The Veritas Blog

Reflecting on Physician Suicide? For the Health of it™ Vol 4, No. 1

Posted by on Jan 27, 2016 in Broken Health Care, Building Better Health & Health Care, community, Defining problems in the Business of Medicine, Human, Humane, Mission: Healing | 0 comments

For the Health of it™ Vol 3, No. 11 Blaming What is “Medicine” for Physician Suicide? A few days ago I sent this email to a group of folks who are trying to create alternatives to what is The (broken) Business of Medicine.  One of the leaders of the group sent this link (Warning: if you click on the link, you will see plenty of advertising) https://nv223.infusionsoft.com/app/linkClick/10444/23dc518a1e22e88c/367748/9e9fb72930f43b1a and asked for thoughts. This is what I said (below in quotes).   What are your thoughts? Thanks for your help. MFM “She might have more credibility if she got rid of the advertising. Talked with her a couple weeks ago.  Nice chat. Invited her to join Veritas Health Care @ www.VeritasHC.org. No response. Not a fan of self aggrandizement and hypocrisy. I am a fan of >conversation, >cooperation, >cooperative action, >listening, >hearing, >mutual support, >mutual education, >leading by example, >servant leadership, >transparency, >reciprocity, >giving credit where credit is due, >integrity, >mission integrity, >prodding each other, >to “Do the right thing, always”, >to teach and learn from each other, >Hippocrates and the >Hippocratic Oath. THE HIPPOCRATIC OATH IS OUR GUIDE We don’t need to reinvent the wheel, we just need to use it … The OATH THAT IS. The Hippocratic Oath, which has guided the >Medical Profession and the >Art of Medicine for centuries, to “First do no harm” and  “Do good”,  has been >systematically ignored by >many physicians for >money >profit >personal gain during the last several decades. The Business of Medicine has >hijacked >The Patient<>Physician Relationship, because The Medical Profession sold out. Had the Medical Profession NOT sold out >> FOR MONEY to the >> FOR PROFIT OVER PEOPLE << Business of Medicine, we would not be having this conversation. But here we are … Physicians, People, Patients all wounded by >the Business of Medicine. The >Profession and >Art of Medicine must operate outside of >Constraints imposed by business and government. That is our Physician obligation by oath. That is the mission I signed up for. I welcome any and all Non Physicians, to join us on this mission. THE TASK? Do you care about health and health care? Join with us. Take the oath and take back the medical profession and restore the patient-physician relationship. Care first.  Money later. MFM Michael F. Mascia, MD, MPH...

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For the Health of it™ Vol 3, No. 10: Medical Mystery #1

Posted by on Dec 11, 2015 in Medical Mystery Series, MM#1 | 1 comment

Medical Mystery # 1:  MM#1 is a 31 Year Old Man with Multiple Embolic Events of Undetermined Cause Since February 2010 INTRODUCTION TO THE VHC MEDICAL MYSTERY SERIES Welcome to Medical Mysteries.  What is your diagnosis and treatment plan? This is the first in our series of case discussions that are designed to help folks work around the barriers they have found in their quest for best care and treatment of a specific life, limb, or organ threatening medical problem. Please help us find the definitive diagnosis and treatment plan for MM#1, our First Medical Mystery.  We have been struggling to help him get a definitive diagnosis and therapeutic plan since his first stroke in February 2010.  Chief Complaint: I need a definitive diagnosis and therapeutic plan to help me manage the recurrent embolic events I have been having since February 3, 2010 31 year old, married (no children) white male. With multiple embolic events of undetermined cause Medical Mystery #1: Narrative summary Present Illness:  MM#1 was in his usual stable and functional state of health until 2/3/2010, when he awakened with severe headache and slurring of speech. Since that date he has demonstrated several, embolic strokes and an MI. History of random, uncontrolled embolic events that has produced 4 ischemic strokes, 1 myocardial infarction and is strongly suspected in significant renal scarring resulting in Stage 3 renal failure.  To date no definitive cause for these clots has been determined and no certainty current treatment will control future events. Ischemic cerebral events occurred on 2/3/10; 7/12/10; 7/28/10 (these three events are thought the same clot progressed further in the artery, rather than 3 separate embolic events).  4th stroke 10/14/13.  8/31/15 MI (blood clot in main artery) treated with interventional cardiac catheterization and stent placement. Multiple tests to determine source of clots have all been negative (bubble studies, trans esophageal echo cardiograms (TEE), Cardiac MRI/A).  Hypercoagulable studies completed several times.  Only findings of significance are; Factor VIII was elevated (range: 61-158%…my result 171).  In addition the VWF activity (Ristocetin Cofactor) was elevated (range: 40-220%…my result 320), MM #1 is heterozygous for the MTHFR A1298C Mutation and negative (normal) for the C677T mutation in the MTHFR gene. Thromboelastogram? Serum Protein Electrophoresis? SIGNIFICANT PAST MEDICAL HISTORY: Diagnosed with Leber’s congenital amaurosis (retinal dystrophy) at 4 months of age at University of Chicago, received visual services in several states (WI, Mo, IL, NM) but no remedial treatment.  Wears glasses for magnification, is a Braille reader. No recorded history of blindness in either parent or in their extended families. Medically unremarkable adolescence and early adulthood.  Attended college and currently works for city police department in the Southwest. Family history: MM#1’s parents are both alive with no remarkable medical histories.  He has two siblings…older brother by 2 years with normal vision and health.  Younger brother also had visual retinal dystrophy not as severe, in addition younger brother contracted acute lymphocytic leukemia and died 06/2012 at 15 years of age.  No history of leukemia or other significant cancers in family prior to this. Please send your questions, comments, suggestions, suggested differential diagnosis, Recommended Diagnosis and Treatment plans to mfmascia@VeritasHC.org or post comments on this blog for further discussion and recommendations.  We prefer that you keep your name OFF the blog comments and submit details by email...

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For the Health of it™ Vol 3. No. 9 Reflections on a Visit to Massachusetts General Hospital

Posted by on Nov 26, 2015 in B2 = B Squared = Best Care™©, Faith, Trust, Uncategorized | 0 comments

For the Health of it™ Vol 3. No. 9 Reflections on a visit to Massachusetts General Hospital: The Aura of Peace and Calm & the Implicit Patient-Physician Contract to “Do the Right Thing, Always.” Early November 2015 10:50 AM, Blake 14 Waiting Room Siting alone, it had been just a few minutes since the message came from the dad that his wife will go in for a Cesarean Section.  While staring into space and looking down upon the City of Boston from the waiting room, an aura of peace and calm came over me.  “These are hallowed halls” I think, “born of a noble profession and tradition” to “First do no harm” and “Do good”.  It boils down to this: “Do the right thing, always.”  That’s my expectation of MGH and the obligation that is carried by those of us who have taken “the oath”.  After all, I have known and worked with people from this place since my college days.  “Where have we gone wrong?” I wonder.  “How is it that The Business of Medicine has gone so far off track?” I think, “The best of the Art of Medicine can be delivered to those in need through MGH and other places like this that I have worked in.” and “You have been a part of this for over 4o years, now” I say to myself, while breathing a sigh of relief “she is in good hands”.  I know how it works … from the inside and the outside and from the casualties I have seen over the years … I know exactly how it works and sometimes fails to work. And yet, despite my worry and fear of the bad things that can happen … even in the best of hands, I too feel the aura of peace and calm that comes from the faith and trust in the implicit contract between People-Patient<>Physician-Provider to “Do the right thing, always”.  And, there is no doubt that this aura … these feelings come from bonding … the faith and trust I put into the hands of the folks at MGH.  This is the same faith and trust I bring to the critically ill patients and their families I care for and treat.  They trust I will “First do no harm”, “Do Good.” and “Do the right thing always.” Soon, another text message arrives to drive me out of my thoughts.  This one is complete with a photo of the new baby in Dad’s arms next to smiling mom … my daughter … this is personal.  I can tell dad is beaming under the misfit surgical mask.  “How is she?” “Good” he texts, but it is about 40 minutes before he comes out to greet me and bring me in to see with my own eyes.  I see all is well.  Mother is well.  The baby is exceptionally pretty.  Not just in my eyes. “You have confidence in this place” I say.  He nods. “Why is that?” I ask? ‘They have a deep bench that’s just as good as the first team.” He answered.  “That’s why you come here, right?” I ask.  He nods again.  That’s what it takes to deliver best care and treatment every minute of every day.  Even in the best of hands, things don’t always go...

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For the Health Of It™©, Volume 3 #8 Battery Explosion? Reliability, Self Reliance and Reliable Partners in Health & Health Care

Posted by on Aug 11, 2015 in B2 = B Squared = Best Care™©, Best Practices, Building Best Practices, Building Better Health & Health Care, Reliable Partners | 0 comments

For the Health of it™ Vol 3. No. 8 On the Need for “Rational” Self-reliance and Reliable Partners to Get Best Health & Health Care Michael F. Mascia, MD, MPH with Thanks to *Lanie Adamson for editorial assistance Ten years ago, Katrina got my full attention. Katrina?  Battery Explosion?  Huh?  OK, I hear you screaming, “What does that have to do with the need for reliability, self-reliance and reliable partners in Health and Health Care?  What does a battery explosion have to do with Health and Health Care?”  Let me explain how the battery explosion in the bank of deep cycle batteries of my solar power system triggered this blog.  And, let me explain why “rational” self-reliance and reliable partners are needed for you to Take The Best Care™ of yourself and those in your charge. Autonomy vs “Rational” Self-reliance plus Reliable Partners? Are we autonomous?  Is it possible? Not really.  Autonomy is “the state of existing or acting separately from others.”[1] So, by definition, the autonomous state is not really possible.  Humankind is destined for something other than autonomy, because each and every human, from conception to death, relies on and interacts with people, other animals and all things in his or her environment.  That environment, of course, includes other human beings, and those human beings rely on and interact with more human beings, and so on around the globe. The simple act of living and breathing means interacting with other humans, other animals and all other things living and non living on the planet and larger universe.  Autonomy is an illusion, or, as other gifted authors have noted, “No Man is an Island”[2,3].  I prefer to think in terms of optimal, sensible or “rational self-reliance”.  What is that? What is “Rational Self-reliance?” Action That Counts Self-reliance is “reliance on one’s own efforts and abilities.”[4] And “rational self-reliance” implies reasonable limits and the inevitable need for and rational use of help from others.  The term “rational self-reliance” is useful to describe the ability to survive without the help of others when safe, possible, sensible, and serves the best interest of the individual and those in his or her charge.  Each responsible adult must determine safe limits and safe practices, and must know how and when to turn to others for help, when the needs arise.  That’s right, for able bodied adults, “rational self-reliance” includes and requires the ability to survive, at least for a limited time, without the help of others, and to come to the aid of others with jeopardy to none. In a nutshell, the idea is this: responsible, able bodied adults can and should learn to take the best care of themselves and those in their charge.  This idea implies and assumes that each and every capable adult should be learning, training and teaching how to deliver best self-care and learning how to get best care and treatment.  That requires cooperation, learning, training with others and the ability to get proper help, if and when you need it, and to get the best products and services if and when necessary. Therefore, we see the need for reliable partners, if we expect our actions to have the best results = the best care and treatment with the best possible outcome. Limits of Self-reliance: One Extreme Example...

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For the Health Of It™©, Volume 3 #7 Ticks, Lyme & Other Diseases

Posted by on Apr 27, 2015 in lyme disease, red meat allergy, Tick season again | 0 comments

Ticks, Lyme and Other Diseases Yes, it is tick season again.  How do I know?  I plucked one of the ugly critters off me three days ago.  Since it was an adult female deer tick and I had no idea how long it was stuck on me, I took prophylactic doxycycline, 200 Mg. Single dose to prevent Lyme Disease.  The ring around the bite was a bit different and larger than a “normal” bite as well. Photos of “the tick” and “the bite”.  Tick noted and removed on or about April 22, 2015.  Bite photo late on the day of removal. CDC Website link on Lyme Disease is below http://www.cdc.gov/lyme/index.html Lyme Disease Prophylaxis after the tick bite “For prevention of Lyme disease after a recognized tick bite, routine use of antimicrobial prophylaxis or serologic testing is not recommended (E-III). A single dose of doxycycline may be offered to adult patients (200 mg dose) and to children 8 years of age (4 mg/kg up to a maximum dose of 200 mg) (B- I) when all of the following circumstances exist: (a) the attached tick can be reliably identified as an adult or nymphal I. scapularis tick that is estimated to have been attached for 36 h on the basis of the degree of engorgement of the tick with blood or of certainty about the time of exposure to the tick; (b) prophylaxis can be started within 72 h of the time that the tick was removed; (c) ecologic information indicates that the local rate of infection of these ticks withB. burgdorferi is 20%; and (d) doxycycline treatment is not contraindicated. The timelimit of 72 h is suggested because of the absence of data on the efficacy of chemoprophylaxis for tick bites following tick removal after longer time intervals. Infection of 20% of ticks with B. burgdorferi generally occurs in parts of New England, in parts of the mid-Atlantic States, and in parts of Minnesota and Wisconsin, but not in most other locations in the United States.” I was unable to find any literature on antibiotic prophylaxis of Lyme Disease after a bite for children below 8 years of age.  Please send the link, if you know of any evidence in this regard. This is the link to the complete article is below http://www.idsociety.org/uploadedfiles/idsa/guidelines-patient_care/pdf_library/lyme%20disease.pdf This is the link to the Tick Blog posted last year http://veritashc.org/take-the-best-care-of-yourself/health-volume-2-15-tick-season/ New: Useful Web Site Recommendation for Guidance on Tick Management and Control http://www.tickencounter.org/ On Ticks and Tick Transmitted Diseases http://www.cdc.gov/ticks/diseases/index.html http://www.cdc.gov/ticks/symptoms.html On Tick Associated Red Meat Allergy http://uvamagazine.org/articles/ticked_off_carnivores/ Please contact me mfmascia@VeritasHC.org, or comment on this blog, with criticism, corrections, recommendations, or any other feedback. Thanks for your help. Dr....

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For the Health Of It™©, Volume 3 #6 Preventable Hospital Deaths: What are we waiting for?

Posted by on Apr 25, 2015 in Best Practices, Broken Health Care, Building Best Practices, Preventable Death | Comments Off on For the Health Of It™©, Volume 3 #6 Preventable Hospital Deaths: What are we waiting for?

Preventable Hospital Deaths: Why is this accepted and what can we do about it?  A Call for Action Last night I had a chat about preventable hospital deaths and preventable deaths in general.  The conversation was triggered by a phone call from one of our VHC members and his knowledge of a recent preventable death associated with a treatment error.  We were wondering why there is no uproar about preventable deaths in general and why adverse outcomes in hospitals; specifically preventable deaths and injuries  seem to go … unnoticed.  The silence surrounding this issue is hard for me to comprehend?  Is it denial?  Is it “learned hopelessness”?  Is it part of “unconditional surrender” to The Business of Medicine?  Do people really believe they have no choice?  What is this inaction about?  Are people saying, “That can’t happen to me” in silence?   What can we do about it? The words outrageous and atrocity come to my mind when considering the fact that the most vulnerable of the vulnerable are dying at an alarming rate  as a result of substandard care delivered in hospitals.  The estimated and reported preventable death rates in the US hospitals are variable but the conservative estimates range around 100,000 preventable hospital deaths per year (may be much higher — between 210,000 and 440,000 patients each year). http://www.npr.org/blogs/health/2013/09/20/224507654/how-many-die-from-medical-mistakes-in-u-s-hospitals  What can we do to fix it?  Put adverse outcomes and money flow on display.  Huh?  Yes, if we put the numbers up there and encourage people to walk away from the “bad actors” and elective surgeries the problem will be fixed rapidly. As I recall, NY State began displaying outcomes for cardiac surgery while I was at SUNY in Syracuse.  That was a brilliant move and it triggered quite a bit of commotion and motion toward better care.  Patients took themselves to the hospitals with better outcomes and hospitals made an effort to improve their outcomes.  Sure, there were games played with the numbers and screams claiming “my patients are sicker than your patients” … that points to another problem. Now, we have the technology to expand that New York effort.  We need larger real time displays that cover outcomes from all the nations hospitals.  Money flow (with names) and outcomes should be on real time display.   I call it the “Greedometer”. How about a campaign to follow the flow of money and the outcomes for every hospital in the nation?  Zero Profit & Zero Bonus UNTIL Zero Preventable Deaths and Zero Preventable Injuries.  Patients can be encouraged to hold off on any and all elective surgery unless or until the problem is resolved in their hospital.  That get’s administrative attention, because $$$ elective “bread and butter” surgery is “the thing” that funds the profit and bonus pot. Hospitals can be put on color coded state and national maps (global for that matter) … and updated on a regular basis … preferably on a daily basis … all shades of RED (stop) YELLOW (caution) GREEN (go) When 84 people die and 157 people are seriously injured due to a faulty ignition switch, GM gets appropriately hammered, it is all over the press and people can choose to walk away from GM vehicles, or not, depending upon their personal assessment of the situation. “GM had argued it was...

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For the Health Of It™©, Volume 3 #5 Unconditional Love And Direct Feedback: What’s The Connection?

Posted by on Feb 27, 2015 in Direct, Feedback, Guest Essay, Guest Post, Irv Rubin, Love, Uncategorized, Unconditional | 0 comments

By: Irv Rubin, Ph.D If your first reaction to seeing that title included thoughts along the line—“You’ve gotta be kidding!” “There must be a typo.” “This I have to see!”— you’d not be alone. How can it be that a human behavior— direct feedback—considered by most to be “hellish” has anything to do with a desire—unconditional love—most human beings see as an unreachable “nirvana?” The fact, as I hope to explain, is that not only does face-to-face feedback have ‘something’ to do with unconditional love it has ‘everything’ to do with it. Simply put, unconditional love is not an end-state but rather a reward we have the opportunity to experience along a journey we call life. Feedback is the beacon that will keep us on that path…if we so choose.   “Hellish”— A Pretty Strong Word! [See: Rubin, I. What’s In A Word?] Associating the word “hellish” with the word feedback may be a bit strong…or not. Try thinking of another familiar regularly spoken word [that isn’t blasphmous] that can easily trigger reactions like the following. Sweaty palms. Knots in the pit of the stomach. Anxious increases in heart rate. Mild headaches. Such reactions would be considered ludicrous in response to the mere mention of words like food, water, air, and sunshine. After all, without them, life as we know it would be full of hardship and suffering. Ultimately life itself would cease. In other words, they are essential to our quality of life, to our very survival. As is feedback, which regularly triggers reactions just like that. Still not sold? Imagine it is Friday afternoon ten minutes before heading home from work for the weekend. An e-mail from your manager pops up on your screen with a Red ! in the subject heading. The message simply reads: “I need to see you Monday morning as soon as you come in. I have some feedback for you.” Have a fun, relaxing, stress-free weekend being fully present with your family! A far cry from Webster’s two-part definition of what feedback is ‘supposed to mean.’ The first part touches upon such things as “to satisfy; minister to; gratify; supply with nourishment.” The second part touches upon such things as “to support or strengthen by encouragement.”   Nirvana—An “Idealistically” Strong Word? Perspectives on ‘unconditional love’ are abundant, highly diverse, and widely available. For a smattering of just the plethora of perspectives that goes back to Bible [separate from just Goggling “unconditional love”] try Goggling http://www.rapidnet.com/~jbeard/bdm/Introduction/uncondit.htm So the one I’d like to offer is clearly a matter of ‘biased choice.’        Mine is spiritually-based not religiously based. It is a page from Mark Nepo’s The Book of Awakening. “Unconditional love is not so much about how we receive and endure each other as it is about the deep vow to never, under any conditions, stop bringing the flawed truth of who we are to each other. Much is said about unconditional love today, and I fear that it has been misconstrued as an extreme form of ‘turning the other cheek,’ which to anyone who has been abused is not good advice. However, this exaggerated passivity is quite different from the unimpeded flow of love that carries who we are. In truth, unconditional love does not require a passive acceptance of whatever happens in the...

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For the Health Of It™©, Volume 3 #4 Timeless Leadership Challenges: The Lion King

Posted by on Feb 27, 2015 in community, Faith, Guest Essay, Guest Post, Human, Humane, Mulling it over, Profession, Uncategorized, Values | 0 comments

by Irv Rubin, Ph.D A Disclaimer          I’d seen The Lion King before. I saw it quite differently recently. As best as I can tell, several current contextual factors contributed to the difference. My personal journey passed the ¾ century mark. Warren Bennis, a friend, colleague, mentor, and contemporary passed away. But it was Angie Keister’s phone interview of me for an article on ‘values in OD’ that stirred the kind of looking way back out-loud reminiscing that left me mulling; “What’s it all about Alfie?” Organizing a few of these Lion King-triggered musings from a few scenes is useful to me. I hope they prove useful to others and our beloved profession, as a reminder of what our profession “was supposed to be ‘ all about’.”   The Scar[s] To Prove It          As the Lion King, Mufasa made every effort to treat his younger brother Scar with respect and dignity. These efforts proved to be insufficient to mitigate Scar’s ego-driven jealousy of Mafusa’s young son Simba becoming the heir to the throne. A throne Scar so feverishly sought and believed he was entitled to have. A jealousy that fed Scar’s hubris and led to his killing Mafusa. An ego that developed and manipulated the plan to have Simba believe it was he who had caused his father’s death and in his ‘shame,’ disappear from the scene. Feigning humility and gratitude, Scar ‘accedes’ to assume the throne, and proceeds to exhibit exactly the kind of leadership principles our founding fathers and mothers predicted…and our profession has endeavored to mitigate. One scene will suffice. When Nala—who was to become Simba’s betrothed when he became the Lion King—rejects and denies one of Scar’s “less-than-appropriate” advances, when he doesn’t get what he wants/what he believes he is entitled to have, he screams out: “I own you. I own everything!!” Self-will runs riot when the ego releases our hubris. Examples of ”pulling rank” are sadly numerous. Be it a parent who shouts at a spouse or child—“Because I said so, that’s why!” Be it a CEO or senior executive or supervisor whose facial expressions clearly warn— “That kind of behavior could become ‘career-limiting,’ a resume-generating event.” Be it a manager, a President, a Priest justifying “less-than-appropriate” advances. Behaviors sadly familiar to all of us. But my musing led me to a few deeper leadership challenges. What is it that we do believe/profess about what exactly it is that a “company owns?” Surely not as a CW classic would have us believe; “I sold my soul to the company store.” But if that is a true reflection of what we believe/profess then I need to ask, myself, the same question James Haskett posed; “Why isn’t servant leadership more prevalent?” Three corollaries flow from that question; (1) What role do we believe/profess that the notion of “soul” plays in the world of business? (2) Why is the “L” word—love— so verboten around Board Room tables? (3) Why do we not put more faith in the insights from past ‘elders’ like Max DePree when, in Leadership Is An Art, he emphasized the “importance of love, elegance, caring, and inclusivity as central elements of management?” My ‘answer to myself’ came in the form of an interaction I was honored to have had with Doug McGregor, a...

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For the Health Of It™©, Volume 3 #3: Physicians & Nurses, Do Your Job?

Posted by on Feb 18, 2015 in Building Best Practices, Building Better Health & Health Care, StepWisely®™© Tool Kit, Take The Best Care™© of Yourself, TopTenTargets™© = T3™© | 0 comments

Physicians and Nurses: Do Your Job? A Few Simple Steps: Promote motion toward basics & optimizing patient engagement, care and treatment. For all health and health care facilities, imagine this: Yes, Listen to the patient. See the impact of your decisions on the front lines. Imagine if … administrators stopped administrating & bean-counters stopped counting beans for 20% of their work time and that time had to be spent in patient care on the front lines of care and treatment … 1.  they could be trained to care 2.  go to the front lines of care and 3.  act as helpers, scribes and clerks for 4.  physicians and 5.  nurses who could then spend the extra time (not interacting with technology) doing their jobs including 6.  listening to patients (looking at the patient, not the computer) 7.  examining patients 8.  having conversations with patients and 9.  coming to acceptable care and treatment plans and terms WITH patients and 10. addressing larger patient concerns and precipitating factors 11. following up with patients 12. Working with patients on health and wellness stuff to keep them going on their own and out of the hospital. Simple things that can be thunk can be done … and patients can report on adherence. Have a sweet day and take the best care of yourself and those in your charge. Thanks for listening, Dr. Mike PS. I love conversations, comments, discussions and...

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For the Health Of It™©, Volume 3 #2 QIPI and B2 Building Best Practices: Bridgton, Maine 1975 -1985

Posted by on Jan 11, 2015 in B2 = B Squared = Best Care™©, Best Practices, Building Best Practices, Building Better Health & Health Care, Patients are Stakeholders and Providers, Quality & Perforance Improvement, StepWisely®™© Tool Kit, Take The Best Care™© of Yourself, TopTenTargets™© = T3™© | 0 comments

The Joy of Healing: Bridgton, Maine 1975 -1985 Berry Pond, Sweden, Maine Why would a city boy from New York, go from Miami, Florida to work in rural Maine?  Short answer: Life and Lifestyle.  I was done with the NY hustle and the Miami frenzy.  Finished with outrageous prices and people rushing around for … what reason?  Tired of talk and not enough action.   This was the “dream” place and these were the best years for my family and my Family Medicine career.  Sure, there are dreams and there are Dreams.  And there is no perfect place for anything.  Let me be blunt.  It is not easy to earn a living and to live in rural Maine, and it is not “perfect” for many reasons.  But, for now I will focus on the positive. We chose Bridgton because it was a great place for me to work and think; to provide comprehensive and “definitive care” to patients who appreciated it, a setting that would allow me to use all my knowledge and skill, to care for and treat those in need, to teach, to do research, to promote programs that would help build the health and health care of individuals, families and the community.  Plus it gave me time and a place to recover with and for my young family.  It was a chance to live and grow together in a beautiful rural New England location.  We were just far enough away from the “inlaws and outlaws” (a phrase borrowed from my father) and we had every intention of staying here for the long haul.  So, in July 1975 the Lakes Region of Maine became the place to put my dreams into action. What was it about this place that made it right for us?  “Do what you love and Love what you do,”  “You have to go where you find your Renaissance.”  These are phrases I have used over the years to encourage patients, friends, family and especially my children.  As I look back on it, as odd as it may sound, Bridgton, Maine provided a Renaissance opportunity for me and my family … an opportunity to put my ideas into Action.  How did it play out?  In retrospect, I would have to say that these were probably the most productive years of my life.  But, it was not about me and I was not alone … it was about reciprocity, give and take, or in the words of Hans Selye, it was “altruistic egotism”.  Do what you love in ways that are good for others.  And, I have to say, as best I can tell, we were, for the most part, all on the same page for about ten years. In other words, we were a group of young and dedicated physicians, nurses and other providers, we all loved what we did, we did it for the patients and the community, and we were “the only game in town” for the bulk of the community.  And all patients and providers benefited from the work.  It was out of this soup that came many remarkable things.  But the focus of this message is on Quality Improvement, Performance Improvement and Building Best Practices (QIPI & B2).  During these years at the hospital, we developed an exemplary, robust and...

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