3 Curses Of Modern Medicine

Well, do YOU love everything about your job?!

Is it so surprising that I would have pet peeves and things I would change about mine?

Frustration

I’ve been getting ready for vacation this last week and it seems like when you’re really busy with multiple tasks, little irritations tend to get under your skin.  And BIG irritations become almost intolerable!

This week I’ve been reminded over and over of the 3 curses of modern medicine, and thought I would write about what I would change about medicine, if I could.

1.  Government regulation 

The government is intruding more and more into the daily practice of medicine.  From the Meaningful Use fiasco to endless HEDIS audits to the Patient Centered Medical Home initiative, the federal government is insisting on more and more control of the daily practice of medicine.  They also are beginning to insist on the power to decide which doctors provide good care and to pay them more on the basis of these metrics.

Why should patients care about these problems?  As I wrote a few months ago, if the government decides how much to pay doctors based on their patients’ test results, doctors will begin to fire patients who refuse to (or who are unable to) get their numbers into the goal range.

The problem with government metrics determining how doctors are paid is that DOCTORS aren’t in control of their patients’ illness.  PATIENTS are.  The government doesn’t care that the doctor ordered the tests and recommended dietary change and regular exercise and weight loss and ophthalmology/podiatry/dental care.  The government only cares that the tests didn’t get done and the meds didn’t get taken and the eye exam didn’t get done.  So patients who don’t take their doctors’ advice (who are frustrating patients to take care of in the first place, see #3 below) will begin to be shown the door and told to find another doctor.

2.  Administrative busywork

From documentation requirements for the above government initiatives (and others) to medication and test preauthorizations, doctors are having to spend more and more time on finding and jumping through government and insurance-company hoops.  The only alternative to ME spending my time on the phone and filling out paperwork is hiring more staff to do it for me.  (We not-so-privately think that’s part of the government’s plan to stimulate the economy and create jobs.  Create more and more busywork to clutter up the practice of medicine so that doctors have to hire more staff to take care of it.)

3.  Being a prescription-writing service

I have a handful of patients who refuse to listen to me.  The only reason they come in is because they need a medication and for that, they need to see a doctor.  They resent having to come in, abuse my staff, complain about everything, and force me to hold their prescription hostage until they either make a personal appearance or get their bloodwork done.  They are exhausting!  I have told more than one of them that I would be happy to forward their records to another doctor if they are so unhappy coming to see me.  The thing is, they see doctors as interchangeable and medical care as an inconvenience, not as an opportunity to create a healthier life.

On the upside, I realize that the reason these three things irritate me so much is that they distract me from what I LOVE about medicine.  Every minute I spend jumping through government and insurance hoops and filling out paperwork is a minute I can’t ever get back and spend doing what I love.  The extra staff I need to deal with government regulations mean extra patients I have to cram into the schedule to pay the additional overhead expenses.

Every patient I see that doesn’t listen to me or take my advice is an appointment slot where I can’t see someone who honestly WANTS my help.  The more patients I have to see in a day, the less time I can spend getting to know each individual patient and understanding their unique needs.  When we decrease appointment times from 15 to 10 minutes so we can fit in more patients, we sacrifice quality in favor of quantity.

I don’t know where medicine is headed.  The next 3 years will see major growing pains in the American health system.  It will be an interesting time!  However, I am reminded of an often quoted Chinese curse:

“May you live in interesting times.”

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Sailors’ Wisdom: Life Lessons From The Boat

A few weeks ago my son Chris and I took a two-day sailing course on Sandusky Bay.  Captain Dave of Fair Wind Sailing School was a great teacher and we learned a lot.  I was thinking back on the lessons and realized they make great life lessons too.  Here are just a few:

1.  Always check the chart!  Before heading out into unfamiliar waters, a wise captain studies the chart.  Water looks the same (for the most part) no matter what’s underneath, and if your boat has a 4-foot draft you need to know where the water is deep enough to navigate safely.  To quote Captain Dave, “Rocks are bad!”  When starting a new venture or learning a new skill, it helps to consult an expert and get some guidance.  Learn from someone else’s experience, not from your own mistakes!  Find the rocks on the chart, so you don’t find them with your keel.

2.  Mind the wind and weather!  Especially on Lake Erie, the weather can change quickly.  Checking the forecast before starting out and getting frequent updates will keep you from being caught with too much sail for the wind or out of your harbor with a storm building.  Adjusting for changing conditions is easier if done in advance.  In finance, in business and in life keeping an eye on coming events and watching forecasts can keep you from making costly mistakes.

3.  Know who has the right of way!  When two boats are on a collision course they both need to know who has right of way.  The one with right of way is expected to stay his course, and the other is expected to change course.  Knowing the etiquette and expected behavior for different situations makes it easier for all of us to avoid ruffled feathers and close calls.

4.  Practice your knots!  Skills need maintained.  You have to practice and hone your skills until they are second-nature.  Sometimes you have to be able to perform tasks without thinking about them, like tying knots on a boat in a hurry.  I hadn’t tied a bowline in about 5 years, and I fumbled a little trying to show Chris how to fasten the jib sheets.  (That was embarrassing).  So we spent some downtime over lunch practicing in the cockpit with dock lines.  The only way to stay on top of your game with important skills is practice, practice, practice.

4.  Pull in your fenders!  Captain Dave has a funny story about a type-A captain he knows who forgot to pull in his fenders (the bumpers that keep boats from rubbing against the dock) when he was out on a sail.  So someone announced on the public VHF channel that his fenders were still out!  That poor guy was so embarrassed.  Not that it’s a big deal to leave your fenders out, from a safety standpoint (in fact we forgot once to pull ours in) but it’s kind of a mark of a sloppy sailor.  You never know when someone will point out your mistakes in front of everyone, so try to pay attention to the little things!

We had such a wonderful time with our sailing lessons, and we plan to spend another day later this fall out on Sandusky Bay playing on Old School.

Here’s a picture of Chris working on Old School‘s pesky jib sheets!

Chris and Old School

Question:  Have you ever been on a sailboat?  What was your experience?

 

 

 

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Meditation, Relaxation and Health

Has anybody out there ever practiced meditation?  I have practiced it off and on for years, but always found it difficult to simply sit still and meditate.  It is easier for me to move while I meditate, so I enjoy Tai Chi, yoga and martial arts.

Guided-visualization recordings are also very enjoyable, as well as live sessions where another person helps me calm my mind and get into the needed quiet mental space.  There have been a lot of patients in the office this week who would benefit from a little relaxation, so I recorded a guided-meditation exercise for you!

Before you roll your eyes and think Dr. Jen has gone off the deep end 😉 you should know that meditation and relaxation therapy have been scientifically validated over and over.  They lower blood pressure and decrease symptoms of anxiety and depression.  Meditation is good for you!

Before you listen to this recording, I want you to choose a quiet place where you can be undisturbed for about 15 minutes.  Put on quiet instrumental music (i.e. no vocals or words at all).  My favorite position for this sort of meditation is seated in a comfortable chair, my back supported, with both feet flat on the ground.  You may feel more comfortable lying flat on your back or on your side with a pillow between your legs.  Whatever makes you most comfortable is the right position for you!

Before we start I want to give you some visuals to use.  I will talk about energy a lot.  The basic visualization of energy is of a cool, clean white mist surrounding you on all sides.  I think of it as the feeling you get when you jump into a cool swimming pool on a hot, sticky summer day:  refreshing and clean.

Go ahead and click on this link to begin:

Guided Meditation For Health

Once you’re done, please feel free to leave me a comment and let me know how you feel!  You can use the recording as often as you like, can download it to your smartphone or MP3 player for use on-the-go.  With practice, it gets easier to reach that calm, relaxed state of mind and it gets more and more beneficial.

Question:  Have you ever done anything like this before?  Did you enjoy it?  Do you know anybody else who could use some help with relaxation and stress relief?

 

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3 Freedoms For You

Happy birthday America!  We are celebrating freedom, liberty, the pursuit of happiness, courage, sacrifice, family, and all the other things America stands for.

FlagHeart

I’ve asked on my Facebook page this week what types of things people are praying to be free of.  (Sorry for the lousy grammar).  Answers varied, but most of them revolve around behaviors that impact health and well-being.

What freedoms would I wish for my patients, family, friends and followers?  I think I’ve figured out 3 very important ones.

1.  Freedom from cigarettes.  Smoking is the number-one preventable cause of death in the world.  One of every 5 deaths in the USA is caused by (or contributed to by) smoking.  It increases the risk of lung cancer, heart attack, stroke, COPD (emphysema and chronic bronchitis), leukemia, bladder cancer, cancers of the upper respiratory and GI tracts (oral cavity, throat, larynx and esophagus), and a host of other illnesses.  It also increases the risk of cervical cancer, but scientists aren’t sure of the reason why.  The CDC website has much more information about the health risks of smoking.  Be free!  Don’t smoke!

2.  Freedom from overweight and obesity.  Overeating and eating the wrong foods is a very big cause of health complications.  Diabetes, high blood pressure, sleep apnea, heart disease, breast cancer, colon cancer, arthritis, liver disease and many other serious illnesses are more common in people who are obese.  Freedom from overweight and obesity are a process, not an event 🙂  Every day you can make healthier choices to eat better and be more active.  The past is gone, you can’t change it.  You CAN make good decisions today!  If you need help you can call my office at 440-582-1484 and make an appointment to discuss weight loss, I’d love to help!

3.  Freedom from stress.  It is estimated that 80% of primary-care doctor visits are directly or indirectly related to health consequences of stress.  Depression and anxiety, stomach ulcers, headaches, high blood pressure, obesity, insomnia, the list goes on!  We live in a very stressful world and often we get overwhelmed by it.  We do things to soothe the stress that aren’t very healthy (like overeating, drinking too much, and smoking or using other drugs).

So what should we do if we’ve decided to be free from the above problems?  First of all, DECLARE YOUR INDEPENDENCE!  Make a conscious decision that TODAY I am free.

Second, RALLY THE TROOPS!   Tell your friends and family members about your decision to get healthier.  Tell them you’re going to quit smoking, lose weight, reduce the stress in your life or correct whatever else is making you sick.  Make an appointment with your doctor for extra support.

Third, PREPARE FOR BATTLE!  Anyone who has tried to quit smoking or lose weight knows that it’s an ongoing struggle.  Do a self-check and try to identify the weaknesses in your defenses.  When do you REALLY want a cigarette or an unhealthy snack?  (See my post about combating cravings for more info.)  Pencil in some down-time to relax or read or do whatever gives you pleasure.  Delegate some responsibilities if possible.

Fourth, CELEBRATE YOUR VICTORIES.  The quest to be healthy is a long, grueling war.  Every little victory should be celebrated.  You are surrounded by media messages and temptations all day long, all telling you to take the easy path and contributing to your stress.  Every time you resist an unhealthy message and make a healthy choice, you should give yourself a big pat on the back and celebrate it.

The Founding Fathers didn’t have cheerleaders, but you do!  I’m right here, always ready to help you celebrate and to encourage you when you’ve had a bad day.  Like my Facebook page or follow me on Twitter if you haven’t already.  Send me an email at drjen@jenniferwurstmd.com if you’d like, letting me know about your successes and asking for help when you struggle.

HERE’S TO FREEDOM!

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