It has reminded me of the comment made by Steve Bogdewic one day in a faculty meeting where we were all complaining about how unappreciated we were by our Dean, how we all busted our butts with no additional resources or institutional support, etc. He basically reminded all of us that Family Medicine is still very much the new kid on the block in academic medical centers, that we are basically still on the Conestoga Wagons crossing the Great Plains eating sourdough hard tack and drinking bad coffee, wishing we were in San Francisco drinking great wine and eating Pacific Salmon.
We bought a small model of one of those Prairie Schooners and placed it on our conference table for every one of our faculty meetings after that just to remind us of the need to be patient while we fight off the Indians, endure cold nights out on the plains on our way West. Michael L. Parchman, M.D.
Medical education is not just a program for building knowledge and skills in its recipients... it is also an experience which creates attitudes and expectations. A. Flexner
It is much more important to know what sort of patient has a disease than what sort of disease a patient has. William Osler MD (1849 - 1919)
I really like this (counterintuitive) thread. My favorite Steve Martin skit involved Steve as a medieval barber who (dressed in starched white lab coat) was telling a patient with abdominal pain, "We used to think this was caused by witches and evil spirits, but now we know (looking particularly smug) it's caused by a large toad in the stomach." (from Paul Nutting)
Thanks to David Loxterkamp, M.D. (NEJM, Dec 26, 1996 - "Hearing Voices...") for a guiding New Year Thought... " Yea, though we walk through the valley of managed care and our business (if not our soul) is traded on the floor of the New York Stock Exchange, we are lucky to be here, doing what we do, still students of medicine, tending to the afflictions and infirmities of those who call us doctor."
If I’d have know they were going to schedule this patient today, I’d have called in sick. by one of our least complaining faculty in Nebraska.
Carl Hammerschlag was asked by a Native American patient if he could dance. He shuffled his feet a bit and the patient said, "That’s good." Realizing that there was some purpose to the patient’s request, Carl asked him if he would dance as well. The patient adjusted his oxygen cannula and danced vigorously right there on his bed. Carl paused for a moment, then asked the patient if he could teach him to dance like that. The healer said, "I can teach you my steps, but you must hear your own music."
Unfortunately, there is a pervasive sense in the work world that we are more responsible to our tasks than to our people, that our jobs take precedence over our relationships, and that our achievements rather than our character measure our worth. Andy Macfarlan, FP in North Carolina
My favorite quote for American health care (RCB):
Americans can always be counted on to do the right thing,
....after they have exhausted all other possibilities. Winston Churchill
The basic science of medical education is money
Heat is to water as money is to curricular change -
John Hickner, M.D.
I figure that the only thing a test tells you is what you know on one particular day about what someone else thinks is important. Ed Mantler, FP resident on day of inservice exam 1995
Physicians occupy an unusual spot in the social structure of rural communities. From an economic standpoint, they are successful entrepreneurs, well-paid business people similar to bankers and lawyers. On the other hand, they are also social servants like policemen or teachers, just as essential to the welfare and functioning of the community but paid for through a fee-for-service mechanism outside of local community control. This anomalous status requires some fairly innovative interpersonal and structural relationships to strike a workable balance. Rosenblatt and Moscovice, 1982
Did you know that Nebraska has the only Frontier County in the nation? Look it up! Shouldn't this help us in getting grants?
The Real Frontier lies in the stimulation of the Creative mind of Man. - Mari Sandoz
"I tell you the old-fashioned doctor who used to cure you of all illnesses has quite disappeared. Now there are only specialists and they all advertise in the papers." F. Dostoyevsky The Brothers Karamazov 1880 via Joseph Merrill M.D.
Built within our traditional medical systems are roadblocks. I find many of these to be irrelevant or myths. I try to spend my time getting by these to deliver the best care that I can. Bob Boyer, Rural Doc in Kingman, KS
Compare and contrast the following two statements. Your solutions must be legible, understandable by all ages of voters, and not cost more than 10% of the GDP. More importantly, voters must think that they are getting the best health care that they can get.
The wise family physician is one who knows how much he/she is but is more concerned with how much more he/she can become. Hunter Woodall, Family Physician
I agree with Ken Bertka, and his posting reminded me of others. We should, indeed, continue in the Marcus Welby tradition but with two holsters, one filled with a Palm, the other with a portable ultrasound. As our Family Medicine Doc of the future used to say, "The bureaucratic mentality is the one constant in the universe." – Dr McCoy, Star Trek IV
Many of the quotes that follow have a rural twang, but I think you will agree they apply to us in Family Medicine. Perhaps the current environment has indeed made us more distant from others and more rural than ever. Try to take a break and share some of the words and impressions from past postings on this area and some convenient ones:
The "pain" of becoming "The New Family Doctor" is saying "no" to the old system and running the risk that many patients will feel forced to find a new family physician who accepts their managed care plans and the service-limiting features of these plans. This is a giant leap that most doctors won't take; instead, we sign every contract placed on our desk and perpetuate the down-ward spiral of the system. Rats on a wheel - it is time to say "no" to the present mess and do what is right for taking care of patients and populations! Ken Bertka, M.D. Toledo, OH
No, compassion does not replace knowledge in a physician. But lack of it in a knowledgeable physician still creates road blocks and makes every one of us look bad. Stephen McKernan, DO
"Has anyone found---" Back when Family Practice was General Practice, a niche that was held was that of patient advocate and continuity provider. Both characteristics have deteriorated for several reasons. I submit that we haven't come up with a new "niche" to replace or re-institute those two and remain significantly threatened as a market competitor. Pat Crow
"Physicians occupy an unusual spot in the social structure of rural communities. From an economic standpoint, they are successful entrepreneurs, well-paid business people similar to bankers and lawyers. On the other hand, they are also social servants like policemen or teachers, just as essential to the welfare and functioning of the community but paid for through a fee-for-service mechanism outside of local community control. This anomalous status requires some fairly innovative interpersonal and structural relationships to strike a workable balance." Rosenblatt and Moscovice, 1982
I think it is difficult for young physicians who have not worked in a rural setting, and some older doctors who have (But have only seen one way of doing it), to understand that it is not "Family" or "Practice" but rather the effective integration of the two. There are many models for creating protected time for personal and family space in any setting, especially rural, and the only physicians who make it long-term in any setting are those who either ignore/neglect family or practice, or those who find incredible fulfillment by learning to integrate their lives.-- Randy Longenecker ³A Reflective Practitioner in a Rural Setting²
The best places to learn are not always the most convenient places to teach - Helen McIlvain, FP faculty, researcher, educator, counselor, friend
Patients want clinically competent physicians who listen to them and care about them. I also believe what our patients fear most about a doctor is that we won't believe them, and how easy it is for us to underestimate how frightening their illnesses, traumas, surgeries, etc can be to them. One of my mantras which nauseates the residents sometimes is, "They don't care how much you know until the know how much you care." We must be deliberate in teaching our residents how to communicate this at each visit. They must be able to do it without exhausting themselves emotionally and must be efficient at it. On the other hand, this type of communication can't just be an act. There has to be a genuine interest in our patients welfare expressed. I call this part of growing up in medicine. It’s a process that takes us from the very idealistic through disillusionment and often cynicism and eventually to a balanced view of what we can and can't expect of ourselves, our patients and the system in which we work. It brings us to the conclusion that it doesn't have to "cost" too much to care and that is a very valuable gift we give our patients. It also helps us recognize what a gift the patients give us in their confidence and trust in us when they ask us to help them. Of course the patients want us to be knowledgeable and competent as well. This is more easily taught. However, I wonder if our system of drumming competence into our learners sometimes drums out the compassion. I also believe that the current entrepreneurial climate which permeates our profession goes a long way to drum compassion and empathy out of us, not to mention the allegiance out of our patients. "Lijoi, Andre" <alijoi@WELLSPAN.ORG>
By Jeff Faux, of the Economic Policy Institute: "A second insight revealed by the awful gaping hole in the Manhattan skyline was how ill-served we have been by a politics that perpetuates the illusion that we are all on our own and, in particular, holds the institutions of public service in contempt. For two decades, politicians of both parties have celebrated the pursuit of private gain over public service. Shrinking government has become a preoccupation of political leaders through deregulation, privatization, and cuts in public services. . .
"Private provision of public services has been the dominant philosophy of government in our time. Only natural, the economists told us. People were motivated by money. It's human nature…. "Collective solutions are a thing of the past . . . The era of big government is over. . . . You are on your own." Public service was "old" economy, just for losers. A teacher in New York City schools starts at $30,000. A brand new securities lawyer starts at $120,000. Does anyone believe that this represents sensible priorities? "And does anyone believe that the firefighters who marched into that inferno did it for money? Does anyone think that people working for a private company hiring people for as little as possible would have had the same motivation -- would have been as efficient? At the moment when efficiency really counts?"
"My own experience in speaking to physicians, is that the only questions they ask are questions of detail...how much money they would get; whether they would have to get up nights at the demand of whoever called them." California Insurance Commission Member, 1918
Just keep in mind that bitterly disappointed teachers can be either very effective, or very dangerous. from the movie Finding Forrester