Tag Archives: physician

On Shared Advocacy

Posted on by
7

dsc_0645

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?

—–

*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

Posted on by
4

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 Community

Posted on by
2

img_4595

NaBloPoMo 2016, Letters to Patients, Day 10

To Patients Who Feel Alone Sometimes:

Who holds you up?

Day 2 post-election, it is still positively surreal.  Monday night I saw Facebook friends post passionate, emotional, sometimes desperate pleas, urging their friends to vote one way or another.  I also saw friends acknowledging the long, strange trip, looking forward to the next chapter, expressing both relief and trepidation.  A cloud of separation hung over my heart as I read some of my friends’ words then. 

Something inside urged me to contact a high school classmate.  We did not know each other well back then, and we didn’t always like each other.  But I always felt a mutual respect.  She does not post about politics; I do…a lot.  I know we differ in many of our positions and views.  I also know her to be thoughtful, kind, ethical, and just.  I know she has a lot going on in her life right now.  Our Facebook friendship has grown the past few years, and more and more I feel a cosmic connection.  I am meant to know this person again and better, in this later phase of life.  So I messaged her privately, just to tell her I was thinking of her.  I sent hope, and wishes that we could sit down over tea, somewhere cozy, and share our lives—slowly, thoughtfully, kindly, lovingly.  Turns out my little message helped hold her up yesterday.  On this day of anxiety and tension, hope and uncertainty, this long-distance connection gives me strength and peace.  It reminds me of a recent article by the Dalai Lama on our need to be needed.

I’ve said and written so often that I’m so grateful for my tribe(s), the communities that surround and support me in everything I do.  When I see patients, I make it a point to ask about emotional support networks. They don’t have to be vast or deep.  They just need to be strong and reliable.  No matter what our station, our illness, our cultural origin, or our political leaning, we live longer, healthier, happier, and easier when we connect with others.  It can be many, often, and deep.  It can be few and intermittent.  It just has to be meaningful and enough.

Lastly, supportive relationships function best when they are also reciprocal.  I don’t mean quid pro quo.  I mean mutual, shared, communal, uncalculated support.  I ask patients, “Do you have enough people you know you can turn to, people who will be there for you, in times of personal crisis?”  I want so much for you to answer without hesitation, “Yes, definitely, no question.”  Then I can relax about your health.  You (all) got this.