Tag Archives: health

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.

 

 

On What You Can Do

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img_4564NaBloPoMo 2016, Letters to Patients, Day 12

To Patients Wondering What to Do:

Take this Wise Lady’s advice.

I had an inspiring conversation this week, one that lifted me up, which I sorely needed.

This incredible woman grew up in the era before women could have credit cards in their own names, before women could play organized sports, and before spousal rape was finally outlawed.  She survived brain tumor surgery and the death of her son.  She has attained advanced education, acquired innovative skills, built and sold a business.  Throughout it all she seems to have thrived.

I queried her response to adversity.  Was she born wired for resilience?  Did she acquire such effective coping skills simply by experience?  She referenced the teachings of her father.  Through her childhood, she said, he taught her to how to face difficulties.  Before she went off to college her dad had a specific talk with her:  “Here’s how you deal with problems,” he said.  “When faced with a problem, first ask yourself, ‘what can I do?’”  Not what should I do, what do others expect me to do, what would s/he/they do.  “What can I do?”  “If you can’t figure it out right away, stop.  Go outside, take a walk.  Come back and ask again, ‘What can I do?’”

Wise Lady said this one strategy got her through myriad struggles and crises in life, and she taught it to her kids the way her dad taught her.  But life flung faster, sharper arrows her way, and she had to develop additional coping tactics.  Seeking a path to clarity through the mires of crisis, she began asking herself, “What do I need to get rid of?”  And that has made all the difference since.

I will tell you, Wise Lady has a serenity about her countenance that I meet only occasionally anymore.  She has racked miles on her soul, yet I sense no cynicism or regret.  I so want to be like her!

From now on I will ask myself more often,

“What can I do?” and

“What do I need to get rid of?”