Words that matter…to me

journal

September 24 was a mentally fertile day…on at least three occasions in my life.

From time to time I have managed to keep a journal.
Here are three of my 9/24 entries.

September, 24 1978 (College sophomore, 18 years old)

I cannot afford to lose a day;
my life is only as short as it is.

9 24 78

September 24, 1983 (Third year medical student, 23 years old)

Life and alarm clocks
go hand in hand
unnaturally.

9 24 83

September 24, 1995 (Anesthesiologist, 35 years old)

Unless it makes any difference why the sun comes up everyday,
don’t waste time arguing about it.

9 24 95

If you’d like to see more of this kind of thing, they pop up from time to time on my Twitter feed.

Or check out the listing in this post’s comments section.

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I need some advice…

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Tomorrow (Tuesday – September 16, 2014) I will have the honor of speaking to a gathering of mostly retired physicians at the Kentucky Medical Association’s annual meeting in Louisville, KY.

Given this opportunity, what would you say to them?

What would you encourage them to do?

How would you instill hope that our nation’s healthcare delivery system will survive?

I only have a few hours to hone my message. I need your help.

Please leave your remarks in this blog’s comments section…

Or send me a message on Twitter @jamespmurphymd

Or email me at: basicpaincare@gmail.com

Thanks!

Dr M

Dawn of the planet of the value based

sunrise clark

It is the dawn of a new era.

Many cogs are now required to turn the wheels of our nation’s juggernaut health care industry. Physicians, historically the driving force in medicine, are not generally the “cog” type. This juxtaposition can have unhealthy consequences for all of us.

In his August Wall Street Journal article “Why Doctors Are Sick of Their Profession,” Dr. Sandeep Jauhar documented the pathology in our nation’s medical history. And while I agree with the good doctor’s diagnosis, I am not as comfortable with his treatment plan, which includes:

  1. “giving rewards for patient satisfaction”
  2. “replace the current fee-for-service system with payment methods such as bundled payment, in which doctors on a case are paid a lump sum to divide among themselves”
  3. “pay for performance, which offers incentives for good health outcomes.”

At first glance, Dr. Jauhar’s suggestions would appear to be reasonable measures. But employing such metrics may not sit well with our current physician workforce for a number of valid reasons.

In days past, the medical profession attracted highly intelligent practical dreamers in search of a career that allowed and rewarded unfettered blending of art and science; answering a “calling” that revered the heartfelt patient-physician relationship. If you were a “Renaissance man” or woman, crossing medicine’s threshold felt like coming home. Now in this modern medical renaissance, home is not necessarily where the heart is. Home is now inhabited by impostors masquerading as quality and value.

In days past, creativity and problem solving were vital to success in health care. Now strict adherence to guidelines, meeting quotas, and saving money for third party payers are paramount. Now the “rough spots” in the delivery line -physicians who view patients as individuals as opposed to populations – are being made smooth or else discarded.

Given a metric that determines their “bonus,” worker bees will instinctively aim for that mark. So if earning money to send their kids to college depends on getting a “five star” customer satisfaction rating, then expect health care professionals to make flashing a salesman’s smile the priority. Running a clinic on time will become more important than taking time to comfort that patient who’s problem unexpectedly deserves more attention than the automated schedule allowed…can’t risk upsetting twenty people for the sake of one, you know.

The story goes that Albert Einstein once wrote on his blackboard: Not everything that counts can be counted, and not everything that can be counted counts.

Regardless of the origin, this statement rings with truth. More than an observation, it is a challenge.

hand

I held a hand the other day. There was no procedure code for it. It did not satisfy any quality metric. Truth be told, it was probably more beneficial and more appreciated than the epidural injection that preceded it.

We are living in the dawn of the planet of the value based. Students now embarking upon their medical school journey will emerge light years away from where they began. When they graduate and step into the blinding sunlight of the real world, will they even recognize it?

Or, as in the climactic scene from Planet of the Apes – when Charlton Heston’s character realized man’s demise was his own doing – will they cry out…

You finally really did it!

You maniacs!

You blew it up!

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I hope not.

I will do what I can.

But, then again, I am a rough spot.

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White is the new look for fall

sep me cover

On July 28, 2013, the University of Louisville welcomed the Class of 2017 medical students. As an annual contribution to each new generation of emerging physicians, the Greater Louisville Medical Society purchases the students’ first white coat. As President, it was my honor to congratulate the students on behalf of the Greater Louisville Medical Society. Here are my remarks from the podium.

share in an adventure gandolf

“I’m looking for someone to share in an adventure.”

Fans of the author J.R.R. Tolkein, will recognize this as the challenge Gandalf the wizard made to the hobbit, Bilbo Baggins. This is, among other things, an adventure.

I am honored to be here on behalf your medical society – The Greater Louisville Medical Society – to congratulate you on this milestone. At close to 4000 members, we are one of the largest in country. Our mission is to: promote medicine as art and science, advocate for the wellness of our community, and protect the patient – physician relationship.

Today is a big day for you and for us. Today is a milestone along the road that will lead to a your joining our ranks. Today you are not only putting on your white coats, but you are also becoming members of the Greater Louisville Medical Society. To help you stay connected you will have access to our mobile app, where you can get alerts, educational materials, and access information about your new GLMS colleagues. As sponsors of the White Coat Ceremony, your medical society colleagues are honored to provide: your first white coat, provide, your medical society pin, membership in the Greater Louisville Medical Society, professional photographic portrait of you in your new white coat. We are your colleagues, here to support you, and we welcome you.

The Greater Louisville Medical Society has strong ties to the University of Louisville. Most of our members either graduated from the University or did post-graduate training there. I am proud to call myself a graduate of the University of Louisville Medical School Class of 1985.

Back when I was in your shoes, we did not have a white coat ceremony. Back then they wouldn’t let us wear a white coat until third year, much less actually touch a living patient. I wish we could have had a ceremony like this. That is why I invited my own family to come today. This is a special day for you and for your family and friends who have supported you. To these special people in your life, I also offer my congratulations and my gratitude.

Gratitude, yes, because you have chosen a path that is not easy and does not compensate you materially for the years spent, the sacrifices, the risks – financial, physical, emotional. But it is indeed an adventure.

As I look out upon you I see a discovery. I see a cure. I see lives saved from disaster. I see longer, better, meaningful lives. I see a suicide prevented. I see a critically ill baby saved. I see an aneurysm removed. I see a heart murmur discovered. I see a cancer detected because you followed up on the red blood cells you saw in the urinalysis report.

I also see heartache, depression, fractured lives, and failures. It is all part of the path you have chosen to follow. You may not know all the reasons why you are sitting here today. I don’t think I knew. But every day, from this day forward you will be finding answers.

The white coat itself is significant. I remember the day I finally got mine. We walked around the medical complex and even went to eat lunch in one of the hospital cafeterias. In my 3rd year of medical school Dean Ganzel was my attending on rotation through Otolaryngology. On the last day she, so graciously, took her four medical students to lunch. We ate lunch at the Kentucky Center for the Arts in our white coats. The coat meant something. It said something to the world.

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I have worn many white coats since them – short, long, in between – but whenever I put on the coat it still has meaning. It speaks. So I wondered what the message would be if instead of me, my white coat could says a few words. Well, my white coat and I discussed it and now, on behalf of my white coat, I offer this:

a white coat
I symbolize
the goals you hope
to realize

a white coat
my color’s pure
to show your values
will endure

a white coat
I will glisten
if you can try
to mostly listen

a white coat
in my presence
comfort, care and
convalescence

a white coat
wear this fashion
only if
you share my passion

a white coat
for my profession
put patients first
make no concession

a white coat
answer alarm
with answers that
first do no harm

a white coat
hear the calling
wear me when
you lift the falling

a white coat
my fabric must
be nothing but
a weave of trust

a white coat
ability
tailored with
humility

a white coat
a solemn oath
a way of life
or maybe both

a white coat
I’m going to
forever be
a part of you

Dean Ganzel, colleagues, friends and families, Mom, I thank you for this day. And to the class of 2017, I congratulate you and welcome you. For those who hear this calling there is no greater professional honor than to wear that white coat and hear the words, “That’s my doctor.”

Looking out at you, it is clear that I have found someone to share in an adventure.

Gandalf_the_White_returns

… and the white look is very becoming, I must say.

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This year’s White Coat Ceremony was held on July 27, 2014 and is the subject of current GLMS President, Dr. Bruce Scott’s September eVoice.

bruce evoice

 

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National Pain Care Providers Day

meryl

Every dog has his day, right?

In our culture, groups, individuals, and even inanimate objects are frequently honored with their very own special twenty-four hours. These days of recognition give us pauses to examine their meanings and further their causes.

But there’s a compassionate and deserving group of people who have not yet made the list…the caring people who treat our pain. 

For now, National Pain Care Providers Day is only a dream.

It doesn’t exist.

It should.
It can.
And it will…with your help.

National Pain Care Providers Day
March 20, 2015

npcpd hands screen

It’s time to recognize all who generously and selflessly strive to alleviate suffering. This includes physicians, dentists, nurses, therapists, emergency responders, trainers, masseuses, pharmacists, caregivers, mothers and anyone who gives of her or himself to ease pain.

Why is National Pain Care Providers Day necessary?

Pain is universal. It is the most common medical complaint. There is no escaping it. Pain touches every life. And as our population continues to age, pain is occurring in epidemic proportion.

Pain care is sometimes simple and sometimes extremely complicated. Caregivers can feel tremendous pressure from government agencies, police, lawyers, administrators, addicts, abusers, patients, families, administrators, insurance providers, and the media. As a result, caregivers are too often reduced to feeling “You’re damned if you do and damned if you don’t.”

In reality, they should be praised because of what they do.

Caregivers who persevere deserve our support, gratitude and, at the very least, a day of recognition.

Popular opinions regarding pain care and treatments are evolving rapidly. Taking a special day to spotlight best practices and inspire possibilities would not only bolster the advancement of this vital field of medicine, it would encourage the legions of those who suffer in lonely silence. Less suffering and better lives for all are the goals.

Celebrating National Pain Care Providers Day on March 20, 2015 – the first day of spring – is akin to celebrating hope. From this day forward, the vernal equinox, light overcomes darkness.

RAINBOW SCREEN

So let’s join together and recognize the first day of spring, March 20, 2015, as National Pain Care Providers Day. Let’s make this day special for the special people who treat our pain. Start by sharing your comments and ideas on this blog and/or emailing paincareprovidersday@gmail.com. Pass along the message on social media (Twitter, Facebook, etc.) and contact your civic leaders. Be a vital part of this movement.

Let Hercules himself do what he may,
The cat will mew and dog will have his day.
~ William Shakespeare’s Hamlet

You are the playwright now.
The parchment is blank.
Imagine.
Create.

And celebrate!

National Pain Care Providers Day
March 20, 2015

npcpd screen

 

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Basic Pain Care Certification

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The consequences of pain…

A young mother is terrified helplessly watching her child spiral toward death in anaphylactic shock, because she did not know that an allergy to aspirin could also mean an allergy to ibuprofen.

An elderly man is no longer breathing, because he mistakenly thought he could break his pill in half to save money; when in fact, this caused the immediate release of a lethal dose from his time-release pill. He will die before the ambulance can arrive but could have been saved by a simple subcutaneous injection.

A business executive is transfused her tenth unit of whole blood, but it will not save her from dying from the hemorrhaging ulcer caused by excessive over-the-counter pain medications.

A young football star slumps silently in a corner at his high school friend’s party. Pills acquired from various unlocked medicine cabinets are coursing through his arteries. In three days his grieving parents will be struggling with the decision to remove him from life support.

With alarming frequency, stories like these touch every family.

All are preventable.

 

The consequences of pain…

 

More costly than cancer.

More deadly than car crashes.

More likely than a heart attack.

More common than the common cold.

 

With pain being so ubiquitous, so serious, so PAINFUL, why do we still not know how best to deal with the pain epidemic?

Perhaps, it is precisely because we don’t know?

Then, we should learn.

We should become knowledgeable, skilled, competent, and even certified.

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By “we” I mean everyone – not only health care providers. Pain and pain’s consequences touch every life. We all have a stake.

Lifeguards, plumbers, electricians, firemen, police, pilots, engineers, lawyers, nurses, pharmacists, physicians, etc., etc., etc., must earn certifications. Similarly, by the millions, people of all ages achieve certification in Basic Life Support – and we regularly hear stories of how a bystander stepped in to save a life. A standardized and universal understanding of pain, its treatments, complications, emergencies, and prevention could have similar results.

This point is bolstered by a recent letter from the American Society of Addiction Medicine calling upon the White House to:

…focus holistically on provider and community education, overdose death prevention and increased access to treatment, in order to effectively manage the (opioid) epidemic.

Knowledge is power.

It is time we, as a community, put that power to work.

The roadmap is clear. Like the American Heart Association’s Basic Life Support certification, Basic Pain Care (BPC) can be taught in a standardized algorithmic manner. Learning can be didactic and hands-on. For most, it would only take a few hours to master the skills, earn the certification, and acquire the confidence.

 

A Basic Pain Care curriculum might include:

- Wellness and prevention (diet, exercise, stress)

- Acute care (ice, heat, etc.)

- Over the counter medications

- Prescription medications

- Opioids

- Alternative and complementary treatments

- Drug abuse prevention, recognition, and treatment

- Regulations

- Pitfalls and risks

- Emergency procedures (overdose, seizure, etc.)

 

Imagine how confident you would feel if you knew the best and safest way to treat pain, regardless of the situation – acute, chronic, traumatic, post-operatively, and palliative. Imagine that everyone knew.

 

Imagine the suffering that would be eased.

Imagine the resources that would be spared.

Imagine the lives that would be saved.

Imagine the tears that would never be shed.

 

Now make it real. Join with me in establishing the Basic Pain Care Certification. We can start by getting connected. Share this article. Offer your comments. Follow my Confluential Truth blog and the Twitter account @jamespmurphymd. Email your thoughts to basicpaincare@gmail.com.

Change the consequences of pain.

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Talking Trash

cj title

On July 8, 2014, the Louisville Courier-Journal ran a front-page article about how hard it is to find a drug disposal drop-off in Louisville.  No mention was made of trashing the leftover meds.  Here is the letter to the editor I sent in response on July 10, 2014.

letter to editor

Dear Courier-Journal,

Drug abuse is epidemic.  So no one should trash talk about Martha Elson’s excellent article, Drug Disposal Boosted by Boxes.  But the trash is exactly where leftover abusable drugs can go.  Ms. Elson exposed the number one suppliers of abused pills, and surprisingly, it’s not the doctors. It’s you and me. In fact, about two-thirds of all abused pills come from family and friends, often right out of unlocked medicine cabinets.  As a specialist in Pain Medicine and Addiction, I require my patients to lock up their medications and properly dispose of any leftovers.  But with so few drug drop-off boxes available, what’s a responsible person to do?

Trash them!

oscar

Yes, if you can’t get to a drop-off box, the FDA says it is acceptable to throw your old medications in the trash, provided you first “doctor them up” a bit. Simply mix the pills with kitty litter or coffee grounds.  Seal it in a leak-proof bag (like a zip-lock) and toss it in the garbage.  Easy.

dispose

The more potent the drug is, the greater the need for disposal of the unused leftovers.  The FDA has even determined that the danger from keeping unused powerful narcotics is so ominous, that flushing leftovers down the toilet is acceptable when a drop-off box is unavailable.ty d bol

The Environmental Protection Agency is OK with this policy.  And the FDA says there has been no indication of adverse environmental effects due to flushing leftover pills.

However, leftover pills do contribute to adverse societal effects.  About one-fourth of high school age youth have abused prescription drugs. Approximately three Americans die every hour of every day from a drug overdose.  More Kentuckians die from overdose than die in automobile accidents.  A very large percentage of these overdose deaths involve prescription drugs.

Ms. Elson’s timely article brought to light the progress we are making.  More and more drug drop-offs are becoming available.  We should take advantage of them when we can.  But please do not let your busy schedule, your concern for the environment, or your unfamiliarity with regulations deter you from properly disposing your unused medications.  We are battling a drug abuse epidemic.  People are dying.  Make sure you are not an unwitting supplier. You may save the life of someone you love…  And that’s not talking trash.

trash talk

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