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Patient-centered practices allow physicians to heal themselves, system.

Byline: GUEST VIEWPOINT By Pamela Wible For The Register-Guard

Keep your eyes open. You will soon cross paths with a once-endangered species whose numbers are increasing - the old-fashioned family doctor.

Remember the friendly doctor who treated your family from generation to generation and made house calls? Doctors across the country are getting back to basics, with the sacred patient-physician relationship at the core.

Patients nationwide complain about assembly-line medicine. Some fear they are imposing on their busy doctors and never discuss their pressing concerns during brief office visits. Others avoid doctors due to poor communication and perceived disrespect.

Many are excluded due to lack of finances. Those who get an appointment are often held hostage by a dysfunctional health care system that seems to lack both health and care.

Physicians I meet across the country vent about sweatshop conditions in which they are forced to see more and more complicated patients in shorter visits. They describe themselves as frustrated, overwhelmed factory workers in a system that robs them of the very reason they chose to practice medicine - to provide high-quality patient care.

Debt-ridden residents and medical students confide their biggest deterrent to a career in family medicine is their exposure to discontented family doctors. Some community physicians counsel our future doctors not to pursue a profession in primary care. Dedicated, altruistic students pursue family medicine despite these experiences, hoping to make a difference.

A primary care collapse of epic proportions is predicted. The current dysfunctional model forces doctors with unsustainable workloads to search for escape routes through early retirement, administrative positions or even jobs with pharmaceutical firms. Three young female physicians I know have opted out of medicine altogether in the last few years.

From collective misery has surfaced creative and inspiring physician-driven solutions that renew the joy and honor of the profession by re-creating the nostalgic magic of solo practice. These "ideal micropractices" (idealmicroprac- tice.org) embody principles such as same-day appointments and 24/7 access to one's very own doctor. The doctor is even on time and waiting for the patient's arrival! These ideal practices are technologically advanced and provide excellent, VIP-style care that is patient-centered rather than staff-centered.

National organizations such as the Institute of Healthcare Improvement (ihi.org) support innovative and entreprenuerial physicians who are spearheading patient-centered models around the country. The Future of Family Medicine Project encourages doctors to boldly transform their offices. Physicians and their communities are enjoying the results. Here in Eugene, the novel Family & Community Medicine Clinic was successfully created and designed by the community it serves.

Controlling overhead and removing obstacles to care are essential. Large buildings, plasma screen TVs, and excess staff burden physicians and are barriers to the physician-patient relationship. Once plagued with 74 percent overhead, I saw more than 4,000 patients per year just to pay the bills!

Like many doctors today, I was in survival mode. The sacred patient relationship got lost in the high-productivity marathon to cover expenses. With overhead savings, physicians can afford to see more charity cases and enjoy high-quality, leisurely office visits. Just think - there is no need for a waiting room if one never has to wait!

Patients bask in their physicians' atten- tiveness and accessibility. My patients are thrilled when I answer the phone. One patient, amazed when she reached me late on a Friday night, exclaimed, "Wow, a real person!" She lamented trying to reach her doctor during business hours for two years without success.

Another woman called seeking antidepressants. After I spoke to her briefly, she said she no longer felt depressed. Just hearing my reassuring voice made her happier than a bottle of Prozac. Three of my patients have even decided to go into family medicine after experiencing the true joy of old-fashioned family medicine.

Physicians in ideal practices are empowered and joyful. No longer wounded healers, doctors are able to provide health care in a setting of continuous, ongoing, personal relationships with patients - the foundation of general internal medicine and family medicine. The newfound joy has unified physicians and restored our mission.

Look around. You may run into a happy physician in your neighborhood on a bicycle or carrying a black bag. Make sure you wave. The "old-fashioned" family doctor will greet you by name.

Dr. Pamela Wible of Eugene (345-2437 or idealmedicalpractice.org) consults with doctors and communities nationwide in designing ideal medical practices.
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Title Annotation:Commentary
Publication:The Register-Guard (Eugene, OR)
Date:May 22, 2006
Words:729
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