Monday, February 13, 2017

what good is a story without a teller

What good is a story without someone to tell it? A story without someone to hear it?
True story:
A few years back, a young man in our community was involved in a terrible automobile accident. Prior to that day, he had a reputation as the high school jock, athletic and good looking. He was described as cool and cocky. He was well-liked, if sometimes irresponsible.
The accident left him in a coma for weeks. His doctors gave his family no hope for recovery based on the appearance of his scans. Nevertheless, his parents insisted upon continuing life support. He went from the intensive care unit to acute care to rehab over a period of six weeks or so with no improvement.
Then one day he opened his eyes. He started responding to simple commands. He was able to recognize the people at his bedside. Long story short, he went on to make a full recovery with the exception of a few subtle cognitive deficits. He came out of the experience a humble, caring young man with no recollection of the weeks he spent unconscious.
During his entire hospitalization, the boy’s mother kept a daily journal. It helped her remember what the doctors told her from day to day so she could process it when she had a few moments to herself.

She kept track of who visited her son, how kind and concerned they were, how heartbroken they felt. She recorded everything the doctors and nurses who cared for him said and did, and she recorded her own thoughts and feelings about her son’s condition.
The point is that without his mother’s journals, this entire period in his life would have been lost to him. He had no memory of it. It helped him immensely to read his mother's journals in order to make sense of what had happened to him and what a miracle his recovery represented. They reconnected him with his friends when he read about their bedside visits. He came to understand how close to death he’d come.
His mother's journals weren't lovely flowered books filled with beautiful prose. They were honest and raw and desperate...but they recorded reality for her son and filled in the blanks for him.

She wrote them at a time when she never imagined her son would read them for himself. That chapter in his life might have remained, forever, a story without a reader…and, except for his mother's journals, it might have remained a story without a writer.

PS: It will remain a matter of faith vs speculation as to whether a bedside visit from the boy's beloved dog had any effect on his recovery…but he woke up three days later.


Monday, February 6, 2017

how will your story end?

photo thanks to Andrea Lauren

In my last post, I connected my decision to retire at an early age (if sixty is considered early…) with the evolution of a health care system that has become highly technical and increasingly impersonal. While this transformation may offer some advantages in terms of efficiency and productivity, it jeopardizes the patient/physician connection and ultimately, imperils the patient’s ability to heal.

I closed my practice after thirty years in Family Medicine because working within the system scared me. I told my patients and colleagues I was retiring…when I meant that I was quitting.


I didn’t put it quite that way, of course. It wasn’t as though I simply got fed up with things, turned in my stethoscope and tongue blades, and slammed the door on my way out of the office. I wasn’t impulsive about it at all. I agonized over the decision years.
I didn’t leave because of the long hours, or the fact that I’d been running hopelessly behind schedule all day, every day for three decades. I didn’t leave to take an easier position or to make more money. I didn’t ask to be excused because of fatigue or forgetfulness or ill health.
I didn’t retire because of the oppressive paperwork or its successor--an oppositional-defiant EMR system. I wasn’t defeated by our baffling coding and reimbursement system. The ever-present threat of litigation. A pharmaceutical industry that invests as heavily in marketing as it does in research. A health insurance industry whose number one priority is corporate profit.
That wasn’t what got to me. The problem was that, in an effort to see more patients faster, I was forced to send patients on their way knowing that I hadn’t heard the full story. I often sensed that something else was going on…some issue I didn’t have time to explore. For instance, why a patient’s breath reeked of alcohol when he had an appointment for a sore throat at nine-o’clock in the morning. It took me ten minutes to diagnose and treat his throat, while his alcoholism went untended. Who had time?
In an effort to squeeze more patients into the schedule, important parts of their stories were being missed, and that scared me. Failure to diagnosis is the #1 basis for malpractice claims in this country. Worse, I worried that a patient would suffer or die because I didn’t have time to hear the whole story.
What finally got to me was the erosion of my authority as a competent and caring physician by self-proclaimed intermediaries who had neither knowledge of nor concern for my patients’ wellbeing. By business managers who failed to understand the importance of the patient/physician relationship, and how it impacts the patient’s ability to heal. By corporate geniuses who dismissed the power of eye-to-eye contact, the importance of undivided attention, and the gift of understanding in favor of productivity quotients and RBRVS units.
In the end, the risk to my patients outweighed everything I held sacred in medicine. In the end, I had to leave.
End of story. End of rant.