West Linn Preferred Care

A Letter from Dr. Norcom

noreply@blogger.com (Muller Design Studio) — Tue, 16 Dec 2008 21:00:00 +0000

A New Medical Model

When I was very young, I learned from my grandfather, that the quality of any action or activity was more important than the quantity. I have beautiful memories of him and his peach orchard. Shining summer afternoons - beholding in amazement the color, shape, texture, tone of a quality peach, and his detailed description thereof. He worked the orchard himself, with his own hands and tools, well over two acres of peach trees. “Coppertop, we may not bring as many peaches to market as some growers around here, but I like to sell good peaches” He sold his peaches direct to the consumer. The transaction made sense to me as a boy. It still does.

US physicians, beginning as early as the 1950’s, began accepting “middle man” payment for the care they provided their patients. Without a direct fiscal relationship between doctor and patient the current “system” in the United States is under great economic and quality pressure to take care of more and more people with less and less qualified doctors. Our population is exploding – it has doubled since the 1970’s. And it is aging rapidly. Due to widespread physician dissatisfaction the rate of doctors entering practice in general/primary care has been dwindling slowly each year for the past sixteen years. And doctors are retiring earlier now than ever before. The sum of these changes equals an impending/occurring crisis resulting physician burnout and decreased quality of care.

I practice medicine because I love taking care of patients. I love medicine. My career has been extremely rewarding and at times very frustrating/disheartening due to lack of autonomy and inadequate time to thoroughly listen and address patients’ needs. I learned in medical school that the patient describes their illness and the doctor listens, and then interviews the patient in detailed way. In the current system this crucial first step in medical care can’t even fully occur. Physician economic trade journals are replete with articles on “how to manage the ten-minute visit”, etc. Ten minutes is an insanely short amount of time for even proper care for a sore throat. Most docs work on a strict 15-minute template (some a 10 minute template or six patients per hour!). The 15-minute orchestration gives them effectively about 10-12 minutes with each patient, with 4-6 for diagnosis/listening/physical exam and 6 or so minutes for education and discussion of treatment – pressuring decisions and squelching thoughtful analysis.

In the late 1990’s I grew a practice from zero to 2700 patients in three years; as this numerically “successful” practice grew the quality of the care I provided - even with longer hours at the office and intense effort – decreased. I cared deeply for these patients and found it increasingly frustrating to not be able to give them enough care. I subsequently worked in the “urgent care” arena for a few years – the place where patients go when “their” doctor “can’t” see them. I learned so much during this time about the inadequacies and access issues that people face on a daily basis when trying to obtain care from their “PCP” (Payer Contracted Physician – to coin a new title). I don’t want to be your PCP, I want to be your doctor, the old-fashioned kind – the kind that listens well, thinks cogently, cares about every single decision, and sees you when you’re ill and well – who focuses on you as a whole person – not an insurance code.

Practicing medicine is a sacred art. I have dedicated the whole of my adult life to it. I have been told by colleagues and patients that I’m good at it. But no physician can consistently provide high quality of care at a clip of 30 plus office visits per day, and practice populations from 2,500 to 4,000 patients and rising. These numbers are astounding but, sadly, real. There’s a great chance that this is how your current doctor practices. I know, because I’ve spent my career working within this “system” (more like a factory). The practice of medicine in our country, the “great art and noble endeavor”, has been relegated to the business of “marketing efficiency models”, and the cold diagrams of insurance actuarial tables. Physicians and patients alike have been left paying the real price – decreased quality of the doctor-patient relationship and decreased quality of medical care. Incidence rates for control and screening for major illnesses is bereft with examples of gross inefficiencies in care. Doctors are patients as are being burned by a business model focused on quantity, instead of quality. And the picture is worsening rapidly.

Rates of physicians not accepting new Medicare patients are at an all-time high and rising. Medicare reimbursement for physician services has dropped yearly over the past many years, for both general and specialty care. Many Medicare patients are left obtaining care. Private insurance premiums have risen over 50% in the last decade while primary care physician salaries in some markets, including the Northwest, have not kept pace with inflation. Primary doctors are strained and stretched more than ever, and it’s showing in the care they provide. Somewhere along the way we’ve all forgotten that the relationship is between the patient and the doctor, medically and fiscally – that’s the only way it can work well.

Frank Norcom of Bixby, Oklahoma, grew peaches – really good ones. He grew them because he loved it. He grew fewer than his competitors, and his customers could see and taste the difference. I ate hundreds and hundreds of those peaches. I love good peaches. My grandfather was a giving and charitable man. He believed in quality. So do I. Call me if you feel the same way about your health.

Mind-Body Wellness

noreply@blogger.com (Muller Design Studio) — Tue, 16 Dec 2008 20:00:00 +0000

I’ve had many great discussions with my patients over the years, and one topic that has been repeatedly fascinating to discuss with them is the area of mind-body medicine or wellness. The very term itself creates some interest in almost everyone, as it immediately evokes the essence of what we are at our most basic, a body and a mind – with soul or spirit being a self-believed part of many people, but not all. In my conversations with people of all ages regarding this, I’ve had fun challenging assumptions and I’ve also learned a great deal from my patients.

We all have a basic similar understanding of the word body. We can see it, hear it, touch it, etc., and thereby experience it by using its own five senses. It’s pretty obvious, we are in it, or to some, we are it. And herein lies the first philosophical hurdle of the mind-body realm of inquiry: are we our body or do we inhabit it? Most people see the mind as separated from the body – with the body sort of carrying the mind around with it. This type of thinking has been with us in Western thought for thousands of years and has been supported by our language structure and the scientific method that we use to make discoveries about the body.

The pervasive idea in the West is that medically there are two entities, a body and a mind, but it might be interesting to note that in much of the East these two entities are considered one thing, not separate. And this is my view as well. And it has been a very powerful viewpoint in helping patients both understand and feel better about their symptoms. When we feel better about our symptoms, many times our symptoms get better.

For instance, many common medical symptoms are attributed to ‘stress’ or ‘anxiety’. “Oh, good, I don’t have a serious life threatening medical disease, but wait, doc, my head still hurts.” Reply: “That’s just a ‘stress’ headache – not to worry.” But, my head still hurts, and these pills aren’t working. So stress means mind and the assumption is that ‘medicine’ can’t help. Bummer.

This is an example of how viewing the mind and body as two entities, and believing that the cause of the problem in the body can only be fixed by fixing a mysterious problem in the mind, can be very circular and frustrating.

Many times have I heard patients tell me that other doctors have told them that they suffer from ‘anxiety” and that their symptoms are “all in their head” – implying that they are made up or somehow not real. The physician’s position being that these mind-created symptoms can’t be helped – the patient is on their own. The assumption is that the mind is outside the body and the physician can only help heal the body. This reasoning is counter-productive to holistic care.

However, when we alternatively view the body as containing the brain and replace the word mind with the word brain, I believe we come closer to describing practical reality. We can focus on helping a patient improve their brain function, which will help with many symptoms. Now that mysterious ‘anxiety’ is seen as a product of suboptimal brain function, and the options for therapy to treat that ‘stress’ headache widen. A holistic approach can be taken that recognizes the dynamic and unique nature of each individual’s brain function, personal psychology and social differences. One person might benefit from a medicine to improve the pain from the headache or improve brain function, another from changing jobs or improving relationships, another from exercise or dietary change, some from massage or acupuncture, and most from a multi-faceted treatment plan, a holistic plan.

So we come full circle from viewing the body and mind as separate entities, to viewing the mind as brain and brain as part of the body. Now this integrated shift in perception is subtly powerful as it changes common assumptions about the limitations of healing the body. (And, again, remember that the brain is part of the body).

A holistic approach to healing utilizing conventional pharmacologic medicine has prescribed limitations, and in its current form of insurance driven delivery is suffering from a lack of time with patients for holistic clinical care. To answer this problem locally, as a broad-based primary care doctor, I’ve opened a medical practice in West Linn that treats people as whole individuals, and gives them plenty of time for proper diagnosis, compassion and exploration of all treatment options. You can learn more about my new practice at www.drnorcom.com.

Who knows what interesting innovative ways we’ll find to help you gain optimal health – your whole body, including one of its most important organs, your brain.