More than medicine...

I had diagnosed "abdominal pain" when the real problem was hunger; I confused social issues with medical problems in other patients, too. I mislabeled the hopelessness of long-term unemployment as depression and the poverty that causes patients to miss pills or appointments as noncompliance. In one older patient, I mistook the inability to read for dementia. My medical training had not prepared me for this ambush of social circumstance.
Real-life obstacles had an enormous impact on my patient's lives, but because I had neither the skills nor the resources for treating them, I ignored the social context of disease altogether....

Read more: http://www.sfgate.com/opinion/openforum/article/Funding-healthy-society-helps-cure-health-care-3177542.php#ixzz2OkRE4q4X

A neat poem about life.... from Garrison and Writer's Almanac

Excerpts from "How to be Perfect"

by Ron Padgett

Get some sleep.

Eat an orange every morning.

Be friendly. It will help make you happy.

Hope for everything. Expect nothing.

Take care of things close to home first. Straighten up your room
before you save the world. Then save the world.
Be nice to people before they have a chance to behave badly.

Don't stay angry about anything for more than a week, but don't
forget what made you angry. Hold your anger out at arm's length
and look at it, as if it were a glass ball. Then add it to your glass
ball collection.

Wear comfortable shoes.

Do not spend too much time with large groups of people.

Plan your day so you never have to rush.

Show your appreciation to people who do things for you, even if
you have paid them, even if they do favors you don't want.

After dinner, wash the dishes.

Calm down.

Don't expect your children to love you, so they can, if they want
to.

Don't be too self-critical or too self-congratulatory.

Don't think that progress exists. It doesn't.

Imagine what you would like to see happen, and then don't do
anything to make it impossible.

Forgive your country every once in a while. If that is not
possible, go to another one.

If you feel tired, rest.

Don't be depressed about growing older. It will make you feel
even older. Which is depressing.

Do one thing at a time.

If you burn your finger, put ice on it immediately. If you bang
your finger with a hammer, hold your hand in the air for 20
minutes. you will be surprised by the curative powers of ice and
gravity.

Do not inhale smoke.

Take a deep breath.

Do not smart off to a policeman.

Be good.

Be honest with yourself, diplomatic with others.

Do not go crazy a lot. It's a waste of time.

Drink plenty of water. When asked what you would like to
drink, say, "Water, please."

Take out the trash.

Love life.

Use exact change.

When there's shooting in the street, don't go near the window.
Excerpts from "How to be Perfect" by Ron Padgett, from How to be Perfect. © Coffee House Press, 2007. 

"Living Arrhythmias" with Dr. John C. Grammer

One of the most helpful and hilarious videos that shows the rare mating dance of the cardiac electrophysiologist.... I wish all ECG reading could be this fun!

Should Doctors accept the term "provider"?

I read a fascinating article in the best NYT blog, "Well," that beautifully articulates how the language of medicine is changing, and not necessarily for the better.

The term "provider" being used for every person writing a prescription or seeing patients is so pervasive that I've seen docs ask their patient who their PCP (primary care provider or primary care physician) is. Office staff add "MD" after every name of a referral in an office since even those that work in medicine aren't even clear of the difference.

Should there be a different recognition for Physicians versus say a physician assistant or nurse practitioner who may only have a Master's level training? Whether DO or MD, a "doctor" has completed a 4 year accredited program of medical education with further residency training to become board certified, this all after receiving an undergraduate degree.

I understand this is a difficult topic, and not to risk offending my dear friends and colleagues who function as a midlevel provider (NP or PA), but why is it so difficult for our patients and the public to understand this concept. I am a firm believer that medicine is a team sport, and any terminology that removes hierarchy is a good thing, but in our quest for equality have we gone too far the other way.

A fantastic article in the NEJM delves a little deeper, and I agree that there is a difference in the education that is hard to account for without some differences in nomenclature.

The New Language of Medicine — NEJM

I'm thankful for my NP and PA colleagues, and I know it will take the true team approach to create meaningful reform in our system. My belief is that physicians need to maintain our high standards in care, and that asking to be referred to as "Doctor" is a dedication to our hard work and commitment to training.

A new beginning...

With the onset of 2012, it's hard for me to believe that in six short months I will be a physician. "Dr. Christensen" still sounds so surreal to me even after being in school for 20 of my 26 years of life.

I plan to start this blog up to chronicle my continued journey as I finish my final year of osteopathic medical school and venture into the world of Scrubs and Grey's Anatomy as an INTERN! :audience shudders with fear:

I hope this continues to be a discussion and update on all that I'm learning and as a tool to maintain my humanity in our currently broken healthcare system.

Some things I hope to discuss:

-AMSA
-Osteopathic Medicne
-Patch Adams and his amazing work
-Residency
-Life in General
-Attendings

Thanks for reading...

Learning with a Legend...

Today I started my fourth rotation of third year. Wow.
1 month of surgery down
2 months of IM down...
and now to something COMPLETELY different! I started today with the legend in the osteopathic profession, Dr. Viola Frymann at the Osteopathic Center for Children. Dr. Frymann is arguably the greatest living osteopath, having studied with William Garner Sutherland himself and she has outlived Anne Wales and other pioneers. Amazingly, she still practices 4 days a week and it's evident how she's devoted her life's work to osteopathy and the health of children.

Some highlights of Day 1:
-A patient from japan and another from Italy. Children and families travel to the Osteopathic Center for Children from all over the world with obscure developmental problems. They are never turned away based on their ability to pay and Dr. Frymann's charity, Osteopathy's Promise to Children, raises money for this and providing housing for those who come from all over the world.
-Dr. Frymann begins every interaction by talking with the child, she always asks please and thank you and she flashes her smile. The patient may be crying and thrashing at the beginning of the treatments, but over time with her assistant Anna holding onto clothes and using toys to distract as she treats, the child calms. It's amazing to see the response to the osteopathic treatments. Her goal: Giving every child the chance to achieve their fullest potential.
-I asked her after a treatment about one of the hand positions "Dr. Frymann, what are you treating with that hand position? I didn't recognize it." "The patient, of course," she replied with a smile. "He has two orbits."
-A large part of her success, in my mind, is that the parents aren't in the room during these treatments. In the room today was Dr. Frymann, myself, Anna her assistant, and Lilya, the piano player. Everything is focused on the child she is treating, and appointment times are very flexible as each child gets the treatment.
-Lastly, the music is AMAZING. Dr. Frymann calls out different classical music composers that Lilya plays. "I think you'd like some Scarliatti today" she remarks as she begins treating one little girl. And Japanese children's songs for the child from Japan.

I palpated the head during one especially cooperative little boy today while she treated his pelvis. He has a genetic mutation of PLP1 causing Pelizaeus-Merzbacher-disease, an XLR disorder that I only heard about briefly in my genetics training. After the treatment, his CRI released amazingly, and we "walked" him out with Anna holding him by the arms and me crawling along the floor, moving his feet and bending his knees as he stepped along. When he came in, he was stiff like a board from the hypertonicity in his tissues. The smile on his face, and Dr. Frymann's motherly approval as she watched him "walk" was incredible. Not to mention his smile and laughter...

THIS is real medicine... Check out more about Dr. Viola Frymann at www.osteopathiccenter.org

As i was reading an interview in her Collected works (edited by my Professor, Hollis King) a quote especially struck me:


Our patients today may have a condition which I have chosen to call spiritual starvation. They may be people whose lives are so intensely oriented at a materialistic level, or even an intellectual level, that they do not permit the spiritual side of their natures to be expressed. This starvation affects their whole nature and can be a serious cause of disease.

The laws of nature on a spiritual level are just as precise as those at a physical level. We live by them automatically, whether or not we enunciate them, like gravity.

Spiritual laws at present must be applied to be understood: for example, the law of faith, the law of forgiveness, or the law of love. Love makes plants flourish, makes animals thrive, and makes human beings healthy. Love is the healer which is ours to give and receive. It is the most important additive to the life-diet of one who is sick. I do not know how it works, but I know it does work-always.

The applications of these laws have to be a part of the physician's armamentarium if we are really going to help the whole patient. I think we have to be scientific in the truest meaning of the word. We have tended to use the word "scientific" only in the sense of "materialistic"; the word actually means "in accordance with law."

Thousands of people are experiencing spiritual healing in spite of the physicians. We cannot afford to stand back and pretend that this does not exist; it is happening all around us. It must no longer be something separate from what we do. It is time for us, as a profession, to recognize, explore, and cooperate with the spiritual forces that are being quickened all around us. If we will form a partnership with the Great Physician, listen to his guidance, and invite Him to use our hands as His, to bring healing to this patient, the "impossible" becomes possible and patients experience profound changes during their osteopathic manipulative treatments.


I am excited and honored to have the privilege to learn with this modern master... and to explore this journey of healing on my way to becoming a physician.

Wow.

* OPINION
* FEBRUARY 26, 2009

We Cannot Delay Health-Care Reform
Universal coverage means healthier people and a more productive economy.


By MAX BAUCUS and EDWARD M. KENNEDY

In his address to the joint session of Congress on Tuesday night, President Barack Obama declared that health-care reform "cannot wait, it must not wait, and it will not wait another year." He is right.

Congress has worked hard with the president over the past weeks to begin restoring our nation's shattered economy, and to bring health care to millions of low-income, uninsured children by passing the economic recovery bill and renewing the Children's Health Insurance Program. These were urgent priorities that demanded immediate attention. Now, it is imperative that we turn our attention to comprehensive health-care reform and move quickly with President Obama to fix our broken system.

For decades, obtaining affordable, high-quality health care has been a heavy weight that millions of Americans have been forced to bear on their own. Increasingly, skyrocketing health-care costs have threatened the stability of families, businesses and our economy as a whole.
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Some argue that repairing the health-care system now is impossible, given the urgency and high cost of ending the financial crisis. The claim is that we can fix one problem or the other -- but not both. In truth, the two are inextricably intertwined: Solving the nation's health-care crisis is a fundamental part of healing our economy.

The U.S. spends $2 trillion a year on health care, and that number is expected to double in the next 10 years. America's fiscal situation will remain on shaky ground as long as we continue receiving such poor returns on this crucial investment. If our initial efforts to restore American prosperity are ever to bear true fruit, Congress must follow up by creating a high quality, universally accessible, and cost effective health-care system.

There is also a moral imperative to follow economic recovery efforts with health reform. If Congress can bail out the nation's banks, surely we can help families get the quality, affordable health care they deserve.

Approximately 46 million Americans lack any health insurance at all, according to the Census Bureau. Nearly 25 million more don't have enough insurance to keep their medical bills from sinking them financially. Insurance premiums for a family of four can cost more than $12,000 a year. According to the New America Foundation, that cost could reach $24,000 in 2016 -- an 84% increase from today. At the same time, higher deductibles, larger co-payments and greater exclusions from coverage are causing families to bear more out-of-pocket costs. Debt related to health expenses is now one of the leading causes of personal bankruptcy.

Rising health costs also undermine our strength in the global marketplace. American employers pay far more for health care than their major trading partners, and manufacturers face particularly high pressure to compete internationally. U.S. manufacturers pay $2.38 an hour for health benefits, while manufacturers among our major trading partners pay only 96 cents an hour on average, according to the New America Foundation. Health-care reform is essential to spur growth and keep American businesses on a level playing field with the world.

A reformed health-care system will allow businesses to better afford to offer coverage, and empower every American to choose and purchase insurance plans that fit their budgets. Once universal coverage is reached, the positive effects will be exponential. When every American is covered, the massive costs incurred by doctors and hospitals for treating the uninsured will no longer show up in the premiums of those with health policies. Coverage can become increasingly affordable for all.

The quality of our health-care system, too, demands attention now. Today, even as costs rise, the Rand Corporation has shown that Americans receive the recommended care for their conditions only half of the time. A revitalized system should reward doctors and hospitals for providing effective, efficient care. Cutting-edge health-care technology, better coordination among a patient's various doctors, and efforts to improve care in rural and underserved areas can keep individual patients healthier and make the system work better as a whole.

Health costs also will go down as more people get the preventive care and the timely effective treatments they need.

Health is a public good worthy of major, long-term investment. Our starting point will be the down payment of more than $600 billion that the president included in the budget released today. The challenge of crafting this public policy is certainly large. But just as Congress and the president met the first challenges of restoring our nation's economy, we must also keep our commitment to reforming health care -- now.

Mr. Baucus, a Democratic senator from Montana, is chairman of the Senate Finance Committee. Mr. Kennedy, a Democratic senator from Massachusetts, is chairman of the Senate Health, Education, Labor and Pensions Committee.



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