Family Medicine Activist: What IF...

#HAWMC Day 5

"If time and money were no object, what should happen in health care?

First, allow the humanity of the participants to come through in each relationship.  Let's be neighborly.  Let's respect those involved.  Let's protect each other by sharing potential benefits and harms of available options.  Let's be humans first, patients and doctors later.  Let's make sure we honor and value our worth as humans.  Let's make sure we protect each other from unnecessary expense or harm.

How might this happen?

I like human centering as a strategy for the patient- physician dyad.  If we center on our humanity, we are more comfortable and respectful as we shift through various roles (such as teacher- learner, consumer- consumer coach, patient- physician, steward of resources- steward of resources, etc.) during each clinical engagement. 

Neighborliness helps, too.  I wrote this post a couple years ago as part of developing the Human Centered Health Home (HCHH):

Wednesday, July 28, 2010

The Human Centered Health Home: Protected and Neighborly

As a child, I always felt safe. Growing up in a neighborhood of unlocked homes where every kid could enter any house to play with other kids as allowed by the neighborhood mothers. The moms watched over the children and kept us safe and in line. They also had occasion to use branches from the same weeping willow tree as a switch. I remember hearing,"Go get me a switch from the willow tree and it better not be too small," on a few occasions, as did my playmates. In this environment, we were safe and everyone was neighborly.

I wonder if our medical care system could explore becoming more neighborly. Shouldn't people be safe in the system? Shouldn't we have a safe area where we could rely on a simple set of rules and personal relationships to deliver honest communication about important issues? What about expanding a neighborhood health care concept? (without willow trees).  What about timely information sharing in the context of ongoing  relationships?

Would it be neighborly to work together toward mutually beneficial outcomes?  Would it feel comforting if we would apprise each other about risks and benefits of our considerations?  Would we expect mutual revelation of reasonable estimates of pain, suffering and expense?  Would we find an "adult" switch to provide respectful feedback to keep each other in line?  Would we try to protect each other, our friends and our families from undue hardship?

Would it be neighborly to use sociotechnical innovation such as social media via cyberspace to relate in a timely manner?

A Human Centered Health Home (HCHH) could be a step in the right direction.  Humans first, caring and neighborly, is possible as we head toward the next wave of health care.  Just imagine..

Family Medicine Activist: Wholeness isn't Billable

#HAWMC Day 4

Famed scientist David Bohm was frustrated by the way science seemed to fragment or isolate subject matter.  According to Peter Senge who wrote in the introduction to Bohm's book, Dialogue, "But it's efficacy hinges on its being able to fragment... It fails and may become actively dysfunctional when confronted by wholes, by the need to understand and take effective action in a highly interdependent context."

"The fundamental problem here, according to Bohm, is that the whole is too much.  There is no way by which thought can hold the whole, because thought...limits and defines."

Advocating for Family Medicine is challenging at times for reasons that Dr Bohm would understand.  We have a relationship-based specialty that aims for patient wholeness while having to bill for the care of patient parts.  The wholeness quest wrestles with  the desire to succeed financially.  If we succeed financially by traditional medical billing, we are eroding our clinical success by carving up wholeness into parts.  This is one of the paradoxes of Family Medicine.

Patients may feel the tension as the clinical encounter seeks to break them into parts, while overlooking issues of wholeness, which would be more healthful.  We have to find ways to align the wholeness quest with a realistic business model since we believe that Family Medicine should survive.

God knows wholeness.  Can we?

How can we share the wholeness quest with our patients for our mutual benefit?

Family Medicine Activist: #HAWMC on The Dr Synonymous Show

Day 3 Post for Health Activists Writer's Month Challenge

I blog daily for thirty days and talk about blog posts on my weekly internet radio show:  Dr Synonymous The Dr Synonymous Show April 2, 2013

The April 2, 2013 Dr Synonymous Show on BlogTalk Radio reviewed several posts from Health Activist Writers Challenge Month.  I love these posts and learn a lot.  The Tweets below were used on the show to open the posts and read from them. 

These included Day 2 posts of the "30 posts in 30 days" #HAWMC

Needled & Threaded" #HAWMC Day 2 Stabbed & stitched. Lanced & linked. You get the idea. http://bit.ly/14BZoEB  #diabetes by Melissa Lee @sweetlyvoiced

A Guy With Crohns ‏@JavaJay7333m

Health Activist Writer's Month Challenge - Day 3 #HAWMC @Wegohealth http://wp.me/p2tSKs-7K

Bola Odulate ‏@realitynibs 2 Apr 

 Introductions: 5 Things I Want You to Know http://nyb.lt/39dzdk  #cfs #fibro #hawmc

Aaron Damigos ‏@aaronmichaeld 2 Apr
Day 2 - Introductions http://aaronmichaeld.tumblr.com/post/46981486854/130402-1726-introductions …

Alissa Janchenko ‏@divinemissliss 2 Apr My Day 2 post for #HAWMC: http://www.breakingupwithcaptaincrunch.com/2013/04/hawmc-day-2.html …  

 Heather Coleman ‏@heathercoleman 2 Apr  

#HAWMC Day 2: The Top 5 Things I Want You To Know About Postpartum Psychosis http://wp.me/pxfji-49  #mentalhealth

Jamee Miller ‏@JameeTMiller 2 Apr (new post} 5 Things ... #chronicillness #awareness #community #support #bowelobstruction #HAWMC http://tinyurl.com/br7m32f

Heidi DuPree ‏@heididupree 2 Apr Day 2 #HAWMC 5 things about my health and activism http://fb.me/KeZhGcCt

 Emily ‏@emilymword 2 Apr

What was the most helpful advice you had when you were a new migraineur? What advice would you give? http://thatmword.com/post/46948193451/day-2-what-new-migraineurs-need-to-know …

A. Patrick Jonas, MD ‏@apjonas 2 Apr Family Medicine Activist: What is Family Medicine? Day 2 #HAWMC http://shar.es/dYQoR  via @sharethis #FMRevolution #hcr #hcsm

Health Activist Writer's Month Challenge is off to a good start. More posts will be reviewed on my show next Tuesday, but continuously available for listening via Blog Talk Radio.  

Family Medicine Activist: What is Family Medicine?

HAWMC 2013 Day 2

So I'm a Family Physician in the private practice of Family Medicine.  What is Family Medicine?

"Family medicine is the medical specialty which provides continuing, comprehensive health care for the individual and family. It is a specialty in breadth that integrates the biological, clinical and behavioral sciences. The scope of family medicine encompasses all ages, both sexes, each organ system and every disease entity." (1986) (2010 COD) From the American Academy of Family Physicians

It sounds fairly broad and deep, and it is.  It has to be to respond to your needs.  Notice that it includes integration of biological, clinical and behavioral sciences.  The behavioral part is very important because it enables the Family Physician to connect with the context of your situation.  I've often said, "Context is everything."  What good is it to tell someone how to care for their elbow pain unless the doctor knows where the elbow has been and where it's going?

Your life, your story and your ongoing narrative are the focus of Family Medicine.  Your parts don't have much meaning without your life and  your whole being.  You are born, have a life, then die, then have a hereafter.  All of that matters to your Family Physician in the context of your life.

Not surprisingly, the Family Physician's context matters, too.  As the wholeness of the physician meets that of the patient, there is increased potential to relate and allow better health to happen.  Even when health is failing near the end of life, wholeness can be maintained as the dyad of patient and physician recognize the meaning of the lives lived.  A spiritual aspect of the relationship may add comfort at these times and others. The family context of the Family Medicine dyad may often provide insights about birth, health, illness, disease and death.

The biological and clinical aspects of Family Medicine include all diseases, therapies and diagnoses.  The relationship based nature of the specialty generally adds to the ability to treat and respond to medical diagnoses.  The comprehensive nature of the specialty includes coordinating care across multiple specialties and settings.  It requires collaboration and teamwork with physicians and other professionals.  It may be cumbersome and confusing at times because of the vastness of the modern health care non-system, but patients and Family Physicians can work together in context to get things done.

My life as a Family Physician has no meaning without patients.  They are the key relationships in my career. They allow me to learn about the human condition and apply that learning to shared planning and problem solving.  Their values, goals and beliefs are important aspects of our relationship and mold the decisions that we share in identifying health care and disease care strategies.

Family Medicine Activist: 30 Posts in 30 Days HAWMC 2013

Hi Folks.  I'm participating in the HAWMC 2013, committing to 30 posts in 30 days.  This is my 3rd time to participate.  Yes, I was posting in Nov 2011 and April 2012, which are still available if you look at those months in my Dr Synonymous Archives.

I am a Health Activist for Family Medicine.  As a Family Physician, I worry about patients and my fellow Family Physicians.  We're in a convoluted health care non-system that is bankrupting America.  No end is in sight.  Superficial recommendations for healthcare reform have been initiated.  So far, though, it looks as if there are more training and new jobs in the IRS responding to the Affordable Care Act than training for new Family Physicians or other Primary Care Physicians.  There is a huge shortage of front line physicians.

What will happen?  I don't know.  But I have ideas and I listen to others and read a lot.  I have a vast array of health care experience since graduating from the Ohio State University College of Medicine in 1976.  I'm in private practice with another physician and a part-time family nurse practitioner since 1999 in Beavercreek, Ohio.  Before that, I started four Family Practice offices from scratch and upgraded three other practices (two campus health centers and one University Family Practice Center).

After 175,000 patient encounters, I have some insights about health and health care.  Patients still need interaction with a personal, Family Physician to have the best health path.  The Medical Industrial Complex is too costly to face it alone.

My training and practice sites have included small town, rural, urban, private, community hospitals, university hospitals, and suburban.  I've been on the faculty of three medical schools, medical director at a holistic training school and directed a physician assistant training program.  I've taught medical students, residents, fellows, nurse practitioners, physician assistants and others.  I've been on many commissions, committees and boards and served as President of the Ohio Academy of Family Physicians.  I'm trained in Reiki, Neurolinguistic Programming, Non-Directive Imaging, chair massage, aromatherapy, reflexology, sound attunement therapy and others.  Currently, I'm on a community board that's developing a free clinic.

Before the health care training, I graduated from West Point in 1968 and served as an Army officer in the Corps of Engineers with Airborne, Army Ranger training and rotary wing aviator school before serving in Vietnam in the Aviation Section of the 45th Engineer Group.  I flew Hueys and Kiowas in Vietnam and at Ft Riley, KS before going civilian and starting OSU COM.

So now, I'm a social media enthusiast and health activist.  I'm questing for more insight about the human condition as it applies to Family Medicine and life.  I blog and have a Blog Talk Radio show as Dr Synonymous.  On Twitter, I'm @apjonas.  On LinkedIn, I'm A. Patrick Jonas.  I also use Facebook for personal and family purposes and have a FB site for The Center for Innovation in Family and Community Health which exists to Strengthen the Healing Community and to promote the Human Centered Health Home.  It is launching Direct Ohio Care- a subscription medical practice network for Ohio.

Now that you know part of my background, I will share my perspectives as a Family Medicine Activist on HAWMC 2013 and ask for opinions about most of my blog posts.  I look forward to reading the posts of other activists and discussing many of them on my Dr Synonymous Show.

Peace to all of you.  Onward