Relationship Revolution

 

“In my lifetime I want to see the culture of medicine driven more by relationship than by revenue.”

–me

 

Nice to be back, friends!

This post is a bit different from my usual format and style.  It’s maybe more raw and blunt.

Please bear with me and keep an open mind?

I know posting this may be risky.  It started out as just jotting down ideas for a longer, more detailed future post.  I had to get the ideas and thoughts out so I could focus on work.  And then the ‘jotting’ somehow evolved into what I imagine a poetry slam might look like.  So I decided to post as is.

My long term objective is to stimulate generous thought and respectful discussion between patients and physicians.  I wish to prod us out of our default complaint modes and reorient all of us to the idea that we are all on the same team, but our connections are under siege by outside forces.  The system harms and oppresses us, physicians and patients, the end users, and the ones with the real power.  Together, we are the sleeping (sedated?) giant that must rise up and reclaim the system for ourselves.  This post is an attempt to spark the flame that draws us together, by pointing directly to the spikes that drive us apart.

Disclaimer: What follows is my own expression and does not represent or reflect the opinion or position of any colleague, institution, or professional society with whom I associate or to which I belong.

ice castle spider legs

I hear my colleagues say: Get rid of the patient portal!

It’s too much!

Limiting characters does not work, they just send multiple messages

Charging for messages just makes more work

“They abuse the system”

“We give an inch, they take a mile”

Keep them away!

Us vs. Them mentality.

Antithetical to mission of medicine: To meet patients where they need us, and help them.

WHY?

Because we are too busy.

DOING WHAT?

Every. F*ing. Thing.

Rx prior authorizations

Endless documentation, infinite clicks

Rx refills with no information on follow up or patient status

Filling slots to meet RVU goals

Prescribing more meds to meet “quality” goals

Keeping up with the latest evidence for every disease, test, treatment, guideline, diet fad

Rushing to the next patient so that the patient we’re with does not have time to even think of their questions, must less ask them

Patients walk away from visits with their true needs unmet.

So they use the resources available to them to ask for what they need.

And this ‘adds’ to our work

And we feel busier and more frustrated, exhausted, frayed, irritable

We feel Overwhelmed.

 

Patients also feel it

They feel unseen, unheard, dismissed, discarded

And they don’t understand or relate to where it comes from

They get angry

So they send more messages: to us, about us; criticizing us, lashing out

Making us feel bad about ourselves

Which manifests as defensiveness first, then even more frustration, exhaustion, irritability

But we don’t disengage.

We remember our calling.

We forge on in smoldering resentment, pride, bitterness, duty, guilt, shame, and occasional fulfillment

 

And then abstractions to reconcile the cognitive dissonance

 

Patients suck

All they do is take take take

They don’t understand that I’m Doing My Best to help them

Why don’t they appreciate me

They are so entitled these days

They want everything now now now

They think I’m at their beck and call

Like I’m not working every minute of every day

Like I don’t have a family and a life also

Like I live only to serve them

Patients are the enemy

Really?

 

Oh and it happens on both sides

 

Doctors suck

All they do is type away at that blasted computer

They don’t even look up, see me, or hear me

They don’t understand what I need

They just want to see more patients

Make more money

I’m just a number to them

A cog on a conveyor belt

They’re all in the pockets of Big Pharma and Insurance

They withhold the help I need

They hoard it

They don’t care about me

They Don’t Care About Patients

All they care about is making the next buck

Doctors are the enemy

Really?

ice castle doorway

There is no substitute for the Time and Energy

Required to cultivate Healthy, mutually Respectful, mutually Fulfilling, mutually Beneficial relationships

It is always a two-way street

Our relationships kill us or save us.  Always.

snake river keystone

Doctors and patients must find ways to reconnect

Find one another through the thick morass

And Hold Tight

In Solidarity

Learn, Train and Practice Together

Our Communication, Empathy, Compassion, and Collaboration skills

Defend against the forces that drive us apart

Advocate for one another and for our Sacred Contract

So we may once again

Heal Through Connection

 

3 thoughts on “Relationship Revolution

  1. Catherine, thank you for this. I recently moved & had to start over with a new GP & psychiatrist. It’s daunting, but I was determined to start creating relationships with them both—to patiently answer questions I’ve had to answer 100 times before, to calmly present my learned experience, to thank them for caring about my obesity/intolerance to drugs/etc.
    I will not give up this time. I will not get mad/silent/offended. I will keep looking for the person and the professional while I hold my boundaries and self-respect.
    Thank you for the important work you do.

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  2. The idea that we are all on the same team seems so elemental; why is it so darn difficult? It feels like there is something in certain systems—not just in medicine, but education, civil discourse, even religion—that benefits if we cannot come together. With regard to health care, I can blame insurance, and undoubtedly a lot of blame lies there, but there’s something more that I can’t wrap my head around. It sometimes seems that from the moment we come into the world, we are encouraged to look for differences and to jockey for the top position. I love this post, Cathy, and I’m so glad to see you back in the blogosphere. Keep asking the hard questions—and living them—until one day, as Rilke predicts, we will “live along some distant day into the answer.”

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  3. OMG, Cathy, you just slammed one of my hot bottons–with so much force it’s now stuck.

    One day I will share my thoughts in more detail. To me, the root of most of our primary care woes lies within three f….ing letters: R..V..U.

    “You get what you pay for”. Most docs, especially primary care in the NM system are paid by how many RVU’S they generate. True caring, relating, healing cannot be measured in RVU’S.

    Most docs I know want to do “the right thing” but what exactly is “right”. When our worth to the system is defined by how many RVU’S we generate (as it is now) our future, in my opinion, is bleak.

    By the way, I LOVE MY JOB. I strongly encourage my patients to use the patient portal. In the exam room I usually have the computer positioned so my patient can see what I am entering, AND my AVS actually consists of my advice to the patient. I have been fortunate to usually work with an MA who knows how to help me with the pre-auth nonsense. Oh, and I am salaried–though management still closely monitors my RVU production.

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