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?

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.

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.

tell me a story

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.

Dave Chase is well known for his work in documenting the damage our broken healthcare system has done to the lives of every one of us. In his book, The Opioid Crisis Wake-up Call Chase stresses the value of primary care:

…and preventing other crises through access to great value-based primary care, a critical foundation for a fair, rational, affordable, and effective health care system.

Healthcare can return to what it used to be when physicians with their patients made health care decisions rather than insurance companies and third parties. Independent physicians practicing primary care.

Direct Primary Care.


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