Family Medicine: Are We There Yet?

On the path to Family Physician heaven, a doctor paused for a well child check-up, an end of life discussion with a 91 year old and her daughter, a person with facial pain from sinusitis, a boy with a rash on his elbows, a new mother with her infant son and three year old daughter- all with fevers and diarrhea, a pastor with a cough and tuberculosis exposure, a senior citizen needing travel clearance with resolving shingles, a thankful woman who was coming out of a dark depression with medication, a man who snored so bad he was sleeping on the couch, a truck driver recovering from low back surgery in need of examination and clearance to return to work, a woman whose twin 28 year old sister had just committed suicide, a grandmother with insomnia after caring for her twin one year old grandchildren for three days while their mother had surgery, and lunch.

Family Medicine: We'll Cry Later

"Hello, Doctor, this is the Cheryl Smith at the Smith Funeral Home.  Would you be willing to sign the death certificate for Susan Jones, a patient of yours who died during the weekend?"

"Oh no, I wasn't aware, what happened to Ms. Smith?"  I ask as I see Cheryl Smith in my mind's eye and reflect on the last time I saw her a few weeks ago.  I don't recall that she was ill.

"Her husband said that she fell on the ice striking her head and losing consciousness.  She started to seize, he called the squad.  She never regained consciousness and died in the emergency room.  They told him she probably bled into the brain."

"That's really sad," I say while feeling a bit empty.  I think-- I need some time to reflect on this unexpected loss.  Where do I go?  I'm interrupted by one of my office staff, "Dr., Here's Mr. Samuels INR result, is it OK?"  I look at the numbers and the note about Mr. Samuels, reflect on the results and write a few numbers and a comment.  The Medical Assistant says, "Thanks, Your first patient is in the room, coughing.  She may need a breathing treatment."

I take a deep breath, hold it for about five seconds, grab the medical file from the rack outside the first room, read the MA note and vital signs and problem list and glance at the last note I wrote about this patient, knock and enter the room.

When is my grief time for Susan Jones?  Maybe tonight after seeing the last patient.

Family Medicine:  We'll Cry Later.

Bonus Based Medicine: Moving Beyond the Patient to the Cash Register

You may be seeing "Bonus Based Medicine"  in our fading health care system, but not knowing what's happening.  The bonus moving your physician to seem to have low regard for your input is the "elephant in the room".  Evidence based quality guidelines are aligned with more money for physicians from the insurance company and/or their employer.  Unfortunately, you were not studied to best define quality.  You are not yet involved in defining the quality of your health care.

What are you seeing/ feeling of "Bonus Based Medicine?"

Celebrating Humans: We're Worth It

Hi Folks,

It's been almost a month since my last blog post.  A little change of focus while getting the Open Arms Health Clinic in Bellbrook, going.  It's a free clinic supported by donations to the 501(c)3 charitable organization. I'm pleased to be a part of it and honored to get to see patients there in the first few weeks of operations.

It's gratifying to see the effects of caring.  Humans were fairly well designed, especially the heart, which has kind ways of caring for and about others.

Celebrate with me-- the beauty of being human.  You're worth it!

Peace.  More later.
apj