medicine) to their patients.  Direct Primary Care is a membership-based practice model that is included in the Patient Protection and Affordable Care Act as allowable in the state health insurance exchanges. HR3315 would also make it available to persons on Medicare, currently not allowed.

Direct Primary Care Coalition


DOC will launch soon.  More later

Friday, August 3, 2012

The Olympics, Patients and the Human Spirit

Twitter goes wild with Olympic Tweets.  Staying up until 2 AM leads to sluggishness the next day.  Gabby Douglas, the gymnast has 51,000 fans on Facebook as of August 1st. Now that she won the gold medal for all around best female gymnast.  Patients have their favorite Olympic situations and great pride in America via the Olympic Gold Medalists and many others.  Swimming events and women's gymnastics are the most notable so far.  The running and jumping events start tomorrow.  More stars, glory, victories, disasters, failures.  Stay tuned.

We're getting a few more patients who can't pay or don't pay.  A few more are unemployed and can't find the next job.  Smoldering joblessness generates fatigue and stress.  Families are being squeezed.  People are tired.  They will rally, though.  I've seen the stamina of their spirit, and felt it.  It's impressive and heartening.  It becomes part of the heart of family physicians.  They show us again and again.  We love it. Thanks, folks.