Thursday, February 4, 2016

Vanguards of health system change

Dear DPC community members,

I read this article and thought of your boldness. You were the first in the physician community to say “No mas!”; I will not be dominated by all the administrivia and foolishness. I want to serve my patients and community. You launched your Direct Primary Care practice. You are a beacon of hope for those who would follow your lead

I encourage you to read the article and to pause to celebrate your achievement. Where others say….”Something must be done”… your actions showed that it is more than possible. Where others say….”I hope someone will come up with an answer, I am too busy with my day to day to change”… your actions speak louder than words.

As we start a new year, take a moment to celebrate what you have done.

The article concludes with a quote from Avedis Donabedian (a leader of the quality measurement movement) who, at the end of his life (possibly because he experienced the problems with the end of life care delivery process – my speculation) said “The secret of quality is love”.

I think you know that secret as do your patients and colleagues.

Keep up the great work… you are the vanguard of change

Larry Bauer

Monday, October 13, 2014

Our First Blog

This is the first entry in the FMEC Blog. Currently, it is a blog without a full name. That will come in time. But we do have a lot to say and I thought it is only fitting that we begin this journey with the voice of one of the founders of the Family Medicine movement.

Listen for the boldness and the vision. Dr. McWhinney past last year but his voice will continue ringing through the years. This piece was written in 2007 and may be taken as the opening round of the Occupy Healthcare movement. Time to take back the health care system from the dark night.

Laurence Bauer, MSW, MEd

This I Believe
by Ian McWhinney

“Our destiny as general practitioners is to save from collapse the health care systems of the western world.  I use the term general practitioner because it is only by being generalists that our discipline can survive.  Our discipline is unique in medicine.  All the other fields describe themselves in terms of technologies or disease entities.  We describe ourselves in terms of relationships – especially the doctor-patient relationship.  It is customary for patients to join our practice before we know what illnesses and problems they will have.  Our commitment to patients is to care for them whatever illness they bring to us.  That is why we must be generalists.  If we allow our discipline to break up into a hundred pieces, it will die. 

It follows that whenever we sit down in our consulting room, we know that we are going to be face to face with the unknown.  We will usually know the patient, but with a new visit we will not know what their problem will be.  Our special skill is the assessment of undifferentiated clinical problems and we do this day in day out.  To face the unknown takes courage.  Very often we are face to face with suffering and we are all at times tempted to flinch – to withdraw emotionally from the patient.  It takes courage to face suffering without flinching. 

A number of patients will be referred to specialists, while we remain available to them if they need us.  But most of our patients are cared for without my referral to the secondary or tertiary sectors.  We have a much broader experience of illness than any other branch of medicine.  Because we are generalists, we take a wholistic view of our patients.  We are the only field of medicine that transcends the fault line between mind and body. 

All these factors, together with our long-term relationships can give us deep knowledge of our patients’ lives.  Medicine’s orthodoxy draws a straight line between a patient’s disease and his life story.  Our experience teaches us differently.  Yet we seem to make very little use of this knowledge.  Perhaps we are too intimidated by the weight of orthodoxy which dominates our medical schools.  Sooner or later the present paradigm will change.  When it does, we must be there to lead the way.”

Submitted to the FMEC in 2007