This weekend, going to do some table gaming again.
Also, dineLA is here! Planning to go to Ford's Filling Station in Culver City for some new eats. Good deals during that time too!
US vs Sweden, then US vs Mexico coming up.
Getting some good tips on some new Jazz musicians from cable TV. Going to be looking into some new CDs soon.
It's freaking 80 degrees in January. Awesome, strange, sad...you don't get too see green down here in SoCal very often.
Monday, January 19, 2009
Sunday, January 18, 2009
The horizon has arrived
So, the loan is just about payed off. I was planning to have this all paid off in 3 years. Now...what do I do. In some ways, this is the day I hoped for. Do I learn acupunture? Go back to school? Change jobs? Part-time med with focus on music/travel? Move to where it's cheaper? Ughhh....no way, that means the south/midwest. I can't stay in the Inland Empire, though. It's slowly squeezing the life out of me. This is just a feeling, obviously, but...maybe, I can sell the place, take the loss, pay it off (because no loans, now) and move on. That actually feels pretty good to say that. Hmm, these are just initial thoughts. More to come.
Tuesday, January 13, 2009
conundrums
In the midst of the recent push to make medicine more 'effective', HMOs have begun keeping statistics about how well some doctors can meet certain benchmark for patients. Otherwise known as "P for P" or "pay for performance". The thought is that the better numbers doctors achieve for their patients, the better the doctor, the more attractive the doctor, the more healthy the patient, the more the doctor attracts business and money...everyone wins. How about a robot doctor who threatens to choke the patient unless they comply with treatment so that numbers can be met? After all, it's for the patient's well-being, right? How dare they keep me from my numbers and good standing in the company!
A complete absurd situation, to be sure, however, it is at least one possible scenario in this strange, counter-intuitive, bizarre business of medicine many of us doctors find ourselves in now or soon.
Many of my patients have expressed the desire for doctors that listen and take time. If the patient is rushed, they may not express themselves in a way that is understood. I think most people can understand this problem. Who hasn't wished a boss or parent had just spent the time in listening? True, doctors are not parents or bosses. But patients want relationships, not just a robot dispensing advice or pills. Many patients would just as soon slouch on their health if the doctor is cold or has a poor bedside manner. True, there are some people who are extremely motivated to care for their own health. To them, the doctor is a convenient and usable means to an end. A rah-rah guy who gives them kudos for another goal met.
However, many patients are not this way. Some need a fair amount of convincing.
Many respond to emotional stimuli. "I like this guy. He listens. I trust him. Therefore, I will do what he asks." It's not even about whether it's 'good' for him!
By going to a pay-for-performance, the golden 15 minutes that most of us in primary care have with a patient becomes even more crowded. A man who is losing his wife to cancer, just lost a job and can't sleep could care less if his blood pressure is 160/95 instead of 120/80. But screw him! Get him to blood pressure goal, bankrupt him and tell him I hope his wife gets better! This man will remember if I listened to him and helped him ease his emotional burden if even for a few minutes. When (or if in this case) things get better, he may return ready to listen or refer others to me.
If however, the goal is purely get the patient's numbers to goal. Then it doesn't pay to listen to talk to the patient. It is more convenient to get the motivated patients and ignore the unmotivated until they leave your office.
You want to try and effect change in a person's life? (Change in behavior not motivation, only the Holy Spirit can truly change the reason for behavior into the right reason: thanksgiving to Christ for what He has done...does this mean working on one's own health? Maybe: a conversation for another time.) Then establish a good relationship. That means a whole lot more than, "You need to get your blood pressure down. Here take this and don't eat this. Exercise. See you in 3 months."
In effect, by trying to care for the patient, we will end up caring nothing for them. Just numbers. Just money. And just like anything else in the business world, we will have given up any sense of humanity for the veil of helping another just along as they help me.
So screw the poor in motivation, the poor in spirit, the poor in health, the monetarily poor and bring in P for P. After all, isn't this good for the patient? I want to care for my patients by not caring for them at all. It would certainly be easier.
A complete absurd situation, to be sure, however, it is at least one possible scenario in this strange, counter-intuitive, bizarre business of medicine many of us doctors find ourselves in now or soon.
Many of my patients have expressed the desire for doctors that listen and take time. If the patient is rushed, they may not express themselves in a way that is understood. I think most people can understand this problem. Who hasn't wished a boss or parent had just spent the time in listening? True, doctors are not parents or bosses. But patients want relationships, not just a robot dispensing advice or pills. Many patients would just as soon slouch on their health if the doctor is cold or has a poor bedside manner. True, there are some people who are extremely motivated to care for their own health. To them, the doctor is a convenient and usable means to an end. A rah-rah guy who gives them kudos for another goal met.
However, many patients are not this way. Some need a fair amount of convincing.
Many respond to emotional stimuli. "I like this guy. He listens. I trust him. Therefore, I will do what he asks." It's not even about whether it's 'good' for him!
By going to a pay-for-performance, the golden 15 minutes that most of us in primary care have with a patient becomes even more crowded. A man who is losing his wife to cancer, just lost a job and can't sleep could care less if his blood pressure is 160/95 instead of 120/80. But screw him! Get him to blood pressure goal, bankrupt him and tell him I hope his wife gets better! This man will remember if I listened to him and helped him ease his emotional burden if even for a few minutes. When (or if in this case) things get better, he may return ready to listen or refer others to me.
If however, the goal is purely get the patient's numbers to goal. Then it doesn't pay to listen to talk to the patient. It is more convenient to get the motivated patients and ignore the unmotivated until they leave your office.
You want to try and effect change in a person's life? (Change in behavior not motivation, only the Holy Spirit can truly change the reason for behavior into the right reason: thanksgiving to Christ for what He has done...does this mean working on one's own health? Maybe: a conversation for another time.) Then establish a good relationship. That means a whole lot more than, "You need to get your blood pressure down. Here take this and don't eat this. Exercise. See you in 3 months."
In effect, by trying to care for the patient, we will end up caring nothing for them. Just numbers. Just money. And just like anything else in the business world, we will have given up any sense of humanity for the veil of helping another just along as they help me.
So screw the poor in motivation, the poor in spirit, the poor in health, the monetarily poor and bring in P for P. After all, isn't this good for the patient? I want to care for my patients by not caring for them at all. It would certainly be easier.
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