Tag Archives: NaBloPoMo

On Inspiration

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dsc_0460NaBloPoMo 2016, Letters to Patients, Day 17

To Patients Who Share Your Stories:

You inspire me.

For the past week or so Donna Cameron and I have practiced the 3 Question Journal, since I wrote about it 9 days ago.  Every day we look for one thing each that surprised us, touched us, and inspired us.

I find that my inspiration comes almost always from my interactions with others, and often from patients.  It’s the stories.  I bring my laptop into the exam room, and I notice when I stop typing and sit forward, usually chin in hand, to listen to what you have to say.  Usually you’re telling me about a problem you solved at work, or your kids, or that crazy illness or injury you overcame.  You look and sound proud, confident.  You sit up straighter.

The stories from past and present help me tie together your symptoms.  Maybe you get headaches more lately.  But you’re not stressed, you say.  Then looking back, well, your mom has been losing her memory fast the past year.  And your co-worker was diagnosed with cancer.  You found mold in your basement and it’s going to cost you both time and money to abate it.  Oh, and your only son will graduate from high school next year.  Hmmmm, are you sure you only have headaches and not other symptoms, too?  Yeah, you say, you’re actually doing pretty well, all things considered!

I never know what will come up when I see you.  If our relationship is established and positive, I will always look forward to your next visit.  I can’t wait to catch up.  I want to hear what you’ve noticed about your health habits, their consequences and interactions, since we last met.  The little things make me giddy—like the newfound flexibility after a couple of yoga classes, or the discovery of a new favorite health food—who knew quinoa was so delicious as a hot breakfast ?

Maybe the best part comes when I can really relate to a story you tell.  Wow, I think, we live parallel lives!  We struggle with the same barriers to healthy habits.  We share the common experience of perfectionism and self-doubt.  We both seek acknowledgement that we’re doing our best, and forgiveness for our mistakes.  We are all simply human.

Please keep sharing your stories.  You inspire me more than you know.

On Readiness

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NaBloPoMo 2016, Letters to Patients, Day 16

To Patients Contemplating Change:

You’ll do it when you’re ready.  And you’ll know.

My 24 hour Facebook fast is 90% complete, and I feel GREAT!!  Holy COW, I’ve been so productive, and for the most part I feel liberated and lightened.  The darkness of increasing online tension had spread over my consciousness rather insidiously, like a slime mold.  It’s not that I was totally unaware, or that I underestimated its toxic influences; I was just not ready to stop it.  The cost/benefit balance finally tipped and I was moved to act.  It’s that simple and that complicated.

Today I reviewed my notes from the physician health conference 2 months ago.  I came across an important exercise that illustrates my point.  The speaker had us make two lists: energy-depleting activities and energy-enhancing ones.  My second item on the former list was “Facebook+/-“.  It was the third item my latter list.  She then asked us: If we had 2 extra hours a day, what would we do more?  –Read, write, go outside, meditate, do stuff with kids (outside), plan road trips.  Then, if we had 2 fewer hours per day, what would we cut out?  –Facebook/news, TV/movies.

That was two months ago.  I knew I ‘should’ cut down on my Facebooking, but I was not ready.  Yesterday, finally, I crossed a threshold and the decision was easy.

I hear this all the time from patients.  “I know I should eat healthier.  I know I should exercise more.  I know I should quit smoking, cut back on the alcohol, go to bed earlier, address my relationship problems.”  And, “…I just don’t.”  Both patients and physicians can easily slide into judgment here, thinking, “If you know you should, why don’t you just do it?”  Defensiveness and self-loathing follow closely behind these words.

On the other hand, when patients return having cut out red meat, quit tobacco, and joined a basketball club, I ask them, “What happened?”  Most of the time I hear, “I don’t know.  Something just clicked and I decided it was time.  …And suddenly it was easy.”  Sometimes they identify an a-ha moment—when they first held their newborn baby, for example.  But more often there is no cloud-parting epiphany.  They simply cross the threshold of readiness to change, while walking the journey of life.

I confess I am guilty of impatience and judgment.  When I see your uncontrolled, lifestyle-related medical problems, and you resist behavior change, I feel frustrated.  I know you feel it, too.  But know that I don’t blame you.  If we all did everything we knew we ‘should,’ then—well—you fill in the blank.  The point is: we don’t make changes until we are ready.  Certainly we facilitate readiness—that’s a topic for another post.   Suffice it to say: I see you.  I know you want to live healthy.  You will know when you’re ready, and you’ll move.  Until then, I’m still here with you.

 

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.