Wednesday, June 28, 2017

Fundaments I: The Essence of Healthcare

In general, I steer clear of overt political statements. This in itself is a political stance in a time of hyperpolarizaion. Politics is not what this post is about.

The problem with Healthcare (capital H) is that the term has been politicized to the point that you almost have to shade the word red or blue whenever you write it. Like many words today ("liberal" and "conservative" being two obvious ones in this context) it has lost its meaning in the jumble of policy and polemic that usually accompanies discussion. Talking about the Dread Healthcare means taking a stand for or against one administration or the other; one law or another; one belief system or another.

None of this could be further from the fundamental definition of healthcare. There is nothing political about giving or receiving medical or wellness assistance - it is a normal human activity and in all probability has always been so. Ancient Egyptian mummies show signs of medical intervention and even earlier human remains show that the species has always tried to fix what was physically wrong.

Skull from Early Dynasty Egyptian tomb showing cranial trepanation during life.

In point of fact, the actual act of providing health care is no different now than it was in past centuries. An ailing soul presents to an individual who has some interest (if not expertise) in medical care. The provider assesses, diagnoses and lays on hands in an effort to cure. The laying on may be surgical or prescriptive or acupunctural or spiritual. The essence is the same.

The controversy is not about how the care is done or whether it is done at all. It lies in who can access the care and how it will be paid for. I'm quite sure our earliest ancestors felt the same way as we do, arguing about how long they had to wait in a drafty cave and how many bird eggs the shaman demanded in payment for the intervention. Humans always will question value.

But to lose the essence of medical care as we are now doing in the convolution of policy and economics is both short sighted and dangerous. Any law or any regulation should be written for the express purpose of facilitating the basic practice of medicine. Any law or regulation that interferes with this process or makes it harder to attain the care needed must be discarded.

Tuesday, June 20, 2017

Singing A New Song

About a year ago, my wife accepted a new position in Dallas, TX. It was an academic dream job for her. Once it was apparent that Dallas was a great city to live, there was no hesitation in supporting her career and making the move.

As with any major change, the move brought me to a branching point in my career. Would I open up another solo practice? Would I try to join one of the many established groups in my new city? Or would I take the leap into a different career focus - one of consulting on practice implementation and teaching on healthcare?

Several important factors led to my decision to follow the latter path. First, I am not quite the ingénue I used to be. Pediatric specialties require a long start up time. One needs to earn the trust of the community and of the parents before a practice is seasoned and established. At my age, I wasn't sure I would have time to devote myself to a building process, not to mention for the long-standing attachments that inevitably develop.

Another factor is Dallas's saturation with excellent pediatric orthopaedists. I know them all well and can unfailingly recommend them all. Although I flatter myself to think I would have been welcomed in their numbers, I could hear them say, "But where will you find your patients?"

The final and probably most compelling factor was an opportunity to embrace the role of teacher and mentor. I have always been academic at heart and the siren song of instructing was too great to ignore.

So here I am - same voice but singing a different song.

My consulting service is focused on returning providers of all stripes to the joy that they once had in working in healthcare. I can safely and boldly say that I loved every minute of my clinical practice. and I believe that everyone who chooses to enter the service of medical care feels that or felt that way at one point. Now, in an age of noise and uncertainty, politics and polemics, it is difficult to remember. Why did we choose to become doctors? Nurses? Therapists? Surely it was not to satisfy some policy written by a remote and monolithic government. It was to reach out and help others. As corny and as idealistic as that sounds, it is nevertheless the truth. What other reason would anyone have to devote so much time and sacrifice to such a difficult undertaking.

I am happy to have a platform to give voice to my ideas, even if only a few are listening. I have the opportunity to talk with providers and patients and policy makers - to learn and teach what medical care is all about. As such, this blog has been revitalized to serve as a place to record what I've learned. And hopefully a place to engage in dialogue with others.

Welcome back to my blog. I hope you enjoy the song.

Listen to my podcast at