My son and daughter play violin. I accompany them to every class and stand over them in our living room as they practice. From the very beginning, the teachers required parental involvement. They often spent more time talking to me than my children. They instructed on posture and fingering. Eventually, I learned to read music. I even rented a violin of my own.
As the years have passed, I still play an active role. I know when my son's elbow rides too high or my daughter's wrist curves upward like when carrying a pizza. My ear can tell when a note is a touch too sharp or completely wrong. But as an adult, I find I have little time to practice the same hours as my offspring.
I returned the rented violin after months because it sat unused in the corner.
My children have far surpassed my abilities. Although I have knowledge of the appropriate technique and have learned the series of notes, I am a victim of insufficient practice. And indeed, one can look down the line from less to more experienced and realize the difference repetition makes. Although the notes are the same, the depth and quality of the sound that reverberates through the violin can be very different.
Only when one practices hour after hour, year after year, can the shadowy mirage of mastery shimmer in the distance.
There are no shortcuts.
Not in violin,
and not in medicine.
Tuesday, May 14, 2013
Monday, May 13, 2013
Caring 2.0: #HCSM And The Rise Of The Empathic Physician
We have our rock stars. Our members in the healthcare social media realm who have elevated the conversation to new heights. Physicians are tweeting, blogging, and popping up on news shows across the country. We are using our singular voices to educate on vaccines, heart disease, and the quantified self movement. We are acting locally, but teaching globally. The promise of social media has amplified our voices and carried our message to the unwashed masses.
We once could affect the few thousand who passed through our office doors. We now can touch the lives of millions. This dichotomy, fulfilling our individual covenants as well as our debt to society as a whole, has proven a powerful draw. One only has to look at the conversations on twitter to realize that our ranks are swelling. Not only physicians, but nurses, pharmacists, patients and advocates are both teaching and learning.
We all win, patients and providers alike.
Yet in our exuberance to transform, we continue to neglect certain self evident truths. It's time to pivot. It's time to not only tell people what we know, but who we are. Knowledge has it's limits, but does caring?
I propose we move to a Caring 2.0 mindset. The days of unidirectional emotion emanating from patient and bouncing off stoic expressionless physician are gone. Like the Healthcare 2.0 movement, the elevation of caregiving requires a blurring of the line between teacher and student. I can see no better way forward than social media.
We are human. We suffer, triumph, and struggle with our own inner demons. As Louise Aronson said in her book A History of the Present Illness:
Doctors, you see, aren't so different from patients. Every day we hope someone will see past our elaborate and very impressive window display to the jumble of expired products weighing down the shelves and choking the aisles of our psyches.
It is in this imperfection that we realize our best version of ourselves,
that we become the doctors our patients really need.
We once could affect the few thousand who passed through our office doors. We now can touch the lives of millions. This dichotomy, fulfilling our individual covenants as well as our debt to society as a whole, has proven a powerful draw. One only has to look at the conversations on twitter to realize that our ranks are swelling. Not only physicians, but nurses, pharmacists, patients and advocates are both teaching and learning.
We all win, patients and providers alike.
Yet in our exuberance to transform, we continue to neglect certain self evident truths. It's time to pivot. It's time to not only tell people what we know, but who we are. Knowledge has it's limits, but does caring?
I propose we move to a Caring 2.0 mindset. The days of unidirectional emotion emanating from patient and bouncing off stoic expressionless physician are gone. Like the Healthcare 2.0 movement, the elevation of caregiving requires a blurring of the line between teacher and student. I can see no better way forward than social media.
We are human. We suffer, triumph, and struggle with our own inner demons. As Louise Aronson said in her book A History of the Present Illness:
Doctors, you see, aren't so different from patients. Every day we hope someone will see past our elaborate and very impressive window display to the jumble of expired products weighing down the shelves and choking the aisles of our psyches.
It is in this imperfection that we realize our best version of ourselves,
that we become the doctors our patients really need.
Friday, May 10, 2013
CrisisMD Launched Today
CrisisMD.com launched today!
Our goal is to provide healthcare coaching, translational services, and advocacy to those in the midst of a crisis. Below find the post that spurred this business venture. It appeared recently on kevinmd.com.
If Only The Patient Had An Advocate
It had all been so easy when Jim was still around. Lisa’s ex-husband had many shortcomings, but being a critical care specialist sure came in handy. Any time her mom or dad had a health crisis, he was right there in the middle of it: advocating, interpreting, breaking down the complexities into easily digestible morsels of information. But then Lisa’s father died, and the emotional and physical stress brought the unstable union to a breaking point.
Years later, she sat in the ICU holding her mother’s hand and longing for the man that she had grown to despise. She felt a slight tenderness stir in her heart that was suddenly extinguished by picturing her previous husband with his new, almost teenage love interest.
Damn!
Lisa’s mother suffered another stroke. The ventilator had been removed but her mental state was dubious at best. She was not eating. And the hospitalist was suggesting a feeding tube. Lisa recoiled. Her memories of her agitated grandmother socked away in a nursing home pulling on the plastic protruding from her abdomen was too much a burden to be replayed a generation later.
If only Dr. Phillips would come to the hospital. As her mom’s primary care physician, Lisa trusted him. But he abandoned his privileges years ago. He once confided that he no longer knew how to take care of such sick patients. Lisa missed his optimism and his gentle hand on her shoulder resting tenderly. He understood her struggles. The hospitalist was nice enough, but young. He seemed overly concerned with protocol and rarely spent more than a minute in the room without leaving to answer a page. He certainly had no advanced knowledge of the woman lying in the bed in front of him.
The family meeting was pathetic. Instead of the hospitalist, a palliative care nurse joined the social worker and other supportive staff. Thirty minutes later, Lisa walked out more confused than ever. Most of the conversation resolved around disposition: nursing home, home with hospice, or rehabilitation center. Each member had their own checklist of salient decisions that often seemed far removed from her mother’s wants or needs. There was no question who each participant worked for. The hospital, the government, anyone except for the poor helpless struggling patient.
Lisa thought of Jim again. If only she had an advocate. Someone who answered to her and her mother instead of the litany of outside interested parties. If only her doctors would lift their heads from the computer screen for just a few moments. If only someone with medical knowledge took a moment to see the forest from the trees.
The mice keep running through the maze trying to find the elusive cheese.
Damn!
What the hell has happened to our medical system?
Our goal is to provide healthcare coaching, translational services, and advocacy to those in the midst of a crisis. Below find the post that spurred this business venture. It appeared recently on kevinmd.com.
If Only The Patient Had An Advocate
It had all been so easy when Jim was still around. Lisa’s ex-husband had many shortcomings, but being a critical care specialist sure came in handy. Any time her mom or dad had a health crisis, he was right there in the middle of it: advocating, interpreting, breaking down the complexities into easily digestible morsels of information. But then Lisa’s father died, and the emotional and physical stress brought the unstable union to a breaking point.
Years later, she sat in the ICU holding her mother’s hand and longing for the man that she had grown to despise. She felt a slight tenderness stir in her heart that was suddenly extinguished by picturing her previous husband with his new, almost teenage love interest.
Damn!
Lisa’s mother suffered another stroke. The ventilator had been removed but her mental state was dubious at best. She was not eating. And the hospitalist was suggesting a feeding tube. Lisa recoiled. Her memories of her agitated grandmother socked away in a nursing home pulling on the plastic protruding from her abdomen was too much a burden to be replayed a generation later.
If only Dr. Phillips would come to the hospital. As her mom’s primary care physician, Lisa trusted him. But he abandoned his privileges years ago. He once confided that he no longer knew how to take care of such sick patients. Lisa missed his optimism and his gentle hand on her shoulder resting tenderly. He understood her struggles. The hospitalist was nice enough, but young. He seemed overly concerned with protocol and rarely spent more than a minute in the room without leaving to answer a page. He certainly had no advanced knowledge of the woman lying in the bed in front of him.
The family meeting was pathetic. Instead of the hospitalist, a palliative care nurse joined the social worker and other supportive staff. Thirty minutes later, Lisa walked out more confused than ever. Most of the conversation resolved around disposition: nursing home, home with hospice, or rehabilitation center. Each member had their own checklist of salient decisions that often seemed far removed from her mother’s wants or needs. There was no question who each participant worked for. The hospital, the government, anyone except for the poor helpless struggling patient.
Lisa thought of Jim again. If only she had an advocate. Someone who answered to her and her mother instead of the litany of outside interested parties. If only her doctors would lift their heads from the computer screen for just a few moments. If only someone with medical knowledge took a moment to see the forest from the trees.
The mice keep running through the maze trying to find the elusive cheese.
Damn!
What the hell has happened to our medical system?
Thursday, May 9, 2013
Poof!
It happened once before. I logged onto the computer on a particularly challenging day to find that my blog was gone. Just like that. After countless posts, telling stories, complaining and rejoicing...poof. I was on WordPress at the time. I called the help line and frantically explained the situation. Weeks later I got the data back, unformatted and imported to a new web address.
I was crushed. Not just about the loss of all that writing, but more because the conversation had stopped. The unidirectional talk that I had been having with myself and my readers came to a sudden unexpected end. And when it finally came back, the connection had severed.
For a long time there was silence.
My writing is now hosted on blogger. Four hundred and seventy six posts later, the self expression dwarfs that of it's forebearer. Yet, I have taken no actions to record or backup my posts. Like a game of Russian Roulette, I keep hitting the publish button in complete denial. I have no explanation why I am paralyzed in taking such precautionary measures.
Poof!
Many have told me to collate my posts into a book. They say to self publish or get an agent. I have contemplated many times. But I could no more anthologize than I could backup my blog. We don't record our conversations with our friends, our loved ones. We remember them.
And this, my friend, is my conversation with you. I spew forth the randomness and you sometimes respond. You comment, email, or retweet. We have a relationship, real or imagined, I can't always tell.
I guess it was never really about the specific words.
I was just trying to tell you things.
I was crushed. Not just about the loss of all that writing, but more because the conversation had stopped. The unidirectional talk that I had been having with myself and my readers came to a sudden unexpected end. And when it finally came back, the connection had severed.
For a long time there was silence.
My writing is now hosted on blogger. Four hundred and seventy six posts later, the self expression dwarfs that of it's forebearer. Yet, I have taken no actions to record or backup my posts. Like a game of Russian Roulette, I keep hitting the publish button in complete denial. I have no explanation why I am paralyzed in taking such precautionary measures.
Poof!
Many have told me to collate my posts into a book. They say to self publish or get an agent. I have contemplated many times. But I could no more anthologize than I could backup my blog. We don't record our conversations with our friends, our loved ones. We remember them.
And this, my friend, is my conversation with you. I spew forth the randomness and you sometimes respond. You comment, email, or retweet. We have a relationship, real or imagined, I can't always tell.
I guess it was never really about the specific words.
I was just trying to tell you things.
Tuesday, May 7, 2013
Fatherhood And My Son's Kindle
It's kinda curious. For all the technology I live and breath, put me in an empty room with an IPAD and after a few minutes of browsing, I'm bored. I've tried to wile away the hours on the Internet, but I can't. I'm just not built that way. Even the games and downloads lose me fairly quickly.
My son, on the other hand, is an altogether different creature. He somehow wrangled us into allowing him to use his own (birthday) money to buy a Kindle. And at the age of eight, he is already bumping heads with his fifteen minute daily allotment. He carries the little device in it's dark blue case around the house like a trophy. He may be limited in minutes, but no one can deny him the pleasure of feeling the weight underneath his wanting hands.
For him, the tiny screen frames a world of wonder and technology. It's not just the games, but Google Earth, Wikipedia, and a vast marketplace for all those lovely objects his rambuctious boy mind desires. It's a destination unto itself filled with both learning and shiny sparkling objects.
It is what his heart desires above all else.
He takes the Kindle everywhere. He lugs it to the grocery store, paws it at Home Depot, and cradles it before violin practice. It's always by his side.
The other night after a long shopping trip, we gathered the kids together for an evening bath. My son ran into the room frantic.
Mommy, Daddy...where's my Kindle?
An exhaustive search of the house lead to a startling conclusion. We must've left it in the shopping cart at Target. My son twisted his hands in knots waiting for me to connect to the lost and found. Nothing!
As I lay awake that night, I listened to him toss and turn in the adjacent room. Occasionally he would jump out of bed and search an odd drawer or basket. The next morning he crawled into bed between my wife and I. His eyes full of tears, he nestled into my arms.
As silly as it sounds, I hurt for him. I hurt for his little boy hopes and dreams. I mourned for the exquisite suppleness of inexperience. Of course I could buy him another kindle (which would have taught him nothing), but I can't protect him from the hardships of growing up. I couldn't protect myself.
There will be fights, both physical and mental. There will be disappointments and broken promises. There will be somatic and emotional pain. And like the heart extirpated wildly from my chest, I will have little control over his destiny, yet will feel each horrible prick.
I am like my son, and he is like my Kindle.
I am starting to lose him already.
My son, on the other hand, is an altogether different creature. He somehow wrangled us into allowing him to use his own (birthday) money to buy a Kindle. And at the age of eight, he is already bumping heads with his fifteen minute daily allotment. He carries the little device in it's dark blue case around the house like a trophy. He may be limited in minutes, but no one can deny him the pleasure of feeling the weight underneath his wanting hands.
For him, the tiny screen frames a world of wonder and technology. It's not just the games, but Google Earth, Wikipedia, and a vast marketplace for all those lovely objects his rambuctious boy mind desires. It's a destination unto itself filled with both learning and shiny sparkling objects.
It is what his heart desires above all else.
He takes the Kindle everywhere. He lugs it to the grocery store, paws it at Home Depot, and cradles it before violin practice. It's always by his side.
The other night after a long shopping trip, we gathered the kids together for an evening bath. My son ran into the room frantic.
Mommy, Daddy...where's my Kindle?
An exhaustive search of the house lead to a startling conclusion. We must've left it in the shopping cart at Target. My son twisted his hands in knots waiting for me to connect to the lost and found. Nothing!
As I lay awake that night, I listened to him toss and turn in the adjacent room. Occasionally he would jump out of bed and search an odd drawer or basket. The next morning he crawled into bed between my wife and I. His eyes full of tears, he nestled into my arms.
As silly as it sounds, I hurt for him. I hurt for his little boy hopes and dreams. I mourned for the exquisite suppleness of inexperience. Of course I could buy him another kindle (which would have taught him nothing), but I can't protect him from the hardships of growing up. I couldn't protect myself.
There will be fights, both physical and mental. There will be disappointments and broken promises. There will be somatic and emotional pain. And like the heart extirpated wildly from my chest, I will have little control over his destiny, yet will feel each horrible prick.
I am like my son, and he is like my Kindle.
I am starting to lose him already.
Saturday, May 4, 2013
The Power Of The Pen?
I almost fell off my chair. It was bad enough that he showed up to the ER. But what happened next really blew my mind. He fell and bruised a rib. The pain in his left chest had obvious enough origins. But triage had put in for an electrocardiogram and the interpretation apparently scared the resident. The attending took a look, and shook his head.
Left bundle branch block. Better call the Mecca.
A few minutes later a cardiologist and nurse manager were videoconferencing in and interviewing the patient. Next came an order for thrombolytics and transfer to the big medical center ninety minutes away by ambulance (the same medical center that owned the emergency department as well as the local hospital the ambulance bypassed).
Rules are rules. And the bylaws state that all patients given thrombolytics have to be transferred to the brand new multi billion dollar cardiovascular institute no matter how far a distance. It didn't hurt that said institute was having trouble filling it's beds and apparently the administrative folks were starting to lean on the clinical staff.
The cardiac cath was mostly clean. Was it an over call, or did the medicine really just do a great job? He was never given a clear answer. He left the hospital with more questions then answers, and a prescription for a baby aspirin and a statin. He came to my office to try to figure out what had just happened to him.
This sort of thing seems to be occurring more and more often. The business aspects of medicine are starting to trump appropriate care. While no one is saying that more is better, aggressive management has become the rule and not the exception.
Healthcare reformers, politicians, and policy wonks wag their fingers at physicians and place the blame squarely on our shoulders. They say that only the doctor has the power of the pen. They completely ignore the bullying, administrative pressure, and the automatic rules and regulations forced on clinicians by the nonclinical (or no longer clinical) C-Suite.
A recent article in The American Medical News brings to light a radically different view point.
When the federal government sorted through the first round of clinical information it was using to reward hospitals for providing higher-quality care in December 2012, the No. 1 hospital on the list was physician-owned Treasure Valley Hospital in Boise, Idaho. Nine of the top 10 performing hospitals were physician-owned, as were 48 of the top 100.
This news comes three years after the Affordable Care Act effectively prohibited the expansion of such existing facilities and severely limited the creation of new ones.
As Obamacare pushes more and more physicians out of decision making positions and herds them into large academic and nonacademic hospital systems, one would expect one thing and one thing only: spiraling costs. Business exists in order to make money. Businessman go to school to learn about profit. Physicians who leave clinical practice to become administrators aspire to similar ends.
Physicians are the only ones who have made a covenant. We are the only ones who have taken an oath. We are smart, well educated, and innovative. And we have to look each and every patient in the eye before making decisions.
Yet time and time again, we are asked to move out of the way so the smart guys with the business degrees can come in, and make the tough decisions.
(Disclaimer. This story is an amalgam of a number of experiences gleaned over years of practice in a number of different hospital systems. The details of the actual medical story are fiction. Neither the patient mentioned or the medical center are meant to be reflective of any specific patient or hospital.)
Left bundle branch block. Better call the Mecca.
A few minutes later a cardiologist and nurse manager were videoconferencing in and interviewing the patient. Next came an order for thrombolytics and transfer to the big medical center ninety minutes away by ambulance (the same medical center that owned the emergency department as well as the local hospital the ambulance bypassed).
Rules are rules. And the bylaws state that all patients given thrombolytics have to be transferred to the brand new multi billion dollar cardiovascular institute no matter how far a distance. It didn't hurt that said institute was having trouble filling it's beds and apparently the administrative folks were starting to lean on the clinical staff.
The cardiac cath was mostly clean. Was it an over call, or did the medicine really just do a great job? He was never given a clear answer. He left the hospital with more questions then answers, and a prescription for a baby aspirin and a statin. He came to my office to try to figure out what had just happened to him.
This sort of thing seems to be occurring more and more often. The business aspects of medicine are starting to trump appropriate care. While no one is saying that more is better, aggressive management has become the rule and not the exception.
Healthcare reformers, politicians, and policy wonks wag their fingers at physicians and place the blame squarely on our shoulders. They say that only the doctor has the power of the pen. They completely ignore the bullying, administrative pressure, and the automatic rules and regulations forced on clinicians by the nonclinical (or no longer clinical) C-Suite.
A recent article in The American Medical News brings to light a radically different view point.
When the federal government sorted through the first round of clinical information it was using to reward hospitals for providing higher-quality care in December 2012, the No. 1 hospital on the list was physician-owned Treasure Valley Hospital in Boise, Idaho. Nine of the top 10 performing hospitals were physician-owned, as were 48 of the top 100.
This news comes three years after the Affordable Care Act effectively prohibited the expansion of such existing facilities and severely limited the creation of new ones.
As Obamacare pushes more and more physicians out of decision making positions and herds them into large academic and nonacademic hospital systems, one would expect one thing and one thing only: spiraling costs. Business exists in order to make money. Businessman go to school to learn about profit. Physicians who leave clinical practice to become administrators aspire to similar ends.
Physicians are the only ones who have made a covenant. We are the only ones who have taken an oath. We are smart, well educated, and innovative. And we have to look each and every patient in the eye before making decisions.
Yet time and time again, we are asked to move out of the way so the smart guys with the business degrees can come in, and make the tough decisions.
(Disclaimer. This story is an amalgam of a number of experiences gleaned over years of practice in a number of different hospital systems. The details of the actual medical story are fiction. Neither the patient mentioned or the medical center are meant to be reflective of any specific patient or hospital.)
Tuesday, April 30, 2013
An Act Of Submission
As I reached for the doorknob with my right hand, I had but one and only one impulse.
Run! Turn around and run as fast as you can!
It's fair to say that being a physician requires a certain constitution. When one deals in the currency of death, it becomes second nature to hold our heads high when others fall. How else can we view the tortured realities of existence. The average life is chocked full of suffering. People die tragically, unexpectedly. Pain rips through the tender belly of humanity leaving us raw, and yet we stand our ground.
But sometimes it's different. Sometimes the guarded armour of the physician is pierced in just the right fashion to expose the glistening skin overlying the Achilles tendon. We fall, mortally wounded but unable to close our eyes. It is in these times we learn to hurt all over again.
It is in these times, you either shield yourself, or open the door and let the pain run right through you.
I choose to open the door.
The act of writing about what hurts usually soothes me. It gives a morsel of control over that which is ultimately ephemeral.
Today, writing it is an act of submission.
As the raging waves of the ocean crash against the shores of my insides, the waters eventually calm and the tide recedes.
And I am empty once again
Run! Turn around and run as fast as you can!
It's fair to say that being a physician requires a certain constitution. When one deals in the currency of death, it becomes second nature to hold our heads high when others fall. How else can we view the tortured realities of existence. The average life is chocked full of suffering. People die tragically, unexpectedly. Pain rips through the tender belly of humanity leaving us raw, and yet we stand our ground.
But sometimes it's different. Sometimes the guarded armour of the physician is pierced in just the right fashion to expose the glistening skin overlying the Achilles tendon. We fall, mortally wounded but unable to close our eyes. It is in these times we learn to hurt all over again.
It is in these times, you either shield yourself, or open the door and let the pain run right through you.
I choose to open the door.
The act of writing about what hurts usually soothes me. It gives a morsel of control over that which is ultimately ephemeral.
Today, writing it is an act of submission.
As the raging waves of the ocean crash against the shores of my insides, the waters eventually calm and the tide recedes.
And I am empty once again
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