Family Medicine Activist: Genomic Tenth Anniversary

#HAWMC Day 10

This weekend, we celebrate the tenth anniversary of the completion of the Human Genome Project in the US.  The Human Genome Project  There will be an opportunity to reflect on progress to date and look toward the future.  How is it affecting you?

If you're not aware, visit the National Human Genome Research Institute (NHGRI).
click here NHGRI
It has one interesting part called the Genetic and Rare Diseases (GARD) Center which has a helpful search feature.

Other great links from the site are the  NORD -- Rare Diseases and OMIM (Online Mendelian Inheritance in Man) databases with in depth comments from those sites.  Both are searchable to learn more about genetic and rare diseases.  Look up in depth information about your disease on these sites.

Celebrate the Tenth Anniversary of the Human Genome Project.  They are just scratching the surface of genomics.

Family Medicine Activist: Team Work to Make a Diagnosis

HAWMC Day 9

What about your unusual chronic disease when you engage your Family Physician about something else?  Do you mention it?  Should the doctor bring it up?

Yes and Yes, in general.

Each time you see your Family Physician for an illness or injury, your physician develops a "differential diagnosis" which is essentially a list of possible diagnoses that may cause your symptoms (what you feel) or signs (what you and the doctor find physically).

This may originate from a mnemonic (I like SPIT to start with) or other model (there are many).  This reminds me to think of something Serious, something Probable, something Interesting -to me or the patient, and something Treatable that may relate to the acute illness.

Your theory about what's happening is extremely important to the physician.  It's also important for them to know if you think it's related to your unusual/chronic disease.  You are familiar with different manifestations of it and you and the doctor form a very knowledgeable duo.  Working as a team keeps the information fresh and enhances the potential for the best outcome.  We need each other.

Family Medicine Activist: End of Life

HAWMC Day 8

I grabbed her right hand.  She squeezed it and looked through the breathing mask at me.  "What should I do?"

She is in the ICU, on the highest oxygen setting with a non-rebreather mask to maximize oxygen available.   The first pneumonia seemed defeated, but the emphysematous lungs had no reserve, continuing to worsen with respiratory failure.  She is at the end.  She knows it.  She is exhausted.  Her kidneys, lungs and heart are finishing together.  I know her and her family well.  I'm her Family Physician.

Her husband is gone.  The family has been taking her around to doctors, which has become her primary social life.

Her pleading eyes spoke of a long life, looking toward the hereafter.  She wanted help.  To get peace.

"You've done well with your life.  Your body is saying it has nothing left."  She had already opted against a ventilator.

"I feel bad about leaving them." she gasped as she looked at her family. "I'm ready to see my husband again."

 "They understand.  They know the meaning of your life.  They know your stories."

 "The hospice team can help with your comfort.  Your struggle is almost over.  You've done well.  God bless you"

"Thank you.  You've been a good doctor," she smiled. "He's the first one I could stand," she gasped to her family. "I'm ready to go."

Family Medicine Activist: You Matter

HAWMC Day 7

I remember one of my sergeants in US Army Ranger School used to say, "It's a case of mind over matter.  We don't mind and you don't matter."   Do you get that "you don't matter" feeling sometimes when you're involved in the health care system?

Sadly, people with mental illness seem to be the first to be discarded.  Hospitals are closing in-patient psychiatry units, since they are not profitable.  Emergency departments are jammed with patients since there aren't enough Family Physicians or other primary care physicians to care for them. Strangely, many hospitals are closing Family Medicine residency training programs, just when Family Physicians are in great demand, because they aren't as profitable as other specialty training.  They don't admit as many patients or send as many patients to Emergency Departments (which you may appreciate).

How does it get better?

It starts with your mirror.  Look at yourself in your mirror every day and enthusiastically say, "I love you!"  It knows that you matter.  Your mother knows that you matter.  And, your Family Physician knows that you matter.  You do matter.  Well or sick or injured, you matter.

One other way to matter in health care settings is to reaffirm your identity/ humanity.  Be more than your disease or your cholesterol.  How do you do this when your Family Physician is busy with medical activities?  Remember where I wrote that "context is everything" a few days ago?  You can firm up your physician's knowledge of the context of your life.

Physicians share information about patients by "presenting" information about them to each other when  needed.  Similar information about your context would include your age, marital status, gender, occupation, living arrangements and location, and where you are headed in your life, work, play or other narrative.  Providing elements of your context as part of the expansion of your chief complaint (reason for the visit) and  history of present illness should help your physician.  It might sound like this as your physician thinks of your situation, "This 42 year old female high school principal who lives in a home in Beavercreek with her husband is intending to start a PhD program in June and is here today for left knee pain for the last two weeks.  She is  a tennis club member and their season started two weeks ago."

Do you notice how the context of this person's situation should help the physician to personalize the diagnostic process and treatment plan?  The information enables the physician to have a broader understanding of the potential diagnoses and individual treatment strategies for this unique person.

Your Family Physician also enjoys their relationship based specialty more as they get a deeper understanding of you and other family.  People are interesting.  Body parts and numbers aren't as interesting without a person with a context.

As your Family Physician and other specialists better understand your context, they can better personalize your care.  Because...YOU MATTER!

Family Medicine Activist: "Dear Family Medicine"

#HAWMC Day 6

Dear Family Medicine,

Thank you.  For being there.  When I was a brand new baby in the newborn nursery.  Well, you examined me in my mom's hospital room.  She and Dad were happy.  I was a bit jaundiced (yellow), but never felt so loved.  My mom said she had like, this "love beam" coming out of her heart, all for me.  Dad laughed a lot.  You asked who I looked like.  Grandma answered the question when she first saw me in Mom's arms.  "Oh, he looks just like Aunt Suzi when she was a newborn."  I wasn't happy to hear that when I was older.

Thank you.  For being there.  When I had right foot pain, getting worse every day at school in the third grade.  Finally, Mom brought me in to see you.  You examined my foot, noting that all my toes seemed normal and not tender.  "Let me see your shoes," you said.  "Aha, I think you're going to be better now," you said, as you handed me the tube of chapstick you took from the inside of my right shoe.  Mom laughed.  You smiled.

Thank you.  For being there.  When I got my first stitches.  They were right on top of my head.  I was in my seventh grade football uniform.  Someone jumped on top or me, cutting my head with his helmet.  Oh, you wondered how I could get cut if I had my helmet on.  I remembered how surprised you were, and how you smiled when my mother said, "It was during the pre-game prayer.  Someone jumped on top when they kneeled down."

Thank you.  For being there.