The Story Space Between Physician and Patient

The healthcare mess just seems to be growing into a what appears to be a bigger and bigger train wreck bound to happen, fueled by the ridiculously black-and-white mentality of partisan politics, all whipped together into a froth of total uselessness by this being an election year. After the election, the political nonsense continues.

Where does one begin?

David Chase and Leonard Kisch in “95 Theses for a New Health Ecosystem” party thinks there is some way to save our healthcare system. Notice the emphasis on “systems” improvements. The view from the top. Same view that has created so much of the existing problems in healthcare. They have made the suggestions readily available and welcome comments. This is admirable, but it’s still a “systems” fix.

The “Medicare-for-all” faction would like the public to believe there’s something salvageable in the current mix of government and big business. The key word here is single-payer, not Medicare.

Both are questionable assumptions.

More and more patients are seeking solutions to their healthcare problems elsewhere, even in foreign countries.

Some are moving to alternative health care resources. The term alternative health care takes a lot of hits from the medical establishment. Dr Stephen Barrett has hosted Quackwatch for many years.  A large number of medical associations denigrate “alternative” health care. Instead these organizations should stop complaining and do some “evidence-based” studies on why more and more people are abandoning the existing healthcare system for something else.

Or why physicians such as Dr. Rocky Bilhartz are organizing an Institute of Practitioners with a mission to “take back medicine.”

Or why physicians such as Dr. Michael Accad write a blog AlertandOriented to help focus our attention on what really counts in medicine:

Alert and Oriented” is a medical phrase that describes the mental status of a patient who, despite being in serious shock from trauma or disease, maintains clarity of mind and focus of thought.

Sadly, the medical community enmeshed in today’s health care system is like a patient in acute shock. The only chance to survive is to remain alert and oriented.

Or why primary care physicians in larger and larger numbers are abandoning the train wreck model and are beginning to see patients on their own terms. It’s called Direct Primary Care.

It all comes down to story. I’ve written here before about the non-checklist nature of expertise as well as the very human need for story. Indeed, Roger Schank in Tell Me a Story posits that human beings organize knowledge in story structure.

There is need for story in the practice of medicine. Dr. Craig Bowron does a very good job of describing that story space between the primary care physician and the patient. This is the seat of any physician’s expertise. The metric mavens don’t even know this space exists, and couldn’t “monetize” if they tried.

What will never be part of the system is the sacred space that I and an ailing patient occupy when I pull a chair to the bedside and commit all of my energy, education, and humanity to listening to and deciphering his or her story.

In the end, after the healthcare train wreck, there will only be you and your primary care physician and this very important story space.

Healthcare can return to what it used to be and where we should be looking to go with patient care.

Direct Primary Care.

Hallelujah!

dhaugen

Some young HR person once looked at my CV and asked me, quite seriously, if I had really done everything I had listed there. Well, yes. Because I am someone who can’t sit in a Morris Miller cubicle every day, much less for any great stretch of time. Once the problem is solved, I get bored and I’m ready to move on to the next challenge. This hasn’t afforded me any great stability in my work life. I simply arrive in places about ten years ahead of time. So far, at least, that penchant for early arrival hasn’t been accompanied with a pocketbook full of door knobs.

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