Simplifying Medicine
December 12, 2014 by Selena Horner
The state of health care is reaching a tipping point. We’ve known there is going to be a physician shortage for a few years. It’s already happening. Have you tried to see a physician lately? Unless you have a crystal ball and create a future appointment to meet your projected acute need, it is doubtful you’ll be seeing your primary care physician when you need your primary care physician. What does this mean? It means that consumer behaviors are changing. Consumers are accepting services from professionals other than their primary care physician. It also means they are cognitively learning what many of us women learned during our child birthing years: get familiar with all the OB/GYNs because when you are in labor the OB/GYN on call is the one that will deliver your child. Women in my generation have been trained to accept being bounced around between OB/GYN (it was out of our control so we had to accept nonfamiliarity).
I’m treating a retired physician who used to be a frequent referral to me. We’ve had interesting discussions about health care and how it is changing. She brought in an interesting article, probably because I apologize when I don’t have an answer. (Often times, there isn’t an answer.) I think the other reason for the article was the simple fact that I’ve had a dream in my head for way too many years and I finally implemented it into my care. She knows, just as well as I do, that I’m making things up as I go. She also knows, just as well as I do, that I have a solid rationale for each aspect I’m incorporating into her treatment plan. She also knows that all I’ve got to offer are all my senses and my brain.  For the first time, I can use most all my senses: vision, hearing, feeling to go into a deeper level of verbal cues and manual cues because of the vision I finally implemented as a tool in my clinic. Last week I mentioned that it might be nice to have force platforms and video cameras incorporated into my dream to quantify and provide data for analysis to assist with improving movement patterns. Hence, the reason for the “A Piece of  My Mind” she shared from JAMA.
I no longer feel the need to apologize for the simplicity of my care. I may not have all the bells and whistles and technology. I don’t make 75+% of my decisions on the results of diagnostic tests. I don’t know the patient’s body better than the patient does. By bringing in and sharing that article with me, she gave me the highest gift of praise. This gift of praise isn’t for me alone to enjoy – it reaches to all physical therapists. The simplicity of your care – using your senses and your brain – is enough to make an impact.
The article highlights the misuse of technology. “Verghese writes that when physicians evaluate patients today, they chiefly examine the electronic medical record and the laboratory and imaging results, instead of the patient herself. Physicians follow abstractions  – maps – rather than the patient – the territory.”
The Piece of My Mind had a call to action: the Stanford 25 as a way to return the focus of care back to the patient with an examination process.
The author mentions humility…. not being an authoritative interpreter of the patient… and focusing on creating a therapeutic alliance.
What does this mean for physical therapists? It means times are changing. We can step up and assist with the physician shortage. Consumers, right now, are going where they can get care and realize the ability to see the same primary care provider for all needs is a thing of the past. It means the medical community knows and realizes that a thorough physical examination is more important than depending on high cost laboratory and imaging results. The simplicity of our approach now has more value than it ever has. Simplicity is acceptable.
So, for all of you out there who sometimes feel that the simplicity of your care may not be enough. Think again… I share with you the gift of praise I received. Merry Christmas! May you continue to make an impact in the lives of others via the simplicity of your care.
Until next time,
~Selena