The Seven Essentials for Pain Practice Success* …Sailing the Seven C’s

cloudmpc

Success is counted sweetest by those who ne’er succeed.
~Emily Dickinson

You treat chronic pain? Thank goodness someone does.
~My physician colleagues … on numerous occasions

I have treated chronic pain in a variety of practice settings, large and small, for almost thirty years. It has not always been easy. But I have found that success in this specialty is possible when the practice foundation consists of seven basic elements:

Cost-effective
Cooperation
Compliance
Consensus
Culture
Cause
Care

Chronic pain is not an exotic clinical niche. It is a chronic illness and should be approached step-wise as one would approach other chronic illnesses:

(1) Gather information;
(2) Make a diagnosis;
(3) Implement a plan of care;
(4) Assess the results; and
(5) Make adjustments.

A physician is generally comfortable with this paradigm when it applies to caring for an individual pain patient. However, regardless of one’s clinical confidence, when the practice’s primary mission is to treat chronic pain, overriding concerns about economic viability, community safety, and regulatory scrutiny become major stressors for a physician. More than just a paradigm is needed.

By embracing The Seven Essentials for Pain Practice Success a healthcare organization of any size or complexity can meet this need and provide quality pain care that is valued by the patient and professionally satisfying to the provider.

The Seven Essentials for Pain Practice Success

1. COST-EFFECTIVE

There’s no escaping the fact that healthcare costs are prodigious and resources are finite. Care providers may feel compelled to offer expensive treatments and order technologically advanced tests, regardless of the cost, out of a desire to provide the best care possible. But “best care” is not equivalent to “most-expensive care.” The success of any pain care practice is dependent upon use of resources – of the patient and the practice- in a manner that optimizes value.

2. COOPERATION

Do not tell patients what you will do to them. Instead, figure out how you can work with them. Providing care in a climate of draconian pain regulations, dogmatic practice guidelines, and dearth of evidence to support treatment options, is optimized by patient-practitioner partnerships. Success requires positive outcomes for the: (1) patient, (2) caregiver, and (3) community. If any of these three stakeholders have bad outcomes, failure is the sum total. With cooperation and teamwork, success is more likely achieved.

3. COMPLIANCE

Be a follower. In addition to an ever-increasing database of clinical guidelines, there are numerous regulations and statutes governing how healthcare providers may treat pain, particularly when treatment involves controlled substances. Some of the rules are federal statutes that apply universally. Other rules are only specific to individual states or communities. Rules governing pain care delivery may not necessarily reflect the best clinical practice, but are usually based upon sound principles. Search for the reason behind the rule. But if all else fails, go ahead and “teach to the test.” Compliance is mandatory. Even if you think “outside the box” do not act outside the box. Know the rules and follow the rules.

4. CONSENSUS

A successful pain practice must agree on how they will operate. Do some providers allow early refills, while others will not? Are some quick to discharge a patient who has an abnormal drug screen, while others give second chances? How often do we drug screen? Do we prescribe drugs on the first visit? Through honest communication the group must reach a consensus on “our way” of doing things.

5. CULTURE

Every organization has its own culture. A successful pain practice understands its culture, knows its weaknesses and knows its strengths. For example, if the group’s dominant culture is intuitive, then it needs safeguards (i.e. objective and detail-oriented policies and procedures) to focus on specifics. Success requires that individuals not only understand their roles, but also are willing to perform in a manner that supports the group’s dominant culture.

6. CAUSE

Successful pain practices know their cause, their mission, the reason the practice exists. Even the most mundane task can be passionately undertaken when team members understand how their actions contribute to the cause. In addition, successful practice managers make sure team members feel appreciated for their efforts.

7. CARE

Caring is the foundation for success. In all decisions, successful pain practices first ask: “Is it in the patient’s best interest?” Beyond that, every human encountered by the organization -patients, family members, hospital administrators, government regulators, insurance brokers, pharmaceutical representatives, colleagues, etc.- is worthy of dignity, respect, and care. The “golden rule” always comes before the rule of gold. Remember that no one cares how much you know until they know how much you care.

Each of the seven essentials for pain practice success is vital. Ignore one and the organization is on thin ice. Embrace them all and the practice, regardless of its size, can be on economical, clinical and ethical solid ground.

Then no one will have to “thank goodness” for what you do.
Instead, you can be thanked for the goodness that you do.

That is sweet success.

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we are great

https://vimeo.com/channels/glms/68703810

James Patrick Murphy, MD, MMM is a Past President of the Greater Louisville Medical Society, Medical Director of Murphy Pain Center, and an Assistant Clinical Professor at the University of Louisville School of Medicine. He is board-certified in Pain Medicine, Anesthesiology, and Addiction Medicine and has a Master of Medical Management from the USC Marshall School of Business.

*Note: This article was originally titled: The Five Essentials for Pain Practice Success. “Cost-effectiveness” was added on July 30, 2015; “Cooperation” was added on September 30, 2015; each prompting a change in the title.

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Treating Pain With Truth

collage

Then you will know the truth, and the truth will set you free.
~ John 8:32 (NIV)

…Pain free?

Confluential Truth blog posts address various issues, and many share a healthcare theme. Often the focus is on chronic pain. The following collection of Confluential Truth offers my views on how chronic pain may be effectively and safely treated, especially when the treatment involves controlled substances. Each essay is like a chapter in a mini-textbook about treating chronic pain. They are offered here hoping to provide insight into improving quality of life for pain sufferers and pain care providers.

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PROLOGUE:  The Algiatrist – To set the tone, a poem about treating pain and being “useful.”

INTRO ALGIATRIST https://jamespmurphymd.com/2013/11/22/the-algiatrist

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CHAPTER ONE:  The Dream of Pain Care – A transcript of my address to the physicians and staff of Norton Healthcare – the what, why & how. If you only have time to read one essay, this is the one.

1 wolfe https://jamespmurphymd.com/2014/04/25/the-dream-of-pain-care-enough-to-cope-the-seventeenth-r-dietz-wolfe-memorial-lecture

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CHAPTER TWO:  Pathway to Partnership, Part 1 (KY) – Here is how we do it in Kentucky when we do it right.2 ky path  https://jamespmurphymd.com/2015/02/13/pathway-to-partnership

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CHAPTER THREE:  Pathway to Partnership, Part 2 (IN) – Here is how we do it in Indiana when we do it right.

Screen Shot 2015-07-17 at 12.33.44 PM

https://jamespmurphymd.com/2015/03/29/pathway-to-partnership-part-ii-in

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CHAPTER FOUR:  Are We In Agreement? – Expectations, edification and enlightenment result from properly implemented patient-physician “agreements.”

agree

https://jamespmurphymd.com/2014/02/19/are-we-in-agreement

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CHAPTER FIVE:  Treating Pain Patients Like Addicts – There is ample overlap between optimal treatment for addiction and optimal treatment for chronic pain. Utilizing this knowledge can enhance the effectiveness and mitigate the risks inherent to treating chronic pain with controlled substances.5 tx like addicts https://jamespmurphymd.com/2014/11/21/treating-pain-patients-like-addicts

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CHAPTER SIX:  Basic Pain Care Certification – It’s a sad fact the number of deaths associated with drug overdose is roughly equivalent to the number of motor vehicle fatalities. Imagine how many might die on our roads if, instead of a driver’s license, all you needed to drive a car was a prescription from a doctor. Now, imagine how many less might die of drug overdose if you had earn a “license” to use controlled substances…

4.5 pain care certhttps://jamespmurphymd.com/2014/08/06/basic-pain-care-certification

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CHAPTER SEVEN:  Strength in Numbers – Successful chronic pain treatment involves: (a) medical care; (b) counseling; and (c) a support system. Find all three and you have probably found…

6 str in num https://jamespmurphymd.com/2014/07/02/strength-in-numbers

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CHAPTER EIGHT:  It’s Only Words – Over the years I have given many presentations concerning medication management for chronic pain. Often I have said that if there is only one concept I want the group to take away it’s that “addiction” and “physical dependence” are not the same thing.

8 words https://jamespmurphymd.com/2014/04/03/its-only-words

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CHAPTER NINE:  Talking Trash – We spend much time worrying about the acquisition of pain medications but too often don’t know what to do with them when we are done.

7 talk trash     https://jamespmurphymd.com/2014/07/21/talking-trash

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CHAPTER TEN:  Is There Method To This March Madness? – Too often our focus is on a specific drug, when in reality the culprit is the disease.

9 march madnesshttps://jamespmurphymd.com/2014/03/18/is-there-method-to-this-march-madness

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EPILOGUE:  Proclaim Pain Care Providers Day! – Don’t just provide great pain care… Proclaim it!

10 PCPD https://jamespmurphymd.com/2015/01/22/proclaim-pain-care-providers-day

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westminster podium

James Patrick Murphy, MD, MMM is Chair of the Board of Governors -and Immediate Past President- of the Greater Louisville Medical Society, Medical Director of Murphy Pain Center, and an Assistant Clinical Professor at the University of Louisville School of Medicine. Dr. Murphy contributes to numerous publications, has presented before national and international audiences, and consults with a wide spectrum of agencies and individuals regarding pain, addiction, and the future of healthcare in our country. He is board-certified in Pain Medicine, Anesthesiology, and Addiction Medicine.

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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.

9403531070_63bc08e2e1_o

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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Is it the singer or is it the song?

I love music.

I am not what one might call “musical.” I don’t have the pipes of a Whitney Houston (see: The Star Spangled Banner) or the soulfulness of a Bob Dylan (see: Blowing in the Wind), but I appreciate their unique virtuosity.

I am a pain care physician. Pain, like music, is a sensory and emotional experience. I don’t sing or play. I touch and treat.

Sometimes I may hit the perfect note, perform the perfect procedure, compose the perfect plan of care.

Other times, despite being well versed, my plan of care may not strike the right chord. Then creating a pleasant sensory and emotional experience depends upon the passion and conviction with which my care is conducted; my song is sung.

Is it the singer or is it the song?

Is it the caregiver or is it the care given?

Music is not only intertwined with my pain care. It is woven into every aspect of my life, including my Twitter feed.

Begging the question: Is it the tweeter or is it the tweet?

Let’s find out.

For a about a year I have been composing a Twitter message or two per day. Recently, I went back and was able to find forty tweets that were “musical” in some way. It may not be America’s top forty, but I think Casey Kasem would still have been pleased.

casey kasem b and w

There are songs from rock, country, and classical genres; from musicals, commercials, television, and the silver screen. Some are serious; some are silly. Original works, live performances, even parodies.

I now invite you to take a little journey through my musical tweets. Click on the image and the link should take you right to the performance. See if you can guess the song before you link to it. Ponder how it relates to the message. Enjoy the sensory and emotional experience. And decide for yourself…

Is it the tweeter or is it the twuuth* ?

 

* twuuth (definition)

  • noun\ˈtwüth\ the twuuth : the truth in a tweet

 

#40

1 25 oct 13

25 October 2013  How the Ghost Stole Pain Care. Dramatic reading by Phil Ward and music composed by Megan McIver

https://twitter.com/jamespmurphymd/status/393876826809843712/photo/1

http://vimeo.com/77715467

 

#39

2 21 dec 13

21 December 2013  A Winter’s Solstice

https://twitter.com/jamespmurphymd/status/414443104792354816?refsrc=email

https://www.youtube.com/watch?v=kh_sckAUkgE&list=PLe1seBFJFklgHIqjjUUUhxZmL_rchZau9

 

#38

3 10 jan 2014

10 January 2014  Act Naturally

https://twitter.com/jamespmurphymd/status/421697528891854848/photo/1

https://www.youtube.com/watch?v=c-07qmTUi9A

 

#37

4 12 jan 2014

12 January 2014 Les Miserables

https://twitter.com/jamespmurphymd/status/422410734950043648/photo/1

https://www.youtube.com/watch?v=HPIos2mXbUE

 

#36

5 26 jan 14

26 January 2014 I’m Only Sleeping

https://twitter.com/jamespmurphymd/status/427318581399789569/photo/1

https://www.youtube.com/watch?v=8KAsr-hix9s

 

#35

6 10 feb 14

10 February 2014 The Gold and Beyond

https://twitter.com/jamespmurphymd/status/433042987648417792?refsrc=email

https://www.youtube.com/watch?v=2hBB4DPw-h4

 

#34

7 12 feb 14

12 February 2014 ABC

https://twitter.com/jamespmurphymd/status/433632926316515329/photo/1

https://www.youtube.com/watch?v=I8GvDLDYhNM

 

#33

8 12 feb 14

12 February 2014 Hearing Winter

https://twitter.com/jamespmurphymd/status/433655563193286656/photo/1

https://www.youtube.com/watch?v=VaXGGPVNnxU

 

#32

9 17 feb 14

17 February 2014 The Way We Were

https://twitter.com/jamespmurphymd/status/435621354222526464/photo/1

https://www.youtube.com/watch?v=6VhNaXV8K4U

 

#31

10 17 feb 14

17 February 2014 Peace of Mind

https://twitter.com/jamespmurphymd/status/435639476686045184/photo/1

https://www.youtube.com/watch?v=Q5ZL8qvEmR0

 

#30

11 21 feb 14

21 February 2014 Doctor Pat

https://twitter.com/jamespmurphymd/status/437033465536462849/photo/1

https://www.youtube.com/watch?v=6vuUpSnPXz0

 

#29

12 22 feb 14

22 February 2014 Honesty

https://twitter.com/jamespmurphymd/status/437388430465462273/photo/1

https://www.youtube.com/watch?v=R4gOIt-M02A

 

#28

13 2 mar 14

2 March 2014 My Bologna

https://twitter.com/jamespmurphymd/status/440310294867234816/photo/1

https://www.youtube.com/watch?v=rmPRHJd3uHI

 

#27

14 5 mar 14

5 March 2014 Oklahoma

https://twitter.com/jamespmurphymd/status/441273659001286657/photo/1

https://www.youtube.com/watch?v=ZbrnXl2gO_k

 

#26

15 14 mar 14

14 March 2014 Hair

https://twitter.com/jamespmurphymd/status/444682878396293120?refsrc=email

https://www.youtube.com/watch?v=7Qf2R-1saDQ

 

#25

16 29 mar 14

29 March 2014 Stupid

 

https://twitter.com/jamespmurphymd/status/449943660134555649?refsrc=email

https://www.youtube.com/watch?v=ers0YPoMxbk

 

#24

17 4 apr 14

4 April 2014 Words

https://twitter.com/jamespmurphymd/status/452173873299980291?refsrc=email

https://www.youtube.com/watch?v=sr-WW5abcwQ

 

#23

18 7 apr 14

7 April 2014 Oops

https://twitter.com/jamespmurphymd/status/453267038077984768?refsrc=email

http://vimeo.com/54035300

 

#22

19 9 apr 14

9 April 2014 Call On Me

https://twitter.com/jamespmurphymd/status/453922140312440833?refsrc=email

https://www.youtube.com/watch?v=Wh86uSsux1M&feature=kp

 

#21

20 17 apr 14

17 April 2014 Lights Went Out

https://twitter.com/jamespmurphymd/status/456764575258402816?refsrc=email

https://www.youtube.com/watch?v=uSSJwKixbKU

 

#20

21 19 apr 14

19 April 2014 Little Wonders

https://twitter.com/jamespmurphymd/status/457546932161110016?refsrc=email

https://www.youtube.com/watch?v=tWU8_uUJJu0

 

#19

22 28 apr 14

28 April 2014 Undun

https://twitter.com/jamespmurphymd/status/460961322163642368?refsrc=email

https://www.youtube.com/watch?v=QzSLxYLuJhI

 

#18

23 15 may 14

15 May 2014 I’m Sorry 

https://twitter.com/jamespmurphymd/status/467135943741157378?refsrc=email

https://www.youtube.com/watch?v=4a_vhiBxi90

 

#17

24 5 june 14

5 June 2014 Let It Go

https://twitter.com/jamespmurphymd/status/474655637620535296?refsrc=email

https://www.youtube.com/watch?v=EtAG3e3JLNI

 

#16

royals

5 June 2014 We Will Never Be Doctors

https://www.youtube.com/watch?v=mxyNzqQNa50

 

#15

25 7 june 14

7 June 2014 Daniel Boone 

https://twitter.com/jamespmurphymd/status/475246656968200192?refsrc=email

https://www.youtube.com/watch?v=VLMCO-JZqWs

 

#14

26 10 jun 14

10 June 2014 Turn It Off

https://twitter.com/jamespmurphymd/status/476212528289038336?refsrc=email

https://www.youtube.com/watch?v=JjCfE1n6nW4&list=PLf470HqOWw3d8Oj5uAXPV19yJ7E7aGDwX&index=163

 

#13

27 13 jun 14

27 June 2014 Don’t Stop Me Now

https://twitter.com/jamespmurphymd/status/477316980274237440?refsrc=email

http://vimeo.com/30126989

 

#12

28 14 jun 14

 14 June 2014 It’s a Grand Old Flag

https://twitter.com/jamespmurphymd/status/477902903290515457/photo/1

http://fan.tcm.com/_James-Cagney-You39re-a-Grand-Old-Flag/video/1146300/66470.html?createPassive=true

 

#11

29 15 jun 14

15 June 2014 In the Living Years 

https://twitter.com/jamespmurphymd/status/478362296126013440?refsrc=email

https://www.youtube.com/watch?v=bWiwde4z9Qk

 

#10

30 16 jun 14

16 June 2014 Pressure

https://twitter.com/jamespmurphymd/status/478599157926473728?refsrc=email

https://www.youtube.com/watch?v=SJCTgtDU-74

 

#9

31 21 jun 14

21 June 2014 Sunrise

https://twitter.com/jamespmurphymd/status/480542585535352832?refsrc=email

http://vimeo.com/88197078

 

#8

32 27 jun 14

27 June 2014 Listen

https://twitter.com/jamespmurphymd/status/482653910616666112?refsrc=email

https://www.youtube.com/watch?v=K5aRRq9mquo

 

#7

33 29 jun 14

29 June 2014 Rumor Has It 

https://twitter.com/jamespmurphymd/status/483451855125479424/photo/1

http://vimeo.com/41795630

 

#6

34 the letter

1 July 2014 The Letter

https://twitter.com/jamespmurphymd/status/484055472618500096

https://www.youtube.com/watch?v=Vrv9slgO7Ic

 

#5

35 all together now

2 July 2014 All Together Now

https://twitter.com/jamespmurphymd/status/484446529210445824

https://www.youtube.com/watch?v=xFpW8g83g6E

 

#4

36 dialogue

4 July 2014 Dialogue

https://twitter.com/jamespmurphymd/status/484941146976567296

https://www.youtube.com/watch?v=YTL53bmYqzM

 

#3

37 danger zone

4 July 2014 Danger Zone

https://twitter.com/jamespmurphymd/status/484955780253106177

https://www.youtube.com/watch?v=58QOBqAWNzE

 

#2

38 if you want it

6 July 2014 If You Want It Here It Is 

https://twitter.com/jamespmurphymd/status/485956691708477442

https://www.youtube.com/watch?v=KWbTZuEWjnc

 

And the #1 musical tweet in the land is…

39 stipe tweet

7 July 2014 Everybody Hurts 

https://twitter.com/jamespmurphymd/status/486224816618213376

https://www.youtube.com/watch?v=ijZRCIrTgQc

 

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keep you feet on the ground

 

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Giving them the business

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On May 22, 2014 the University of Louisville Residents’ Business seminar was the last group I would address as President of the Greater Louisville Medical Society. It went something like this…

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I didn’t have a course like this when I was a resident.

I wish I had.

Somewhere between respiratory acidosis and cardiac preload, learning to read a spreadsheet could have been worked in.

But it wasn’t.

You’re very fortunate that your university is enlightened and generous enough to offer this course for you.

Today, with healthcare taking up about 20% of our nation’s GDP, there are many non-medical types grasping for our nation’s healthcare steering wheel.

Soon you will be finishing your residencies.

You’ll board the healthcare industry train.

You can either be a passenger or a driver.

It’s your choice.

As I prepared for today’s seminar, I thought about what I would say to myself if I could time travel back fifteen years to when I was sitting where you are now, finishing my residency.

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I would tell myself that there are three balls I will have to juggle.

The first ball is your “clinical” ball. Thus far, keeping this ball in the air has been the primary focus of medical school and residency training. Patients’ needs must be met. Your patients must be well.

The second ball is your “family” ball. You’re not on this journey alone. Your loved ones and close friends depend upon you as much as you depend upon them. Lose their support and the stress of being a physician can be overwhelming. Your family must be well.

The third ball is your “self” ball. Do not neglect your own health, outside interests, passions, talents, or loves. Your self must be well.

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The best way to keep these balls in the air is by juggling them yourself. Don’t delegate that job. Even though most of you will be employed, avoid dependence by becoming as comfortable in boardrooms as you are in operating rooms. You must not ignore the business of medicine.

*

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(A letter arrives. It is from the future. It reads…)

Dear 2014 Me,

I’m writing you from the year 2025. Physicians are no longer considered necessary. They just get in the way. Healthcare is a mess. It’s all based on metrics. Everything is quantified and graded. There is no creativity. No innovation. No flexibility. No passion. No compassion. But at least we get to go home when the whistle blows at three p.m.

Yours truly,

2025 Me

*

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This does not have to be our default future. We can do better. But only if we have physicians willing to lead. And physician leaders now must understand the business of medicine, or else medicine will be nothing more than a business. We must be in boardrooms and wrestle back control of the steering wheel.

*

letter 2 screen

(Another letter from the future arrives…)

Dear 2014 Me,

I’m writing you from the year 2025. Physicians are the essential driving force in medicine. Metrics are used to add structure to the art of medicine, not to govern or discipline. The patient-physician relationship is secure and flourishing. Creativity, innovation, and compassion fuel our passions. I don’t know what you told those residents back in 2014, but it must have worked. Thank them for me and for all of us.

 Yours truly,

2025 Me

*

Someone here must have listened. Someone decided to fill the vacuum created by the lack of physician business leadership. Someone stepped up and took firm grasp of the steering wheel guiding our nation’s healthcare. Someone refused to accept our default future.

Who was it?

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*

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Continuity of Care

TourtheTower

On June 1, 2014 at Louisville’s historic and newly renovated Water Tower, the Greater Louisville Medical Society held its annual Presidents’ Celebration.

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As outgoing president I had the honor of introducing Dr. Bruce Scott – my esteemed colleague and childhood friend – as our new President. I also thanked some of the many great folks who worked so hard to make this the most satisfying year of my professional life.

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Before I handed over the President’s gavel to Bruce and assumed my new role as Chair of the GLMS Board of Governors, I had this to say…

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A year ago, as your newly elected President, the last words I said on that stage were:

The Greater Louisville Medical Society is our organization, our tribe, our road to a place where medicine is both science and art, where our community enjoys wellness, and the sacred bond between our patients and us is secure. And my goal this year is to see us united.

murphy speech at pres celeb

It’s one year later, and our profession is under attack as never before. Physician burnout is an epidemic. This is why, more than ever, we must be united.

Back in the day, physicians were a more homogenous group. There were fewer specialists. We shared common values and common goals.

Now government, employers, specialties, patients, and family pull us in many directions. There is an ever-increasing burden for maintenance of board certifications and licensure. Each separate payer and practice facility requires its own credentialing. Medical liability risks keep mounting. The insatiable quest for quantifying quality with data points and benchmarks threatens to crush our creativity and mandate cookbook-style care. Rival non-physician tribes continuously grab pieces of what used to be our acknowledged scope of practice.

How do we respond? All too often by retreating to presumed “safe houses” provided by the one, two, three or more specialty societies each of us believes offers the most protection of our turf.

Got to survive, you know.

The irony is that these refuges are not safe at all. They are static. Stationary. It makes us benign targets for attack by all who would prefer a leaderless mechanized conveyor belt of universal one-size-fits-none healthcare. This sanctimonious deconstruction of our profession is done in homage and servitude to the inscrutable holy trinity of cost-effectiveness, quality, and value.

Survive?

Why not thrive!

Regardless of where your professional journey has led, you and I and our colleagues remain connected at our roots. We still share common values and must share common goals. We are physicians by education, oath, and calling.

And more…

We love our profession.

We love humanity.

And we love each other.

That is why we get up every day, put on our white coats, and go out to save the world.

Because it must be saved.

And we know…

We are the ones who must do it.

United.

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