Monthly Archives: November 2016

On Fasting

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NaBloPoMo 2016, Letters to Patients, Day 15

To Patients Who Are Fed Up:

Try fasting.

That pun really was unintended!

I asked a colleague about fasting once—what are the benefits, why does he do it?  He asked, “Don’t you ever feel like it’d be a good thing, every once in a while, to stop eating for a day?”  Ummm… No, are you kidding me?  That would never and still has never occurred to me, I love food too much!

Tonight, however, I think I may understand a little better.  Maybe fasting is about counteracting overconsumption.   Certainly we have a problem with food glut here in the US.  I have heard the word ‘detox’ associated with fasting, too…  Maybe I just refuse to admit how poisoned I am by the food I eat to consider this remedy—I am pre-contemplative here.

I am finally ready to concede, however, that I overconsume Facebook.  Sure, it provides plenty of material for this blog, and I really do interact meaningfully with a lot of people (but wait, do I, really?).  And, I have let it overtake my consciousness too often.  The time suck is interfering with other tasks and yes, relationships, I must admit.  I rationalize that I am ‘reading,’ that it’s a source of so much interesting information and idea exchange.  That may be partially true, and still, it costs too much.

So I commit to a Facebook fast this day, November 15, 2016.  It’s been a long time since my last fast—actually a year, come to think of it—yup, almost exactly!  How funny…

Is there something you need to take a break from?  Something you do habitually, that’s not all bad, but that may be excessive, a little out of control?  Maybe you don’t need to quit it altogether, necessarily.  But maybe taking a little time away will help put it into perspective?  A little break—a pause.  Test your ability to resist, challenge yourself to notice where the habit shows up, what drives it, what you might substitute for it, and how the withdrawl sensations may evolve…

Now I’m wondering if I could actually apply this to my eating.  No, not fasting from all food (again, are you kidding??), but maybe something a little more manageable:  Fast from dessert for a week—substitute fruit.  From sweetened condensed milk on weekdays (“That’s like dessert!” one of my patients exclaimed once)—substitute soy milk.  This looks more like actual behavior change than just fasting… huh.

I will be back on Facebook tomorrow.  It will likely look very similar to my usual pattern, maybe even a rebound effect—a more intense fix after the sudden withdrawl.  Well, we’ll see.  I feel a lightness to trial and error lately, and this is worth a try.  I shall report back, so stay tuned!

 

On Shared Advocacy

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NaBloPoMo 2016, Letters to Patients, Day 14

To Patients Concerned About the Future of Healthcare:

We need one another now more than ever.

In April last year I started this blog to help patients and physicians connect in an increasingly disconnected healthcare system.  Both patients and physicians feel bound and invaded from multiple directions, all interfering with the doctor-patient relationship.  We all suffer for it.

It occurs to me that many of you may not know exactly what we physicians struggle with, that makes some of us so grumpy every day.

What assumptions do you make about us, and how does that impact our interactions?

Here are just a few of our challenges:

Electronic Health Record.  You’d think this would make everything faster, easier.  It has not.  It’s not only your chart.  It’s your billing record.  It’s the demographic, biometric, diagnosis, treatment, and outcome data repository.  And it’s clumsy, to say the least, at all of its functions.  Read more about how it negatively impacts physicians’ quality of life and care here.

Quality Measures.  We all want you to have the best quality care possible.  But how do we measure that?  Many payers base it on outcomes.  Physicians are judged and compensated, for instance, based on their patients’ blood pressure, blood sugar, and whether or not they have quit smoking.  But I cannot control these things.  I cannot make you take your medication or stop eating sugar.  I cannot make you stop smoking.  What I need is to talk to you about your life, so we can figure out the solutions.

Quantity pressure.  But talking requires time—quality time.  The 15 minute clinic slot is designed to maximize volume, not quality (how ironic?).  If you have an acute problem, on top of your uncontrolled blood pressure and diabetes, and we also have to set up your mammogram and colonoscopy, how can I possibly have time to explore, let alone address, the nuances of your health behaviors?

Some of my colleagues advocate for policy change at state and federal levels.  When I suggest that we consider bringing patients on board to help advocate for/with us, some eschew the idea.  We advocate for our patients, not the other way around, they say.  It’s as if we will be seen as weak that we bring you along to speak on our behalf.

The way I see it, we should all stand and speak up for one another.  Yes, in our working relationship I have more power and authority in many ways, and it’s my job to take care of you.  But we are all participants in the larger system, and I think we can make greater, faster change for the better if we all fully understand our shared interests and goals, and advocate for them side by side.

What else do you need to know?

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*For your information, here is an excellent article describing the movement toward integrating physician health into healthcare policy for the benefit of all.

 

 

On Lifelong Learning

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dsc_0522NaBloPoMo 2016, Letters to Patients, Day 13

To My Patients Who Continue to Teach Me:

I’m a better doctor, a better parent, and a better person for knowing you.  Thank you.

To the middle-aged father of five who told me about my tween son, “Just be present.  Wait for it.  He won’t use many words.  When he starts talking, put down whatever you’re doing and listen.”

To the gifted daycare director and mom of two who advised me to ‘come alongside’ the kids rather than ‘coming at’ them.

To the auntie who reassured me that all will be well if I can hang on and ride the tides of marriage.

To the psychologist who taught me mindfulness in the exam room.

To the creative who showed me that left- and right-brainers overlap more than I realized.

To every patient who loves, hates, adores, vexes, uplifts, frustrates, admires and dismisses me, you each teach me a unique and valuable lesson.

Medicine is not about knowing.  It’s about listening, watching, being, waiting, doing, and holding.

Thank you all for the privilege to learn.

May I serve you well in return.