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Tuesday, September 28, 2010

Deliverables and Actualities in Medical Care

   The greatest mistake in the treatment of diseases is that there are physicians for the body and physicians for the soul, although the two cannot be separated.  ~Plato

   This is a combination of an exercise that relates to how to be a good physician and an empathetic practitioner. In the course of teaching today and linking with friends, the above quote came  to mind. I have alluded many times that there is a dis-ease to the disease and that in approach of any individual that this must be taken with a bio-psycho-social bent. That is that the biological, psychological and social components of the patient be taken into account. That includes us for we must all be patients at some times. 

  Taxonomy and what we stand for and believe in is likely the most critical factor in the decision making that goes into the care of the patient. No matter how excellent an individual clinician is, patients can result in negative outcomes if the therapeutic alliance and relationship is marred my mis-taxonomy, arrogance, lack of empathy and egocentrism of the clinician. The days of the paternalistic clinician are gone, but we are evolving into an evidence-informed versus an evidence-based medicine model. Asking the client or patient what they want from the intervention is critical.

  Anyone who has been a student or resident of mine know that for the first night on rotation, they are to sit under a tree and do nothing for an hour. Spare the readings and the like, for to be in tune withourself is to be in tune with the patient. And sadly, one instrument out of tune will affect the delivery of the orchestra to the listening ear. We owe the patients that care and attention. To step away from the petty politics, car payments and entitlement and listen carefully to the person in front of us is essential to enact good care.

  Big challenge, but is it feasible? Yes, if you want it to be. But first you must be at tune with yourself and be kind to yourself. I had the extreme luxury today of teaching social work students and gaining and enhancing a new level of awareness, that is that I get far more than I receive. Makes me a lucky person. My medical students are the same way. The underlying root issue here is the care, empathy and professionalism. Want to impress me? Dont work 24/7 365 days a year, but take time out and laugh and be a kid. Then you will be better for the patients. I thought the social work students would scoff at the toys in my desk, but they understood... its part medicine and part psychology and mainly being good to ourselves to be able to be good to others. My medical students get it in the fact they rose to the challenge when the curveball came their way this week, and they rose to the challenge in a way that made me proud to serve them and their education. But again, medical students and social work students.... I learn more from you than I give I believe.

  Not just medicine, but the day to day discourse of our lives and in interacting with others. Earn trust and respect and treat that other person in front of you with the degree of care and understanding that you would want yourself. Learn from others and your patients.

  Most of all, be yourselves, often.


--- Joel Lamoure September 2010 


6:32 pm edt 

Sunday, September 12, 2010

Architecture and Glass Houses

   I deliberately didn't want to post on 9/11 as there would have been a whole different perspective to the blog. It would have been a blog and discussion about peace, patience, tolerance, understanding and root cause analysis. That to understand the demons in others we seriously need to look at the demons in us. Foe we all have them. There is not one person that is a saint, that is without bad deeds. Does not the wisdom and proverb go that "He who is without sin may cast the first stone?". 

  That is the challenge and the problem. Whether it be in politics at whatever level (in my case hospital and University predominate), there are so many individuals that feel that what they do is above reproach and as such they can throw the first stone and trample over others rights?  But it just doesnt happen where I am, but as much where you are my Friends and in homes, schools, churches (Yes, churches), media , governments etc etc etc. Stone throwing is pandemic sadly and escalates the battles as we tend to take those same stones, embellish them and make them bigger with our own FTW brand and "Righteous" moral indignant spin on the hits we have taken and shoot back. 

  You can join the war and battle that is raging in the psychological realm right now, or chose to step back and not play that game. When a rock comes your way, dont throw it to hurt someone else. Use it to create an island and build your house on that island with the rocks. On that island, grow oranges and flowers and when you are hurt, give the person that hurt you flowers or fruit in return. Take the high ground my friend and build your house there. Even on a dreary day, colour it with bright paint and rich warmth.

  Again, you have the choice my friends. Its always about you and a wise person in passing said this week in their plans to "reduce the chaos" as their immediate plan. I think I will take their advice too. Be yourself, often.


---- Joel Lamoure September 2010 

5:54 am edt 

Saturday, September 4, 2010

Before starting a journey of 1000 steps... PLAN!

   Adventures in Wonderland this week. This overall has been an incredible week on so many levels as I have seen some friends break their shackles and advance beyond their previous scope of functioning and practice and functioning. In my mind, its made even MORE magnificent because they have faced incredible odds, medical conditions, stupid people and more.

  This weeks blog was going to be labelled "Hurt by the ones that hurt " for a variety of reasons but I actually decided to tone that one down. Reason for that is it was intended to be a sweeping commentary of lack of taxonomy and people get hurt that are already in a vulnerable position position and then get bit a minimum of 72% of the time. That taxonomy fails for a variety of reasons and there ends up being numerous casualties. Sort of like going into the fire to save a loved one or animal and then getting overcome by the smoke and being another casualty. Fail. Its critical to go in and serve and protect after assessing the situation, getting proper protection and then going ahead. Given my airline analogy last week, when the notice starts the flight about those oxygen masks that come down (thank goodness I havent had that happen yet), then protect yourself before helping the young, infirm and vulnerable around you. If you dont, you lose and they lose.  Let me mull on this and may become the concepts and target of blog posts yet to come.

  If you want to quit reading now, here is the synopsis. To move ahead you need a destination and a plan. 

  Summary is you cant help others unless you know yourself, your belief systems and have a clear direction to move ahead. I constantly challenge my residents and medical students as to what and where do they want to be 5 years out? An endpoint. Be prepared to make changes in the path along the way at point of need and carpe diem. Want to go the journey of a thousand steps that begins with a single step? Make sure you are aimed in the direction you want to go!! 1000 random forward and backwards steps all over the place statistically will after circles or aimless wandering around and doing twists and turns put you behind 50% of the time. Fail. Also, the journey of 1000 steps may have a big spiky wall in the way... plan to create a work around or take a ladder! Know the approach, the challenges and the goal and be versatile. Life is whats happening to you while you are waiting for the ladder. Pull a Macgyver and built one.. aint pretty but it works! The mind is a creative thing and quite inspiring, or can turn on you and torch the ladder you are trying to build.

  These people this week have faced incredible odds and created a walk around. Left the whining, bitching, moaning, whining, puling behind and soldiered on. Its not about health, but a belief system. Their eyes are on the prize just 999 steps away. Keep steady and consistently apply your beliefs and principles for they are invaluable. Congratulations to you in the face of adversary. The past is equidistantly dead and courage is a tool when we use current challenges to ours and others' advantage. You folks know how to do it and you are right.

   For everyone... Dont think you can do it? You are right. If you DO do it, its an accident. And if you dont succeed, dont take it out on me, loved ones, friends, colleagues, end users of your services etc etc or expect poor planning on your part to constitute an emergency on mine.

   Keep the faith and be yourself, often.


--- Joel Lamoure September 2010 


7:11 pm edt 

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