Friday, May 10, 2013

Not ALL Doctors Golf

The sun is shining. The birds are chirping. It’s time for fitness in the great outdoors. That’s why we love the Treasure Valley, right? And for doctors, this means dusting off that putter … right?
Wrong! It’s true I am a doctor. I love golf, but only about as much as I love shopping for tires or cleaning the lint out of my dryer. With so many triathlons and other outdoor activities that actually burn calories and release endorphins, I can’t figure out the draw of getting a little white ball into a tiny cup. In fact the “activity” involved in golf has always confused me. The only time I personally break a sweat while golfing is when running from cigar smoke on the 19th hole.
I realize that the golf course is supposed to be prime “networking” territory for doctors. I suppose that if one has difficulty with conversation, there’s nothing like watching people wearing plaid pants yell at a ball to break the ice. However, I have found that the practice of medicine comes with some degree of agility regarding small talk. I personally have yet to be at a loss for words whether the conversation is golf, questionable fashion choices or what a patient coughed up this morning. And although my husband might suggest that I personally have never been at a loss for words, I’m pretty sure there are other doctors out there who do just fine without breaking out the saddle shoes and knickers.
I did, however give it a try. After various attempts at “relationship building” on the back nine, including golfing while gigantically pregnant, I have chosen to practice what I preach, and reduce my anxiety and stress. That means no golf and more yoga. I came to this treatment plan after running out of my golf shoes as I chased a wayward ball. My shoes actually got stuck in the mud, and I did a faceplant in a sand trap, limbs flailing, shoeless. If nothing else, I provided the Gang Green at the country club with plenty of amusement as they shouted, “Give her a mulligan!”
I can’t even say I looked good doing it, since the last time I checked, collared polo shirts on women went out in the ’80s. To quote the great Dave Barry, “Although golf was originally restricted to wealthy, overweight Protestants, today it’s open to anybody who owns hideous clothing.” (Thank you, Tiger, for bringing a bit of style back into the game. We all liked you before you ran into that fire hydrant.)
If you’ve ever been to a golf tournament, you know that it involves very long, silent periods interrupted by roars of anger or joy, all directed at a tiny, white ball. And this is actual shouting at the ball, not at the golfers. So to be clear, there is mostly silence, punctuated by cheering and yelling, “Get in the hole!” Need I say more? Serious golfers can be observed examining the ball with the same degree of concentration and caution as an unattended brown package left alone at Newark airport. It’s the kind of silence that begs to be run through, yelling willy nilly at the top of your lungs, “Woo hoo … it’s golfin’ time!!!” I have promised my husband never to do this, on the golf course at least.
So it may be Wednesday, but this doctor is in – or at least is not on the fairways.

Friday, March 15, 2013

Why Doctors Should Do Handstands

I recently read an inspiring post in the NY Times, How Creative Is Your Doctor?  - which really reminded me of why I am who I am.  In the article, Danielle Ofri, M.D. talks about how important it is to exercise that part of our brains that allows me to do things like make huge trash sculptures in the shape of a giant peace sign on Earth Day, or do handstands on the sidewalk with my daughters.

We are trained in medicine so diligently to think diagnostically in algorithms, with rote memorization the backbone of our knowledge.  Our brains become rigid with fact after fact; with years of practice we become experts in information categorizing, our neural networks so programmed it becomes almost reflexive.  So much so that with standardization of health care, one could argue, what will we need human doctors for, after all?

Clearly the knowledge is imperative in what we do.  But how do you teach someone the art of talking, really talking, to a patient, in order to get the whole story?  You can't get the answer if you don't ask the right questions, and sometimes this has to come from the interaction you have with the person in front of you, not the patient. So many times clues about onset of illness, mechanism of injury, and associated symptoms come from first 5 minutes in the room, otherwise know as the "History of Present Illness."

My answer (for now) is to do handstands on the sidewalk.  In order to "Think Different", we need to allow ourselves that creative space and energy to loosen our neural networks and expand the connections in all directions.  Some of us are already built that way (I'm pretty sure Steve Jobs didn't need cartwheels to activate his inner genius)- but most of us need to practice the art of creativity.  In light of all the current changes in healthcare, information and technology, what we really need is doctors who are people.  And we need these people to be human, to think outside of the rigid confines of medical algorithms to get to the bottom of whatever is ailing them.

It's not always easy to break free of the structure, and even frowned upon at times by those entrenched in the system.

Never mind- I will be outside doing handstands.

Thursday, January 3, 2013

Patient Centered Medical Home is not the only solution.

I used to think the Patient Centered Medical Home represented the essence of the new, improved vision of healthcare.  Currently, patients are frustrated, and many are getting lost in the cracks of the system.  Physicians, pressed for time and underpaid, are becoming more and more disillusioned than they are inspired.  

But maybe this is not the solution.  It is exceedingly difficult to define what patients need within the confines of a broken system.  Is a Patient Centered Medical Home truly for the patient?  Or is it for the doctors and the system?  Doctors want good care for their patients, and with the PCMH we can be assured, at least in theory, that patients will be connected to the caregiver they need when they need it, whether it be a family doctor, a home health nurse, or a specialist.   But who controls the information?  The data is stored in a central “location”, virtual or real, where it can be accessed by these providers to ensure the continuity that we all want.

This may work for some people, but for others it could create more hassle and headache.  If a working mom wakes up one morning and she needs a doctor, where can she go that will be what is convenient for her, not for her doctors?  What happens when she calls her regular doctor to make an appointment, but the first available appointment is weeks, even months from now.  There may be some slots saved for walk-ins, but she is guaranteed to wait. She could go to a “traditional” urgent care, and hope she does not have to wait for hours in a waiting room full of sick people, to be seen by someone she has never met.  And there is always the ER.

Maybe, just maybe, we need a new model.  "The best, most efficient (health) care is provided by teams of health professionals in the patient-centered medical home led by physicians, not independent practice by a single health professional”.  This is a quote from the AAFP.  But what if the PCMH is lead by the patient- as the name inherently implies.  Patients should have the right to organize their health care in a way that best suits their needs.  I think we will all look forward to finding a workable solution.