Cell 2 Soul: The Humane Health Care Blog

A Love Letter To My Primary

by Judith Bruder email

As you well know, Doctor, I’m both a medical buff and a hypochondriac, which often crowds up our office visits. But you’re unfailingly patient and kind, and do your best to listen with compassion and grace. Because you do that with every patient, you often are running late. I used to spend that time with a book, but lately I’ve begun watching the restless crowd coming and going in the waiting room, a lot like sitting in a busy hotel lobby. And I think.

To read Ms. Bruder's full letter: Download Judith Bruder to Her Primary Doctor

 

This was first published in the Northhampton Conz Street Chronicle, July, 2018

Comment:  Victor Montori, M.D., in his book, The Patient Revolution, describes Ms. Bruder's sentiment from a physician's perspective: "When love informs patient care, there is no room for the mercantile. Documentation and payer-incentivized care bring in money. Laughing and crying and sharing with our patients do not. Efficient office visits too often ignore the patient.

 

 

What Matters To Me

The question “What matters to me?” (WMTM) allows patients to tell physicians and other care providers about their interests, values, and preferences, as full humans, not just recipients of care. This philosophy is particularly hard for providers to follow during consultations lasting only 10 to15 minutes.

Dr. Sosena Kebede and I have designed a questionnaire to enable us to learn more about what our patients think about this issue.  This is a work in progress.  If you want to see and fill out our questionnaire please access this link.

WMTM has been looked at from a different perspective in Scotland and British Columbia.  Those programs can be accessed at: Download What Matters To Me Programs

Diagram from Scottish Questionnaire

 

 

 

 

Helpless on Hold

by Jane Seskin

Trying to make a doctor’s appointment
with a group practice,
13 minutes of nonstop
recorded repetition
(3-4 times each sentence).

“Your call is very important to us
and we look forward to speaking with you.
We know your time is valuable
and assistance is just a moment away.
We apologize for the delay.
We’re experiencing
a high call volume.
A representative
will assist you momentarily.”
And this nugget of intimidation:
“If you choose to hang up,
you’ll lose your place in line.”

They say the call
may be recorded.
Oh yes, oh please, oh yes!

********************************

Jane Seskin is a clinical social worker and the author of Witness To Resilience: Stories of Intimate Violence. Her experiences calling a doctor's office led to this fine piece that appeared In the NY Times, May 23, 2016.  Jane is a C2S reader, and her piece is published with her approval.

Open Notes: What and Why?

patients and providers on the same page

As a patient, you have the right to read the notes your doctor or clinician writes about you during or after your appointment. Having the chance to read and discuss those notes with your doctor or family member can help you take better control of your health and health care.

As a healthcare professional, you may build better relationships with your patients and take better care of them when you share your visit notes.

OpenNotes is a national initiative working to give patients access to the visit notes written by their doctors, nurses, or other clinicians.

Evidence suggests that opening up visit notes to patients may make care more efficient, improve communication, and most importantly may help patients become more actively involved with their health and health care.

My Favorite Moment as a First Year Doctor

By Dhruv Khullar

NY Times Journal of Medicine, March 25, 2016

"Too often in medicine, you feel like part of a machine, a cog in a massive bureaucracy. We cover each other’s shifts, we maintain a hospital’s patient flow — and at the end of many days, you feel nothing would have been different if another doctor had stepped in.

But standardized care, by definition, is not personalized care: it fails to acknowledge patients’ individuality. [In this age of the electronic medical record, there are still things] only doctors — as humans — can offer: critical thinking, clinical intuition, empathic care, exploring what’s important to patients so they can make the decisions that are right for them."

Dhruv Khullar’s moving Op-Ed piece articulates this with clarity and eloquence.

 

A Doctor Visit

On Listening

Ranjana Srivastava has a memorable essay in the New England Journal of Medicine about listening to patients. Her piece, entitled “Nourishment” speaks to all of us in health care.

She writes that a patient, former pastor, told her “The gift of silent communion is the greatest gift you can give someone.” She learned that with some patients “instead of listening in order to reply, I [now] listen to understand, shielded temporarily from the pressure of performance.”

This reminded me of some lines Andre Dubus wrote in a short story that described how often people confessed their problems to him “and I listened and talked a lot and and never helped anyone at all. So now if someone comes to me I offer what I know I can give: the friendship of a listening face.”* Srivastava has some remarkably insights in her Perspective piece in the November 26, 2015 New England Journal of Medicine. It’s a keeper! Download Nourishment.Srivastava

*Andre Dubus, “We Don’t Live Here Anymore” appears in the collection “Separate Flights.”

Giving You Drugs Won't Help Your Husband

“Are you not giving me any medicine?” her patient asked?

Ms. Shahab was silent for a moment, and then said with a sympathetic gaze, “Medicine for you will not cure your abusive husband.”

"The therapist was born in the isolated Afghan village she still lives in, in 1987 or 1988 — she is not sure. Her father was shot and killed at his mosque shortly before she was born. The reasons for the killing remain unclear, but it shattered their family and forever changed life for Ms. Shahab and her two siblings.

Ms. Shahab and Client (NY Times)

"A marriage was arranged to a man almost 20 years her senior when she was only 13. But the marriage did not stop her from completing her education. She took two of her youngest children with her to school, placing them at the kindergarten as she attended classes."

She is now a therapist in the village, caring for women battered by family and war.

This is an inspiring article:  Afghan Therapist Finds Empathy is Good Medicine.

 

The Impact of Doctor Loss

by Susan Kaplan

photo taken from myprivatemd.org

It didn't occur to me to worry when Dr. Blumberg's* first letter arrived on a Saturday in October.  I opened the envelope and was surprised to learn that Dr. Blumberg was doubling her concierge fees and cutting down on the number of patients in her practice.  She said to let her know if we wanted to continue with her by November 15th, still a month away.  "Well, that gives us plenty of time to consider what to do," I thought, fending off the vague anxiety generated by the phrases "increase in fee" and "reduced number of patients." 
To continue:  Download Doctor Loss - cell2soul

We read a lot about concierge medicine, but rarely from a patient's standpoint. It seems wrong to specialize in "disease of the rich."  It's enlightening to hear about concierge medicine from a consumer.

Susan Kaplan, Ph.D. is a clinical psychologist practicing in the San Francisco Bay Area.   You can reach her at: email.

 

 

On Pride and the Struggle

There’s an old French saying: to cure sometimes, to relieve often, to comfort always.  It could serve a mantra for all health care professionals. It reminds us that it can be more important to treat the person who has the disease than it is to treat the disease the person has.

Two recent vignettes were sent to us that illustrate these points.

Croina’s Pride by James Channing Shaw and

My Struggle by Lee Thompson

Both provide valuable insights for patients, their families and all care givers.

They appear in The Online Journal of Community and Person-Centered Dermatology (OJCPCD), a free, post-publication peer-reviewed, full text, open-access, online publication.