| Patient and Doctor: Changing Job Descriptions by Vicki Rackner MD The flu vaccine shortage captures the basic question in medicine: what is your doctor's job and what is your job in achieving and maintaining your health? You may have come to believe that it's your doctor's job to keep you healthy by doing things for you and to you, like injecting a vaccine. Simple, inexpensive day-to-day things you can do for yourself like hand washing are often devalued or trivialized. History tells the story of how and why patients came to expect their doctors to take charge of keeping them healthy. Flash back to 1918, the year the flu pandemic claimed between 20 million and 40 million lives around the world. This viral illness killed more people than the battleground in WW I, and tens times more than the total numbers of AIDS victims to date. The belief that the hospital is a place to die is founded in experience. In the early 1900's you had a better chance of being harmed than helped if you went to the hospital. The introduction of penicillin in the mid-1900's changed the landscape of medicine. Bacterial infections which once had a death rate of 80 % were now treatable conditions. Each decade brought more powerful medication and more effective diagnostic and therapeutic tools. The ability of the doctor to fight disease was unprecedented. Of course you would put your health in the hands of your doctor; it was the best game in town. The rise in status of technology-based medicine was accompanied by a decline in respect for *folk remedies.* The big impressive landmarks in medicine were illustrated by examples that doctor did to patients. That's the problem in a nutshell. Patients expect doctors to take charge of their health, and interventions based in technology are most revered. A patient's personal responsibility has been minimized, and self-care is under-valued. In both the vaccine shortage and the more global health care picture there is a question: how can we scurry to generate more resources that are now scarce, and how will we pay. The vaccine shortage reminds us that there's a viable alternative. We're promoting the safe, simple accessible intervention of hand washing. This is a concrete example of taking health into your own hands. In his book Leadership, Mayor Rudolph Giuliani describes his approach to the challenges he faced when he assumed leadership of New York City, strangled with knots of debt, crime and unemployment. He began the untangling by eliminating graffiti and getting tough with subway turnstile jumpers. The act of washing graffiti ultimately knit NYC to health. The act of washing hands offers the potential to do the same with our troubled health care system. Fixing our broken health care system is as simple as getting back to basics. You and your and doctor really talking and listening to each other. You and your doctor doing what you say you will do. Making simple day-to-day choices that lead towards health, like regular hand washing or a twenty minute walk four days a week. Conservatively half the diseases we treat can be prevented with better day-to-day choices. Patients and doctors, working hand-in-hand offer powerful medicine in the treatment of our diseased health care system. I invite you to imagine the qualities in your ideal doctor and your job in creating an ideal collaboration with your doctor. Maybe you could even write job descriptions and here's a possible starting point: *Wanted: Caring professional with excellent communications skills, solid clinical judgment and honed technical abilities whom I can proudly call 'My Doctor.' You collect key medical and personal information and put the puzzle pieces together in a way that makes sense. You recognize that I am the expert on my own body, and offer insights that guide me to my choices that make most sense for me based on your knowledge and experience. When we don't see eye-to-eye, we respectfully agree to disagree. I deeply trust you. One day my life could be in your hands* How about your own job description of *patient?* *I'm in the driver's seat in my journey to health. I recognize that all choices can lead in the direction of health...or of disease... and I make consistent choices that lead to health. Even when I'm doing my best I still might get sick, because there are factor I cannot control, like genetics and environmental factors and plain old bad luck. If I get sick, I collaborate with you to restore my health. While I appreciate the many things you do for me, I know that ultimately my health is in my own hands.* As you do so, consider this: you get the best, safest and most cost effective health care when you take your health into your own hands. Ask not what your doctor can do for you; ask what you can do with your doctor. It's more important than ever to take an active role in healthcare. The best way to get top-quality, safe and effective healthcare is to actively and knowledgably participate. Visit http://www.MedicalBridges.com for the tools to get you there. Copyright (c) 2004. Vicki Rackner. All rights reserved. Vicki Rackner, MD, president of Medical Bridges, is a board- certified surgeon who left the operating room to help employees become active participants in their health care. She is a consultant, speaker and author of the Personal Health Journal. Reach her at http://www.MedicalBridges.com or (425) 451-3777. |