Reflections on Primary Care

Over the past several months, I have been thinking a lot about the crisis of primary care in this country. That crisis has become very vivid as I have watched medical residents who have not chosen to become PCPs go through primary care rotations where they learn skills — like feedback, shared decision-making, and motivational interviewing — they have not been taught to value much throughout their medical training.

Nancy is one of those residents. A tall thin young woman with striking red hair, she is rotating through a primary care practice.  As she tries to put into practice the patient centered care skills she is learning, she does so grudgingly.  She is practicing patient centered care, role playing primary care, but you can tell from the tension on her face as she talks to patients that she does not find it either fulfilling or particularly convincing. What she wants are certainties, to order a test or procedure that will produce numbers that she can analyze, dissect, and then use to determine some kind of certainty (i.e treatment) that will deliver something concrete – something she can feel good about — no matter how fleeting.

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Right Care, Right Now

bernard-lown-1-sizedThis past week, I spent two and a half days at a conference put on by the Lown Institute on Right Care in healthcare.  The Lown Institute was started by cardiologist Bernard Lown who has done critical research on sudden cardiac death, developed the direct current defibrillator for use in resuscitation when there is a cardiac arrest, and pioneered other critical cardiac treatments.  In 1962 Lown founded Physicians for Social Responsibility and in 1980, with Russian physician Evgeni Chazov, Lown founded International Physicians for the Prevention of Nuclear War.  In 1985, the two were awarded the Nobel Peace Prize.  I had the privilege of working with Bernard Lown as well as other physicians like David Himmelstein and Steffie Woolhandler of  Physicians for a National Health Program, (PNHP  in the mid 1990’s when they created a group of physicians and nurses who launched a protest against Managed Care.  This Ad Hoc Committee to Defend Health Care created a movement of some of the most prominent physicians and nurses  in Massachusetts who encouraged their colleagues to sign a letter — For Our Patients, Not for Profits:  a Call to Action … Continue reading

The Pope and Women

imagesAlthough I have written about Pope Francis’ extraordinary Xmas speech to the Roman Catholic Curia, I don’t usually write about the Catholic Church.  Although I am married to a lapsed Catholic, and was raised by a devoutly Catholic Nanny, who taught me to say the Rosary before I could say my Jewish prayers, I am not a Catholic.  But the new Pope has instilled hope in many of us who are seeking to reform institutions — like the Catholic Church or in my case of  healthcare.  I can’t help responding, however, to today’s article in the New York Times titled “Women See Themselves as Left Out Amid Talk of Change in the Catholic Church.”  This article appears the day after I finished reading an excellent  biography of Pope Francis The Great Reformer by Austen Ivereigh.

The book is a fascinating look at the Pope’s humble beginnings, his stint as an Argentine Jesuit, his actions during Argentina’s Dirty War and his subsequent role as Cardinal and finally as Pope.  What is so remarkable about the book is the almost entire absence of women in Jorge Bergoglio’s life and thus … Continue reading

NPR’s Last Story on Nurse Safety: VA Is the Hero

This is the script for the fourth installment of Daniel Zwerdling’s amazing series on injured nurses.  It shows that hospital systems can act to protect nurses if they have the will to do so.  The VA has done it again, prove that it delivers some of the best care anywhere.  The national VHA system not only provides quality care for patients, as I am discovering in my months’ long observation of the VA for a book I am writing on VA healthcare.  It provides superior care for staff.  Why don’t all other hospitals follow this model?

nurses-va-91-edit_custom-64cfb8c6dee5b04485ef2c9bb3207ad3a206593e-s1500-c85Special Series
Injured Nurses
At VA Hospitals, Training And Technology Reduce Nurses’ Injuries
February 25, 2015 4:33 PM ET
Daniel Zwerdling 2013

To safely lift Bernard Valencia out of his hospital bed, Cheri Moore uses a ceiling lift and sling. The VA hospital in Loma Linda, Calif., has safe patient handling technology installed throughout its entire facility.

To safely lift Bernard Valencia out of his hospital bed, Cheri Moore uses a ceiling lift and sling. The VA hospital in Loma Linda, Calif., has safe patient handling technology installed throughout its entire facility. Continue reading

Atul Gawande and Palliative Care

k13613741      As I have been reading Atul Gawande’s  new book Being Mortal, I am fascinated by the fact that it has taken this surgeon so long to discover the realities of the human condition, the fact that aging and death really isn’t optional and that there should be a better way. (Reading Gawande, I am reminded of esteemed physician Arnold Relman’s semi-deathbed realization that nurses are actually important to patient care and that physicians rarely talk to their patients, see my blogpost on this). Even though his discussion of the palliative care/hospice option may prove to help Americans understand that there is an alternative to the torturous American way of death, there is a serious problem with a model of medical philosophizing.   These reflection rely far too much on personal experience and not enough on the ability of physicians to reflect on the scientific facts (that so many of the treatments MDs recommend are, in fact, futile) or on a close observation of their patient’s experience (which would clearly highlight the torturous nature of so many modern medical treatments).