back in the good olde days

 

True story:

A couple of weeks ago, while I was with my family for Christmas, I came down with Covid. As soon as I tested positive, I left for home so I could get started on Paxlovid, ASAP. But it was Saturday morning, so of course, my doctor's office was closed. Instead, I spoke with the weekend triage nurse. He advised me to go to an urgent care clinic for evaluation. So, I did.

When I got there, I was told it would be a 2 1/2 to 3 hour wait...and because my case involved Covid, I had to wait in my car. I was told I should not leave the parking lot because if they called me in and I wasn't there, I would be ordered to the back of the line...for another 2-3 hours. Meaning I couldn't even get a cup of coffee or a little lunch to tide me over. Thankfully, I had water and a good book with me. I waited in my car for over 2 hours for my less-than-ten-minute appointment that day.

~Insight Patient Satisfaction Solutions~

While I was in exile the following week, I sent several messages via portal to my PCP asking for a call back to discuss the results of a test that been done weeks earlier. I already knew it was abnormal. But I didn't get a call back. Instead, I got a message referring me to a specialist. With no explanation. With no discussion. With no human dialogue.

The same thing had happened a couple of weeks earlier when I messaged the orthopedist who replaced my knee last year about getting a lift for my shoe. I suspected that a slight leg length discrepancy was causing my hip pain. I had questions. With utmost efficiency and speed a referral appeared among my messages, but again, there was no call back. No discussion. No opportunity to ask those questions. 

Trust me when I tell you it wasn't always this way! Back in the good olde days, when doctors ran their own practices, they took the time they needed with patients, they returned phone calls and answered questions themselves, and billed according to what they felt was reasonable given the patients' circumstances. Things were much different.

"If you are not in control of your time,

you are not in control of your results."

~Brian Moran~

When we launched our practice, the office was open and staffed five days, three evenings, and Saturday mornings every week. Someone was on-call 24/7. When patients called, appointments were available, and if not, we worked through lunch or stayed after hours to take care of them. We were known to have accepted a bushel of apples in lieu of cash if that was what the patient could afford. If someone cut their hand in the middle of the night, instead of sending them to the ER for stitches, we would climb out of bed, drive to the office, disable the alarm system, unlock the door, flip the lights on, and meet the patient there, ourselves. 

Nowadays, we don't see patients after hours in a pinch. We send them off to see someone else. We are tethered to a system that demands we see more patients faster. We labor under the mandates set in place by productivity quotients, the resource-based relative value scale (RBRVS...a rather arbitrary system that nobody understands, but is used to estimate what the physician deserves to be paid), and the constraints imposed by various insurers. Never mind the ever present threat of litigation. 

The corporate health care system that bought us out closed their primary care practices in the evenings and on weekends. This resulted in redirecting patients with non-urgent problems to emergency rooms. Reimbursement for the time we spent navigating a patient's mental health issues went away. Messages still often go unanswered. Compassion, connection, and communication are, apparently, no longer part of the equation.  

"America's health care system

is neither healthy, caring, nor a system."

~Walter Cronkite~

Back in the days when we would haul ourselves out of bed in the middle of the night to see a patient, when we spent every other weekend on call, when we stayed after office hours to get the job done, we were exhausted, all right. But we didn't burn out. We felt a sense of satisfaction and fulfilment. We enjoyed the fruits of self-discipline and service. Patients were appreciative. 

Contrast this with the dissatisfaction some patients feel today. Contrast it with the inconvenience, depersonalization, and frustration they confront when what they need is healing. What do you think is wrong? How would you change things, if you could? What is missing for you?

Rant over. Carry on.

"The simple act of caring is heroic."

~Edward Albert~

jan 

a fork in the road to healing

 

There is a fork in the road along the healing path in narrative medicine. One pathway invites patients to tell the stories of their illnesses. The other beckons health care providers to share their experiences as healers. The journey for both patients and providers is similar. It embraces memory, invites reflection, provides perspective, and engages support.

The patient’s narrative recalls his symptoms. He lists the diagnostic tests that were performed, names the medications that were prescribed, and traces his journey back to health…or not. But equally important is the fact that he can tell you how the diagnosis affected him emotionally and psychologically. He may have despaired to learn he had cancer. His entire world may have spun out of orbit because of a stroke or disabling injury. How will he manage if he can’t work? How will he support his family? Who will pay the bills and mow the lawn? He dreads burdening his wife and children with his care. He wishes he could die…not a healing thought among them.

If, on the other hand, the news is good, let’s say the lump turns out to be benign, or the doctors are able to slip the stent in before the infarction occurs…the patient’s story may end on a happy note. Besides relief and gratitude, there may be some spiritual introspection. A surge in compassion and empathy. New found joy and peace. An entirely different story.

"You must find the place
inside yourself where
nothing is impossible."
~Deepak Chopra~

When the health care provider sets out on his narrative path, it takes him to the bedsides of the people he has cared for over the years. He recalls patients with interesting and unusual presentations, baffling symptoms, and resistant conditions. Amazing recoveries and remarkable courage. He re-experiences his triumphs and his defeats. He may finally admit to the uncertainty, oversights, and errors in judgement that have haunted him over the years. He can name the patients who recovered against all odds, and the ones who succumbed despite his best efforts.

"One of the most valuable things
we can do to heal one another
is to listen to each other's stories."
~Rebecca Falls~

He may finally acknowledge how hard it was to sustain his marriage and to be present for his children. He may have missed his son’s winning soccer goal at the state championship because he was tied up in the operating room, or he may have forgotten his wife’s birthday because of some committee meeting or other. A huge part of his story takes place outside of the hospital and office. 

Our stories take into account more than what happened to us, when it occurred, or how it ended. They embrace how we respond to life’s vagaries, how we interpret and process them, how we survive them, and who we become because of them.

"Telling our story doesn't merely
document who we are.
It helps make us who we are."
~Rita Charon, MD, PhD~

Which narrative path will you take?

jan

    

                                                                                                                                                      

ten sure signs you're ready to write

When I retired in order to begin all over again as a wannabe writer, I didn't know what I was getting myself into. I didn't know if I had any talent for writing, any hope of success, or the necessary dedication to it. Nevertheless, I put my misgivings aside, summoned whatever courage I could muster, and cleared my desk so I was ready to try.

Maybe you should, too.

"If not now, when?"

~Eckert Tolle~

In my experience, these are the top ten signs that you might be ready to begin:

• At any one time, you carry at least five pens with you (six to ten are even better). Go ahead. Check your purse or pockets now.

"You want to be a writer,

but you don't know how or when.

Find a quiet place;

use a humble pen."

~Paul Simon~

• You have enough pens with you, but sometimes you forget to carry paper. Therefore sizable chunks of your manuscript are recorded on napkins, on the back of receipts, on used envelopes, and when that fails...on the back of your hand.

• You have perfected the ability to record plot points, dialogue, and gorgeous prose whenever and wherever your muse is kind enough to share it with you...and, in a pinch, you can get it down without taking your eyes off the road.

• Sudoku makes you cringe.

• You are reluctant but willing to concede that your laptop is a convenience, but you will defend the merits of pen and paper to the end. Remember the likes of Shakespeare, Dostoyevsky, Matthew, Mark, Luke, and John?

• When you're writing, you sometimes make yourself cry.

• Sometimes you make yourself laugh.

• When you read what you've written later on, it happens again.

• You have made peace with the "delete" key.

www.morrissey-solo.com

• "I wasted the whole day," is not part of your vocabulary.

• You make up excuses (oh, all right--you sometimes lie...) so that you can stay home alone.

Oops. That makes eleven sure signs.

The point is that unless you begin, you will never know what you can accomplish. You will never put your passion to the test, exercise your creativity, or realize your dream. Your story will remain forever untold. You will never know who needed to hear it, and you will always wonder about it. 

When do you plan to begin?

"Share your story with someone.

You never know

how one sentence of your life story

could inspire someone to rewrite their own."

~Demi Lovato~

jan

 

the healing power of storytelling

 

Much of what is written about the power of storytelling to heal has to do with more or less intangible, warm, fuzzy concepts like finding your truth, defining your purpose, or sharing your message. It has to do with attention, affirmation, and empowerment. Optimism vs pessimism. Hope vs despair. All of which seem to influence our ability to heal. Somehow.

From a scientific standpoint, we know that storytelling causes the release of hormones such as oxytocin that governs empathy and social interaction, and cortisol that is connected to the stress response. We can measure the levels of these hormones so we have proof. That's what happens.

But the biological correlates of storytelling are far more complicated than that. Take this, for example:

"The coupling between speaker–listener and listener–listener brain pairings was assessed through the use of a spatially local general linear model in which temporally shifted voxel time series in one brain are linearly summed to predict the time series of the spatially corresponding voxel in another brain. Thus for the speaker–listener coupling we have this equation:

where the weights  are determined by minimizing the RMS error and are given by  Here, C is the covariance matrix  and  is the vector of shifted voxel times series, We choose , which is large enough to capture important temporal processes while also minimizing the overall number of model parameters to maintain statistical power. We obtain similar results with ."  

(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2922522/)

Got that? Probably not. You probably don't understand a word of it. I know I don't.

"Maybe stories are just

data with a soul."

~Brene Brown~

 

In plain English, though, this means that stories have the power to heal through the process of:

• Alignment: an unconscious process that enables communication between storyteller and listener so that their brains exhibit mutual temporal, coupled response patterns that synchronize over time. In other words, they are both connected by and engaged in the story.

• Coupling: the emergence of complex behaviors that require coordination of activity between individuals. In health care this is important because this factors into whether the patient will follow directions or change unhealthy behavior. If the health care provider doesn't attend to the patient's whole story, or the patient doesn't feel he has been heard, neurolinguistic coupling can't take place. Nor can healing.

• Dialogue: the exchange of ideas and information that leads to understanding, empathy, and interaction. 

~Cultural Detective Blog~

The interesting thing is that this can all be visualized by scanning the brains of storytellers and listeners with a functional MRI as they interact. You can watch the gradual alignment and coupling of electrical activity in specific areas of their brains as the dialogue progresses. And then you can observe the behavioral changes that follow.

This kind of information is important if you reject the validity of anecdotal evidence, and instead, cling to hard data to make your point: that storytelling directly affects brain function and, in doing so, it affects the physiology of the body. It explains how storytelling heals.

"The truth is, in order to heal

we need to tell our stories

and have them witnessed."

~Sue Monk Kidd~



If your job is to assess the cost effectiveness and clinical correlates of thorough history taking in the health care setting, this information helps make the case for improving physician-patient interaction by embracing the importance of narrative in clinical practice.

There is no doubt that:

.

"A story is a powerful, unifying tool

that connects mankind, breaks down barriers,

and heals wounds."

~nativehope.org~

jan

entering the portal to unlimited possibility

New Year's Day seems special because, depending upon how you look at it, the day symbolizes a new beginning--the dawning of a new year. A time to begin whatever you have been putting off...or to start over again if your last attempt didn't work out as you had hoped.



Perhaps this is the year you will start the novel, or the memoir, or the poem you've always wanted to write...

"Fill your page with

the breathings of your heart."

~William Wordsworth~

...or perhaps you'll pull out a moldering manuscript and give it another try. Maybe you'll sign up for the art or photography class you've been aching to take...or get back to your sketch book and start drawing again. Maybe this will be the year you join a gym...or take to the woods again.

Hopefully, this is the year you will silence the voices in your head that tell you nothing is going to change.

"I can't believe it's been a year

since I didn't become a better person."

~Attribution unknown~

Soon they'll have you believing that, like every other year in the past, you simply will not find time to write, or draw, or compose. You will not get around to clearing some space so you can dance, or indulging yourself with new paints--whatever it is you long to begin. You'll fall back on all the old excuses. You're too busy at work. The kids have too much going on. You have more important things to do--folding the laundry, keeping up with your friends on social media, solving the problems of war, poverty and world hunger.

The question is: Who are you going to listen to? The voice of reason or the pleadings of your heart?



Who will you follow? The lumbering ogre of restraint trudging along the same well-worn path...



~www.poweramoure.com~

...or will you test your wings and let them carry you off to the place where dreams come true?

~Weehawken Creative Arts~

Does the arrival of New Years Day simply mean that another year has gone down the drain? Or is it a portal to possibility that is limited only by one's imagination and courage and passion?

What will you begin this year?

*

"Begin doing what you want to do now.

We are not living in eternity.

We have only this moment,

sparkling like a star in our hand--

and melting like a snowflake."

~Sir Francis Bacon~

*

Happy New Day...

jan