End of Life Care: We Can Do So Much Better (Dedicated to Wilbur)
Ever since I watched my grandfather and grandmother suffer from devastating diseases like diabetes and dementia, I have always been passionate about how we treat people at the end of their lives. With all of the technology, specialized medicine, and wonderful hospitals we have in this country we often never know when it’s time to stop using them. As physicians, we are so afraid of losing patients (i.e. failing), and death and dying in general, that we often lose sight of “life and living”. Sometimes the best medicine is to not only let people go, but more importantly to let them go on their own terms.
Yesterday, I lost of one my longtime patients and supporters- Mr. Wilbur Basset at the age of 89. (I am using his name and picture with permission from his family.) Wilbur and I met when I first moved to practice in Marblehead 8 years ago. What struck me about him was both how healthy he was for an older man, and even better how incredibly sarcastic and funny he was. I always enjoyed that he was for lack of better terms “a curmudgeon”. He never complained unless something was truly bothering him. It took 8 years, and me removing myself from the factory mill of modern day healthcare in order to move to the Direct Care model, for me to actually meet his family and spend time with them. I am so glad that they stuck with me and gave me the chance to show them what medicine can be like.
Unfortunately, over the past few months Wilburs illness and condition worsened. I saw him in the office with his daughter a few weeks ago and I could tell that he was declining. Given how stubborn he was, he always fought through stuff, but this time he just looked different. As I helped him in the car he said “I am so ‘blanking’ done with this.” I just knew he was ready. So after his daughter and I had a great chat about consulting with Hospice, he sadly ended up in the hospital before we could get the consultation scheduled. When I visited him there I could see how miserable he was. After a week or so, which of course included a few unnecessary consults, he rapidly worsened and was transferred to the Kaplan House where he peacefully passed away with family by his side after a day. Fortunately I got to say my goodbye to him yesterday.
As a system, we have to do better for patients like Wilbur and their families. We must do better. For me, I will always remember him the way he was a few weeks ago, and I will always be thankful to have had the opportunity to care for him and his family through his journey. I may not be a specialized surgeon or a cancer specialist, but I am so thankful that Wilbur and his family went Direct Care with me and granted me the most gratifying job in the world. I was his doctor.
Rest in peace Mr Bassett. You have earned it and did it on your terms.
Reasons # 2 and 3: Happy Birthday
I want to dedicate this entry to my now 6 year old twins- Cameron and Isabella. It is amazing to me that time is going by so quickly and that you two are already 6 years old! It seems like just yesterday we were learning how to give you your first baths, and now you are in Kindergarten learning how to write and count. You are now talking back instead of just screaming….although often there is still some screaming. Your are playing soccer, learning how to skate, tumbling, building legos, and all of these other amazing things that are so enjoyable to watch. Yet, most importantly, you are constantly inspiring me to be a better person.
You are a significant part of the reason why I left a well-paying job as an employed physician to put us in debt and start this practice. I know its often hard when I am working many hours trying to take care of patients or working to grow this business, but I want you to know that you are why. I love when when you both ask questions like “how was your patient?, are they ok?, did you get any new patients today?” It shows me that we have taught you to care! In the crazy world we live in we are often bombarded with ugliness and what people are doing wrong. I want you to have a dad who shows you what is right. I want you to see that doing the right thing is not always easy and that people may act like you’re crazy, but to keep doing it. Do not give in to naysayers and fight for what you know and believe to be right. If you do these things you will never fail. You may have to “regroup” and find other solutions sometimes, but you will never fail.
As one of my boyhood idols Wayne Gretzky once said: “You miss 100% of the shots you never take.”
So always take the shot- or at least pass it to someone who has a better scoring chance. And thank you for driving me to be the type of doctor, father, and person that I want to be. As much as I love medicine, I will always love you guys more. I hope you always know that. So Happy Birthday and enjoy the gifts that you will play with for 5 minutes and then never touch again 🙂
ICD-10: It’s Nice Not Knowing You
Today, October 1st 2015, is a very critical day for the “disease management” system that we mistake for a healthcare system in the United States. Today is when the new coding system called ICD-10 goes live for a majority of American physicians and Nurse Practitioners. This is nothing more than another layer of bureaucratic red-tape that does nothing to enhance the quality or cost of your care, but rather furthers the disease process. All it does is waste more of your physicians and office staffs time- time that should be spent working towards your care. Instead it just feeds an already broken machine that is aimlessly running on fumes while blowing exhaust into the faces of the people whom matter most- the doctors and the patients.
Luckily for us and other brave practices and patients across the nation, we have nothing to do with this nonsense. We have decided to escape the mess and fix medicine from the ground up. Our focus is solely on working together towards a system that actually makes sense and works for our patients. This is what gratifies us most- being able to provide care the way we trained to do. So help us raise awareness about the Direct Primary Care model today- National Direct Primary Care Day! Check out the following link, share it, talk about it, and maybe even buy a t-shirt:
And finally, here’s to being part of the solution rather than adding to the problem. We thank you for your support and for being willing to do one of the hardest things for anyone- change.