Human Centering: Enhancing Success in Health Care Situations

Presentation at The Institute of Holistic Leadership  with Pat Jonas, MD  August, 2014

Introductions: Megatrends, Avoiding "Non-Compliance"

Centering: Patient, Payment, Physician, Hypnotherapist, Health System, Public Health, Human

Human Centering:            What it is

                                             What it Does

                                             Why it’s important

Where and/ or when human centering may be beneficial?

How to do it:  Notice how you use your five senses.  Which one leads?

               Become Wholehearted by balancing the autonomic nervous system (“The Mommy Heart”)

P O L A R to another person in dialog  whole (sort of) wholehearted

Notice:   Assumptions, Context of them and you, Process of them and you

Human Centered Health Home (HCHH) Process for dyad

               Respect

               Protect

               Connect

               Detect

               Correct

               Reflect

Holistic Strategies for Human Centering

               Mind-Body Therapies

               Nutriceuticals

               Body Work

               Energy Work (Overtones – one of the secrets)

How to use Human Centering

               In Health Care Engagement as patient/client or practitioner (working and caring)

               In HC System as visitor- e.g., in a hospital (working and caring)

               With a friend who has health problem

Human Centered Health Care (HC)2

               Model

               Context of dyad

               Process of R P C D C R

Heart to Heart Rapport

               Trance A to Trance B

               Rapport: Human to Human, Heart to Heart

               Dialog: Wilber’s Four Quadrants from A Brief History of Everything by Ken Wilber

               Human Connection: P O L A R to Explore, Understand and Act   P I E S x L L W

The Art of Health Care by Bill Anthony, The Art of Helping by Robert Carkhuff

The Structure of Magic Volumes I and II by Richard Bandler and John Grinder

Consulting with NLP by Lewis Walker

Hands of Light by Barbara Brennan, Wheels of Light by Rosalyn Bruyere

HeartMath.com for Quick Coherence Technique

WWW.DrSynonymous.Blogspot.com numerous blog posts: HCHH and process of care in Family Medicine

Non-Compliance Soon to be Top Diagnosis

Within three years, the top diagnosis in EMR's will be non-compliance with medical therapy or dietary therapy or exercise recommendation, etc.  (My opinion)  Patients and physicians are now trapped by the Electronic Medical Record.  The plan of care must include the recommended therapies for the diagnosis or the physician loses bonus potential.  There must be proof that the medicine was prescribed and the pharmacy dispensed it or the physician and/or the pharmacy may lose quality points or bonus dollars.  Just watch.

Information Technology tightens the system and decreases choice.  We used to be forgiving about patients that would sometimes decide not to fill prescriptions or sometimes decide not to take the medicine when they did fill the prescription.  Often, their judgement may have been better than ours as we came to realize.  Over time, we got to understand each others perspectives as our patient-physician relationship developed. Physician and patient learned how to honor each other's judgement.  The quality of the relationship depended on it.  IT initiatives now risk the patient-physician relationship, a central aspect in the quality of health care. The patient has to align with the "Patient Centered" decision of the EMR protocol that aligns with "quality".

Unless they want the diagnosis soon to be number one: Non-Compliance.

What's "Patient Centered" about that?

What do you think?

Many Patients Assigned to New Doctors

Several of my current patients called my office this week on receipt of information assigning them to a new physician (not me).  They are insured via a medicaid managed care product such as Care Source, but two other companies won the Miami Valley area bid to provide medicaid managed care.  We are not a "participating provider" in either of the new plans, so our patients will be assigned by a computer to another doctor.  We'll lose 50-75 patients in this part of the healthcare transformation.  We have meaningful, ongoing relationships with our patients and these losses hurt on the personal side, too.

We'll have to replace those patients, many of whom I've cared for for 6- 15  years, with direct pay patients, who will not have interference by insurance companies or government intervention.  The business survival of thousands of independent Family Physicians is touch and go for the next couple years.  This is a  very rough time in health care for patients, too, as they lose insurance and get a different plan with a $3000- $5000 deductible that they can't afford.  Many can't pay their doctor bills with the higher deductible and eventually lose their physician again.  Duck.

More later.

No More Screening Pelvic Exams for Women

Annals of Internal Medicine | Screening Pelvic Examination in Adult Women: A Clinical Practice Guideline From the American College of PhysiciansScreening Pelvic Examination in Adult Women

On July 1, The above article was published in the Annals of Internal Medicine, adding guidance to a frontline transformation in medical practice.  Family Physicians and Obstetricians have performed millions of pelvic exams in non-symptomatic women, noting in recent years that fewer pap tests were indicated, fewer mammograms were desired and other countries weren't performing near the amount of pelvics per capita as done in the U.S.  Some technological advances have led to better care for symptomatic women and a better understanding of cervical pathology.

The cancer screening for women still includes an annual breast exam, not annual pelvic, not annual pap test, not annual mammogram (but close).  Please understand that "screening" means a test or procedure performed on a person with NO SYMPTOMS.  No Symptoms.  No Symptoms.  Please remember that.

They now may have an annual or less often evaluation and therapeutic intervention session, more focused on their life, goals and dreams and parts.  With less time used up by the pelvic exam, women's health should improve.  (My opinion)

Most women over 40  have a symptom or two in one area or another.  Usually not in the pelvis.  The new guideline does not apply to them. They may more readily schedule an evaluation by their physician without getting distracted by issues of pelvic health.

Let's see how it goes.  What do you think?

Independence Day: Fifty Years After Fifty Gun Salute

July 4th 1964 is a distant memory, expounded on in my post in 2010:
 "Independence Day: Freedom and Underwear" Blog Post from 2010

I was a New Cadet at West Point.  The fifty gun salute, shared with my classmates in the great class of 1968, is my main memory of that day.  I note the photos today on Facebook of the New Cadets at West Point in the Class of 2018.  We are their 50 Year Affiliate Class.  We are connecting with them in various ways over the next four years in a flashback and "flashforth".  I wish them well.

Independence Day 1971 was special, too, since I celebrated it in Vietnam.  No fireworks.  No war that day, either since it was a holiday.  I don't know if the enemy honored it throughout South Vietnam.  Our 45th Engineer Group HQ officers celebrated in the beachfront officer's club which we visited each night to play cards, get refreshed and, on special occasions, sing.  I was one of the song leaders, Kurt Sins (now an attorney in New Orleans) was the piano player.  We sang every patriotic song we could think of on the Fourth of July.  And we did toast America with our favorite beverages.

Independence Day 1976 was another special one.  I had just started my Family Practice Residency in Hershey, PA at the MS Hershey Medical Center of Penn State University. The Governor's Convention (of the United States) was held in Hershey that week, so VIP's were in town and the fireworks from Hershey Park were special for the 200th Birthday of America.

This weekend, I played the CDs of our West Point Glee Club Reunions (2007 and 2011).  I love the music.  I love the meaning of the music.  I love the patriotic songs.  I cry more now as I reflect on some of the people we've lost and those associated with America and its music.  I'm especially touched by America the Beautiful as performed by our West Point Glee Club with a historical narration and The Battle Hymn of the Republic.

 Vietnam, the Vietnam Veteran's Memorial and my friends and classmates who served in the Army occupy my nostalgic reflections.  Twenty members of the great Class of 1968 (No Task Too Great) are honored with their names on "The Wall", reminding us of their deaths from their service in Vietnam.

Independence Day, from the British.  What a commitment the signers made.  We endorsed it at West Point with our Oath on the first day and reaffirmed it  as Army (mostly, but some went into other services) officers with our Oath on graduation day.

Independence is worth celebrating.  Fireworks, singing, gatherings of friends and family.  Way to go America.