Friday, August 22, 2014

Patient Response to Appointment Issues and Priorities

Here's a really insightful comment in response to my post Family Medicine: The Generalist

I'm not sure there's a solution to this problem. As a patient I usually come to the doctor with an assortment of complaints. Often it's hard to summarize everything that's going on in a few short statements on a form or when making an appointment. Issues come and go. New things may have come up since the appointment was made. Also, being an old guy, I think I was trained by the doctor I saw several decades ago to simply talk about everything that is bothering me during an appointment. And I sometimes wonder if some minor problem may contain information that would be helpful to the doctor in understanding the more serious problem...and could actually be connected to it. I come to the doctor not as a symptom, but as a person with a number of reasons to seek medical attention. I greatly appreciate the fact that I can come to a family doctor that way and not have to visit a bunch of specialists who may have conflicting ideas about what's wrong and what to do about it. All that's good...from Dave Levingston

This statement is really helpful to remind physicians of how life really is for our patients.  The era of the Electronic Medical Record adds to the tension of misaligned expectations between patients and physicians.  We don't use ours, yet, but may soon dive in.

My response which didn't show was this:

Thanks, Dave for your comments. We have the continuing creative tension between patients and physicians, trying to figure out the big and little picture at the same time as enjoying a continuing relationship of humans. We might have "little picture" visits and "big picture" visits, to balance focus needs with long range needs. The patient's story remains central to every visit. Both persons stories remain central to the relationship of patient and physician- which we could find a better way to emphasize. Your comments are very insightful and right on.

As we work together on saving the good parts of health care, these considerations are important in designing the electronic connections away from the billing focus of the early EMR's to human focus.  I believe it can be done in Family Medicine as we work with patients and doctors to refocus on what's important.


Sunday, August 10, 2014

The Family Doctor Song

Fellow Family Physicians,

I was humming the "Family Doctor Song" and feeling proud of what I do as a Family Doctor that is so well supported by this song.  The Family Physician author knows about the Myth and the Magic of Family Doctors.  They also understand the Brain and the Heart of Family doctors.  Likewise, the Myth and Magic, Brain and Heart of Family Medicine.

Such insight generating such poetry and translating into such a song is rare.  But, leave it to Family doctors to express the un-expressible in such a way that the imaginations of those who listen to and feel the message, understand it.

Have you heard it yet?  Have you hummed it yet?  Or sung it yet?


Listen to your heart, where the records of thousands of past, present and future patients resonate with human vibrations of meaning.

There is the song.

You are the author.

It isn't finished, yet.


Saturday, August 9, 2014

Family Medicine: Radiation Safety for Patients and Doctors

OK, Family Docs, who is keeping track of radiation exposure in our patients?  (Notice how Radiofrequency ablation adds another pile of radiation onto our patients.)  Could it be...NOBODY?!
How many of your patients have actually signed a consent form for the radiation used in their images?  Could it be...NONE?!
As a Three Mile Island "Alumnus", I remain sensitive about excessive radiation. (Like millions and millions of CT scans, MOST of which seem to be questionable if clinical skills are applied to the patient situation.) How might we get a more organized radiation safety strategy?  What have you experienced in your systems about radiation safety for patients and physicians?  Who has an informed consent form for radiation exposure?   (Especially in Emergency Departments)?

1. Kovoor P, Ricciardello M, Collins L, Uther JB, Ross DL. Risk to patients from radiation associated with radiofrequency ablation for supraventricular tachycardia. Circulation. 1998;98:1534–40. [PubMed]
2. Calkins H, el-Atassi R, Kalbfleisch SJ, Langberg JJ, Morady F. Effect of operator experience on outcome of radiofrequency catheter ablation of accessory pathways. Am J Cardiol. 1993;71:1104–5. [PubMed]
3. Wittkampf FH, Wever EF, Vos K, et al. Reduction of radiation exposure in the cardiac electrophysiology laboratory. PACE. 2000;23:1638–44. [PubMed]