January 13th, 2010 by SteveSimmonsMD in Primary Care Wednesdays
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Some patients in the 21st century approach “modern” healthcare with the same expectations I bring into a deli for lunch: “I’d like the sinus infection with antibiotics and a note for work, please.” I confess, when seeing such a patient I have occasionally acted on the impulse to ask if they would like fries with their order. Yet, these patients do have something to teach us about how to be a 21st century physician.
Eighteen years ago while a fourth year medical student I registered for an elective class on the future of computer science in medicine. This was my first time to see the Internet and I was awed by the vision my instructors had for the future. They had no idea. Read more »
January 6th, 2010 by AlanDappenMD in Primary Care Wednesdays
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About a year ago I made a house call to an elderly widow which has left a lasting impact on me.
Our “trusting relationship” began twelve years earlier while I attended to her dying husband at home. She couldn’t find another doctor to come in to help. Now it was her turn to need help, and like her husband insisted that she stay at home. The woman was being cared for by her middle-aged granddaughter who remained her daily companion.
Both granddaughter and grandmother distrusted the health care industry and had formed many conspiracy theories. They believed in the power of healing through “the Lord” and natural remedies, especially vitamins. I admired their fierce independence while holding my tongue on the magical and, in my opinion, misinformed views of the science of medicine. Both tried, in vain, to convince me that I should use the vitamins and other products they endorsed for my patients. I smiled obligingly, yet made no move to implement these ideas while pondering the paradox and danger of being invited into the “trusting circle” of such divergent world views. Read more »
December 16th, 2009 by AlanDappenMD in Primary Care Wednesdays
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Over the past few weeks, I’ve presented a parody of family medicine, whereby each character (Mrs. Doctor, Mr. Insurance, Patients) represent the current triad of the most dysfunctional of all American families: that of primary care practice. This week, Mrs. Doctor airs her grievances to her counselor about her evermore demanding and unreasonable spouse, Mr. Insurance).
A week after Mrs. Doctor’s visit to her PCP’s office, she sits in a waiting room, awaiting her first visit with the therapist.
Unlike the chaotic, tense reception at her primary care physician’s office, the therapist’s waiting room is everything but: it boasts relaxing designs and colors, is not crowded, and no noise save the soft bubbling from a Zen water fountain can be heard. A feeling of calm invites Mrs. Doctor to sit and reflect.
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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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