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Francis W. Peabody entered medical school in 1903 and almost at once was recognized as an extraordinary human being. After a varied and exciting indoctrination in his profession, including responsibility for children ill with the dreaded poliomyelitis, an extensive medical trip to China, and an unintended role in the start of the Bolshevik Russian Revolution, he became the enormously successful chief of a new Harvard unit at the Boston City Hospital. The expectations for a long productive life were snuffed out by cancer six years later when he was only 45. Gifted in many spheres and possessed of great courage, his especial compassion and wisdom in patient care have made Francis Peabody's short life an inspiring legend for all time, an essential message for anyone who practices medicine, and an uplifting experience for any patient.
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A doctor on the front lines of hospital care illuminates one of the most important and controversial social issues of our time. It is harder to die in this country than ever before. Though the vast majority of Americans would prefer to die at home—which hospice care provides—many of us spend our last days fearful and in pain in a healthcare system ruled by high-tech procedures and a philosophy to “fight disease and illness at all cost.” Dr. Ira Byock, one of the foremost palliative-care physicians in the country, argues that how we die represents a national crisis today. To ensure the best possible elder care, Dr. Byock explains we must not only remake our healthcare system but also move beyond our cultural aversion to thinking about death. The Best Care Possible is a compelling meditation on medicine and ethics told through page-turning life-or-death medical drama. It has the power to lead a new national conversation.
Compassion draws physicians into medicine, but then they believe they must jettison that compassion to survive. Paradoxically, science has now shown that losing that compassion not only harms the patient, it also harms the doctor. How Doctors Care: The Science of Compassionate and Balanced Caring in Medicinee xplains what physicians and other clinicians can do to provide balanced and compassionate caring for patients without becoming emotionally detached or overwhelmed. The text provides a research-informed and non-sentimental description of physician/clinician compassion. Bringing together cutting-edge scientific research for practicing physicians and those in training, How Doctors Care provides the first full articulation of what constitutes optimal compassionate mental performance in the practice of medicine. It argues how maintaining this internal state is the key to physician resilience and fulfillment in a dysfunctional healthcare system. Rather than blaming clinicians for burnout, How Doctors Care argues that healthcare organizations must provide organizational protection and support to clinicians so that they are able to maintain the compassionate internal state they desire so much and that benefits patients the most. Dominic O. Vachon, M.Div., Ph.D., is the John G. Sheedy M.D. Director of the Ruth M. Hillebrand Center for Compassionate Care in Medicine in the College of Science at the University of Notre Dame. He is also a professor of practice in the Preprofessional Studies Department, where he teaches courses in compassionate care in medicine, medical counseling skills, and spiritualties of caring in the helping professions. Dr. Vachon does research on the internal mental and emotional process of the clinician compassion mindset in patient care, clinician communication skills, and innovations in medical training applying the science of compassion. Dr. Vachon has devoted the last 25 years of his professional career to supporting and training physicians, residents, medical students, premedical students, and other clinicians in patient communication skills as well as dealing with burnout and the recovery of compassionate care in the inner lives of clinicians. As a medical psychologist who has spent most of his life training new physicians as well as conducting his own clinical practice, Vachon has been uniquely positioned to hear how physicians suffer in clinical practice and to bring to bear the insights of the science of compassionate caring to help them restore their compassionate ideals and thereby, to improve patient care.
Throughout history, physicians have played a vital role in medical discovery. These physician-scientists devote the majority of their professional effort to seeking new knowledge about health and disease through research and represent the entire continuum of biomedical investigation. They bring a unique perspective to their work and often base their scientific questions on the experience of caring for patients. Physician-scientists also effectively communicate between researchers in the "pure sciences" and practicing health care providers. Yet there has been growing concern in recent decades that, due to complex changes, physician-scientists are vanishing from the scene. In this book, leading physician-scientists and academic physicians examine the problem from a variety of perspectives: historical, demographic, scientific, cultural, sociological, and economic. They make valuable recommendations that—if heeded—should preserve and revitalize the community of physician-scientists as the profession continues to evolve and boundaries between doctors and researchers shift.
With family doctors increasingly overburdened, bureaucratized, and burned out, how can the field change before it's too late? Over the past few decades, as American medical practice has become increasingly specialized, the number of generalists—doctors who care for the whole person—has plummeted. On paper, family medicine sounds noble; in practice, though, the field is so demanding in scope and substance, and the health system so favorable to specialists, that it cannot be fulfilled by most doctors. In Searching for the Family Doctor, Timothy J. Hoff weaves together the early history of the family practice specialty in the United States with the personal narratives of modern-day family doctors. By formalizing this area of practice and instituting specialist-level training requirements, the originators of family practice hoped to increase respect for generalists, improve the pipeline of young medical graduates choosing primary care, and, in so doing, have a major positive impact on the way patients receive care. Drawing on in-depth interviews with fifty-five family doctors, Hoff shows us how these medical professionals have had their calling transformed not only by the indifferent acts of an unsupportive health care system but by the hand of their own medical specialty—a specialty that has chosen to pursue short- over long-term viability, conformity over uniqueness, and protectionism over collaboration. A specialty unable to innovate to keep its membership cohesive and focused on fulfilling the generalist ideal. The family doctor, Hoff explains, was conceived of as a powered-up version of the "country doctor" idea. At a time when doctor-patient relationships are evaporating in the face of highly transactional, fast-food-style medical practice, this ideal seems both nostalgic and revolutionary. However, the realities of highly bureaucratic reimbursement and quality-of-care requirements, educational debt, and ongoing consolidation of the old-fashioned independent doctor's office into corporate health systems have stacked the deck against the altruists and true believers who are drawn to the profession of family practice. As more family doctors wind up working for big health care corporations, their career paths grow more parochial, balkanizing the specialty. Their work roles and professional identities are increasingly niche-oriented. Exploring how to save primary care by giving family doctors a fighting chance to become the generalists we need in our lives, Searching for the Family Doctor is required reading for anyone interested in the troubled state of modern medicine.
Powerful forces of change are at the core of Obamacare—and they could either strengthen or destroy our family doctors. It’s a perfect storm that threatens our hope for more effective and personalized medical care and it holds the potential to drive our trusted Familiar Physicians toward extinction. In the midst of the storm is a new and promising approach within Obamacare called the medical home. Learn what you can do to help assure that the Familiar Physician, the basis for a strong physician-patient relationship, survives the approaching storm. On a national level, there are heroes here—doctors who redirected their lives to make this change happen. Not just for a few months, but for a decade-long crusade. This is the story of Dr. Peter Anderson, a pioneer in team care medicine and a passionate champion for primary care. The Familiar Physician is about the extraordinary vision of IBM’s Dr. Martin Sepúlveda and the powerful crusade of advocacy carried out by IBM’s Dr. Paul Grundy. Their ten-year quest to create solutions for this crisis in primary care has powerful outcomes. Hope is on the horizon, but the struggle is far from over.
Introduction: The house of medicine and medical prices -- The enduring influence of the house of medicine over prices -- The science of work and payment reform -- How doctors get paid -- Conflicts of interest and problems of evidence -- Complexity, agency capture, and the game of codes -- Fixing medical prices
So much of a medical organisation's success rides on the leadership, conduct, and performance of its physicians. How does a health care organisation engage its physicians to lead by example? And how does a physician, in the midst of 25 appointments, 30 phone messages, hospital rounds, and the details of managing a clinical practice, do what needs to be done to foster satisfaction and loyalty among patients? This book eloquently answers these questions. Beeson has created a brilliant guide to implementing physician leadership and behaviour that will create a high-performance workplace built on collaboration, commitment, purpose, and making a difference in the lives of the patients it serves.
"Our fascination with the topic of contextualizing care began about twenty years ago when the evidence-based medicine movement had taken hold. We noticed that although medical residents were skilled at identifying the latest studies and guidelines, their care plans often didn't seem appropriate once one considered the life challenges some of their patients were facing. We'd see, for instance, a patient with poorly controlled asthma put on a higher dose of a medication they weren't taking, rather than a cheaper generic, when the context was that they couldn't afford it. We coined the terms "contextual error" to describe these kinds of mistakes and "contextualized care" when patients' care plans are adapted to their life circumstances"--