December 2nd, 2009 by AlanDappenMD in Primary Care Wednesdays
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Last week, I introduced the key characters in the parody of family medicine which I entitled, Trapped in Family Medicine. Can This Marriage Be Saved.
As the scene opens, we see a typical day in the waiting room of a family practice: the primary care physician (PCP) is 45 minutes behind schedule. The room is packed with frustrated patients who glare accusingly at the receptionist, transferring their feelings of resentment to her for this routine and expected predicament.
Every few minutes someone storms to the front desk, demanding: “How much longer will it be before I’m seen?” … “My time is valuable.” …“I’ll send the bill for my time to PCP and see how he likes it!”…“What makes the PCP so special?”… “This wait happens every time I come and I’m not waiting anymore!”
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November 25th, 2009 by AlanDappenMD in Primary Care Wednesdays
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Prologue
This is not news: your primary care provider (PCP) has been listed on the endangered species list. Harvard Medical School has decided to no longer train primary care physicians – they are too quaint and old fashioned. Estimates show that for every seasoned PCP leaving primary care (which they are doing in larger numbers), it will take 1.7 PCPs to replace them due to expectations of shortened work hours and believing that life style and balance are deservedly theirs over a grinding 60+ hour work week.
Nothing PCPs do to reinvent ourselves frees us from the singular patient question on which the entire primary care patient-doctor relationship hinges: “Doc, are you still a ‘preferred provider’?” Perhaps it’s time to reconsider the plight of the PCP and even our day-to- day health care under a “family system” lens and re-examine the relationships from the perspective of the family therapist.
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November 18th, 2009 by AlanDappenMD in Primary Care Wednesdays
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When I think of the plight of primary care practitioners, particularly in the light of today’s discussion of healthcare reform, I often think of a Dr. Seuss book. My mother read it to me as a child recovering from the chicken pox. I read it to my two sons when they were young. And I encourage you to read it too, even if you’re an adult. The book is entitled Thidwick The Big-Hearted Moose. To me, this 1948 story almost perfectly mimics the overburdened lives of primary care physicians and the innumerable squabblers who’ve come along for the ride in the misguided world of healthcare.
For those who haven’t read Thidwick, here’s a recap of the story: Thidwick is a kind “big hearted” moose blissfully grazing with the rest of his herd on Lake Winna-Bango, minding his on business. One day a Bingle Bug asks if he can ride upon Thidwick’s enormous antler rack for free. Read more »
October 21st, 2009 by AlanDappenMD in Primary Care Wednesdays
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In 2005, I was invited to participate in an innovators’ workshop by the Harvard Interfaculty Group, funded through a grant from the Robert Wood Johnson Foundation. The question at the meeting was this:
“If primary care is critical to a vibrant and cost effective healthcare system, and
If primary care is going extinct, which most now predict;
Who is out there innovating new primary care systems and what is their vision?”
During the four years since this conference, I’ve found that this question is first and foremost when it comes to changing primary care.
I felt honored and surprised to be invited to the meeting. After all, our practice and its innovations are simple and are based on the following: Read more »
October 14th, 2009 by AlanDappenMD in Primary Care Wednesdays
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I am approaching an important anniversary of my heart attack. Until then, I had missed but a single day of work due to illness since starting medical school in 1975. Even in the middle of the heart attack, I played an entire ice hockey game, slept a few hours, had a business meeting with a fellow doctor at Starbucks, and went back to the office to see patients. In retrospect, my actions could be labeled as folly, bravado, machismo, denial, and lucky. I accept all labels as true. Without a trace of shame I have shared this archetypal story with friends, and patients hoping that by laughing hard enough at me, I might prevent at least one person from dropping dead from stupidity. Read more »
