May 16, 2013
As I reached the 6-month mark in my "year away" in New Zealand, I thought I would write some reflections about patient care and personal growth and how they can go hand in hand.—Hugh Silk, MD, founder of Thursday Morning Memos.
I continue to enjoy my year in New Zealand where I am working as a general practitioner and doing urgent care work. I work about 32 hours a week, have no call (all docs pay into an overnight nurse line and urgent care system), and vary my hours so that I can walk my kids to school some days and pick them up others. My walk home allows me to pick up bread at a French patisserie, vegetables at the Chinese market and fish at the fishmongers. I have a little office where I see patients. I bring them in from the waiting room, sit and chat for a bit, then take vitals, examine them, and formulate a plan with them. A quick note in the electronic health record (there are next to no law suits here and billing is not based on notes but rather service) and send them on their way.
If I were a rock band I would title the year “the healing and rebirth tour.” But why does a mid-career physician need such a year? For me, as the U.S. health care system has become a game board for politicians and the hospital system is sending mixed messages about volume versus quality, somewhere in there my psyche got a little jostled. From my conversations with other providers, I think many others are a little rattled as well. More quality, less personnel to help with such goals, see more patients but be sure to prevent future illness while seeing them for their acute issues . . .
Where has our family medicine leadership gone? Where is their voice? When will we direct the efforts back to the values we all believe in? This could be our time to shine.
A breath. A time out. Physician health thyself, then heal others. Then maybe the rest will follow.
And so, a year of healing and rebirth.
New Zealanders have a word for this process—Koru: rebirth, peace, strength. It is part of the national symbol, a fern frond opening.
Lately I have written down all of the things that I think lead to wellness. I have focused on trying to put time into each one of them. A healthy diet of real food, mostly plants, not too much (from Omnivore’s Dilemma); activity including walking to work, ocean swims and long bike rides; a strong social network (not the digital kind) with quality family time and laughing with friends; a sense of purpose with meaningful work that one wants to be a part of and engaging in outside interests; proper sleep, oral care, a little red wine and dark chocolate, and so the list goes.
Many physicians I have spoken with have said that once they were pregnant, their advice changed for pregnant moms; a baby in your life leads to all new parenting advice; a serious health experience leads to a new level of empathy. I was moved last year at a meeting where colleagues shared their collective life and work experience and explained how the two were deeply intertwined. Self-processing over a lifetime leads to being more at ease with discussing aging, sexual health, abusive relationships, substance abuse, spousal difficulties, etc. For all the continuing medical education we acquire, we are far better doctors for the continuing life education that we experience if we are wise enough to process it, reflect upon it, and then share it with patients in an appropriate manner.
This week I sat with a man with advanced Parkinson’s disease and newly developed memory issues. He came alone without his wife this time. The time slot after his was my 15-minute morning tea, so I relaxed and talked with him longer than usual and sipped tea with him. What makes a man well in his state of illness? If wellness is, as the World Health Organization says, “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity,” then this was impossible for him. But what would make him the most well he could be? We did not talk of medicines or occupational health. We talked of jazz and how does one have sex in a condition like this. We talked of the irony and tragedy of an English professor losing his way with word finding and the frustrations that this can lead to. We talked of the movie Iris, of loneliness and frustrations, and when I asked what I could do as his PCP at this time, he said, “You can listen, you can watch out for new treatments for Parkinson’s and you can fill out my form for disabled parking.”
As I filled out the incredibly mundane and yet ever-important form, he copied down the details for the Auckland Jazz Club Tuesday night jams.
I went where he needed to go. My search for personal wellness has me sitting with patients differently and seeing what they need for wellness. I offer my prescription for it when appropriate or I listen and help someone define it at other times.
“Magical moments together behind the closed door.” Like a friend wrote about, moments of touch. And when the door closes and the connection begins—no one can take away these forms of touch. I have heard countless doctors and providers talk about how, no matter how much pressure is put upon us, the moments with the patient remain powerful and rewarding. Perhaps, just maybe, that our example, patients and us together, moving toward wellness and evolving our connectivity, will be an example to the system and the hospitals. There is more than numbers and dollars and quality—there are relationships and lives and wellness. There are feelings and livelihoods and spirits at stake here.
Bobby Kennedy talked about ripples of hope, and he meant it. These are our ripples. Let's hope and pray that family medicine leaders can follow our daily lead; let's hope they will see our passion for caring for our patients on their terms and turn the tide of the system. Efficiency, quality and lean are all noble pursuits but only if grounded in relationships, care and empathy. Finding the balance will take creativity and perseverance from people who are not afraid to tap their own passion. Read Victoria Sweet's God's House for the best chapter I have read on how bad it can go if we are not careful—how efficiency often leads to all new inefficiencies.
So as my patient slowly rose at the end of our visit, I shook his hand as his tremor paused briefly. I looked him in the eye and we thanked each other. We both hoped our next meeting would be at the jazz club.
Each Thursday, the Daily Voice showcases selected Thursday Morning Memos, reflective essays about clinical experiences written by faculty, alumni, residents and students of the Department of Family Medicine & Community Health and, occasionally, contributors from other departments. Thursday Morning Memos is UMass Medical School’s homegrown version of narrative medicine, in which the authors process their experiences through writing. To learn more, visit: http://www.umassmed.edu/news/articles/2011/personal_stories.aspx.