Tag Archives: healthcare system

HEALING PEOPLE, NOT PATIENTS

Creating Authentic Relationships in Modern Healthcare.

In HEALING PEOPLE,NOT PATIENTS Dr. Weinkle describes ways he believes the current healthcare system in our country  fails to meet the needs of both patients and physicians. Reading it, I thought of a new television medical drama in which a determined, idealistic young doctor fights a bureaucratic system to care for  disenfranchised patients. Critics call the show unrealistic, but if they read Dr. Weinkle’s book, they may decide it’s not so far fetched.

The author,  Jonathan Weinkle, M.D. , FAAP

Dr. Weinkle practices primary care medicine at Squirrel Hill Health Center, a federally qualified health clinic in Pittsburgh Pennsylvania. He  serves as Clinical Assistant Professor of Pediatrics and Family Medicine at the University of Pittsburgh, where he also attended medical school. He lives with his wife and three sons.

Dr. Weinkle contacted me after reading  my review of a book by Dr. Danielle Ofri. He asked if I would consider reading and reviewing his book also.  I agreed, and he provided a complimentary PDF copy.

Pitchwerks podcast - #115:Dr. Jonathan Weinkle
Dr. Weinkle’s podcast


Why our healthcare system is broken

One problem, he says,  is the EHR -electronic health record, which doesn’t allow him to express himself the way he would like. He prefers to


open a patient’s (paper) chart,(so it) tells me a story about the patient much like he might tell himself, almost as if I am reading a medical memoir

Although he calls this book  a “how to”- how to restore the sacredness of the doctor-patient relationship– it also  reads like the “medical memoir” he prefers for a patient. It’s his memoir, a telling of his journey from a  medical student entering the “adventure” of medicine to a graduate physician who believes


“Practicing medicine is a privilege, a gift- a sacred trust.

He illustrates several issues plaguing modern medicine using anecdotes about patients from his practice (with details changed to preserve privacy and confidentiality). Our current medical system sabotages   healing by

  • Fractured communication
  • Muddled priorities, where paper work takes precedence over patients
  • Procedures valued over counselling
  • Volume incentivized over value
  • Turning humans in pain into consumers, “as if they were buying televisions”

A turning point and lesson learned

A couple of months into medical school, Dr. Weinkle interviewed a distressed patient in acute alcohol withdrawal. He tried to develop empathy for the man as he unraveled  his long history of alcohol abuse and explored his reasons for trying to quit.

However,as he proceeded to examine the patient, his empathy evaporated when the man rolled up his sleeve for a blood pressure check- revealing a huge tattoo of a Nazi swastika.

Dr. Weinkle is Jewish.


“I am not a vindictive person, but all I could think was, “Well, it serves him right. This is poetic justice.”

He excused himself, never telling his preceptor how ill it (the tattoo)  made him feel, or the malicious thoughts it triggered in his mind.

In HEALING PEOPLE, NOT PATIENTS, Dr. Weinkle explains how he learned to change those kinds of encounters into ones with


Open, honest communication, mutual respect, and shared purpose, even when systemic problems push them into adversarial positions.

But it’s not easy.


even when everyone has the best of intentions,
building a covenantal relationship in the current healthcare system is about as easy as
building a house on the Carolina coast and not having it destroyed by a hurricane.

a male doctor talking to a middle aged woman
Photo by Dr. Weinkle’s son, used by permission

How to fix our healthcare system

One way he makes it happen is by working in a Federally Qualified Health Center, FQHC.

A FQHC is the closest thing we in the U.S. have to “socialized medicine.” Dr. Weinkle has worked in one for 10 years. As he describes it, in a FQHC

Anyone who is a stranger to the healthcare system, who has to clear high barriers in order to access care, should be welcomed in and have help knocking down those barriers.

Most doctors  concentrate on helping patients manage acute and chronic disease and try to address the major causes of disease and death -smoking, poor eating, lack of exercise, stress, sleep deprivation, substance use, and obesity. But doctors like Dr. Weinkle tackle other challenges , the “social determinants” of health. These include

  • Inadequate houses or homelessness
  • Lack of reliable transportatin
  • Unsafe neighborhoods
  • Food Deserts, where healthy food is unavailable
  • Language, ethnic, or cultural differences
  • Discrimination and/or exclusion
  • Unemployment, low wages, and/or poverty
  • Limited education and/or education opportunity

His patient panel consists of people who are

  • Refugees, who often speak little or no English
  • Members of ethnic minorities, including African Americans and Hispanics
  • LGBTQ persons
  • People who are mentally ill and/or developmentally challenged
  • People with stigmatizing illnesses, such as HIV/AIDS
  • People with substance abuse
  • People who have been incarcerated


Dr. Weinkle feels at home taking care of them because

“I come from a long line of people who have been strangers in a long line of places. We are supposed to understand how it feels to be shut out, demonized, misunderstood, or simply ignored.”

Since I finished residency many years ago,  I have had limited experience treating these types of patients, but enough that I understand the challenge, frustration, and sometimes satisfaction of doing so. Non medical professionals may be surprised by Dr. Weinkle’s descriptions of dealing with patients who are often unable or unwilling to cooperate with even basic healthcare steps.  

American medical care has transformed in the past 50 years but most of us wish it still worked like in the “good old days. As Dr. Weinkle describes it


most doctors were solo practitioners who did everything, and a patient, especially in a smaller town, could expect care that felt like home.
Continuity throughout their life… and accompanying them through
old age.
Presence wherever and whenever it was needed, in the middle of the night,

Unfortunately, medicine in the 21st century doesn’t look like that because


There are too many different kinds of care,… and too many demands on a doctor’s time to enable this kind of practice ..


Hospital privileges, insurance credentialing,

and the simple fact that doctors have belatedly learned that we can’t work 168-hour weeks and maintain our own health and family relationships

prevent us from being like our favorite docs of yesteryear.

Dr. Weinkle’s practice uses the concept of a “medical home”, often called the patient centered medical home, PCMH, which many medical offices are adopting, not just FQHC. But it is especially important with patient groups like the ones he and his colleagues care for.

(The concept of PCMH is explained here Defining the PCMH )

He takes it one step further, writing we need more than medical homes, we need medical communities, where doctors work closely with their local hospitals, ERs, pharmacies, and schools to address patients’ needs.

a male doctor examining a smiling baby girl
Dr. Weinkle’s baby girl patient seems to be enjoying her visit. Photo by the girl’s father, used here by permission. When posted on Facebook, this photo received 4000 likes in one week.

The solution- covenant health care

In HEALING PEOPLE, NOT PATIENTS Dr. Wrinkle argues for creating authentic relationships in modern healthcare by  

Promoting health behavior change without insulting or scaring patients, by learning what obstacles they face and helping to resolve them

Honesty about disease outcomes, especially at the end of life; avoiding futile care, and recognizing that sometimes death is not a complication but is the ultimate outcome of some illnesses

“Activated patients”  determined to get better,  to do something about their illnesses, becoming experts on their diagnoses

Doctors and patients valuing and respecting each other’s time and knowledge

Cutting waste- eliminating those things we do in healthcare that don’t add value to care, making it safer or more effective; bureaucratic policies, procedures, and rules that waste both time and money, like prior authorizations, “utilization review”, and 15 minute appointments

Medical education that includes teaching interpersonal skills, with learning objectives given as much importance and time as other medical skills,

Ultimately, Dr. Weinkle wants to see medical care return to being


meetings between two human beings, together forming a covenant to achieve healing

That concept is partially born out of Dr. Weinkle’s Jewish roots discussed in the Appendix- Being a Nice Jewish Doctor

“God forms a covenant—many covenants, actually, sealing the promises with symbols like rainbows (Genesis 9:13), circumcision (Genesis 17:10), and stone tablets engraved with the law (Exodus 24:12).

Image from Lightstock.com, stock photo site, affiliate link

The essence of the Jewish faith, the place where a Jew’s worth as a person is tested most thoroughly, is in the relationship with God—and the parallel relationship with other human beings made in God’s image. ”  


Why you should read HEALING PEOPLE

Health care professionals will find Dr. Weinkle’s concepts an attractive alternative to “burnout”, an encouragement to remember why we entered the profession in the first place, and a challenge to restore the personal touch that makes medicine truly an art.

Patients will find explanations about why medical care is at times fragmented, uncoordinated, and unproductive, will understand the challenge that their own physicians face in providing effective care, and understand how they can be part of the solution.


The book concludes with  an extensive list of Notes listing the references used in each chapter and an exhaustive list of References and Suggested Readings, a few of which I will include below.

Here is a link to Dr. Weinkle’s website where you can read excerpts from the book.

Healers Who Listen

An unexpected connection

You may recognize Dr. Weinkle’s practice location as one that was recently in the news.

a building with sign-Squirrel Hill Health Center

Squirrel Hill is considered a historic center for Jewish life in Pittsburgh. It is home to more than a quarter of Jewish households in the Pittsburgh-area, according to a Brandeis University study of the Greater Pittsburgh Jewish community.

This is also the Pittsburgh  neighborhood where a gunman walked into the Tree of Life Synagogue and opened fire, killing 11 people on October 27, 2018.

I had only exchanged one email with Dr. Weinkle so it wasn’t until a few days later that I made the connection. I wrote to him and was relieved to learn he was safe.  He had attended a Bat Mitzvah there just the week before the attack. Some of the victims were friends and colleagues.

I will tell you more about that in an upcoming post.

Suggested resources

Here are a few of Dr. Weinkle’s recommendations; please note these are affiliate links which help me fund this blog.

Thanks for joining me to meet Dr. Weinkle and review his book. Please follow Watercress Words to learn more about him and his work, as we explore and share the HEART of health.

                              Dr. Aletha 

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10 health blogs you should read- 3 blogs by 3 docs

 

Today I am continuing my series about health blogs you should read.  We’ll look at 3 blogs by physicians in 3 different specialities  today.

For the complete introduction to this series and for the first 2 blogs, go to this post, otherwise continue reading .

 

I recommend these health blogs because they

  • offer valid medical information on a variety of topics.
  • offer sound advice without quick fixes.
  • discuss common everyday health concerns
  • discuss the healthcare system, how it works well and how it doesn’t.
  • offer insights on healthy living, both as individuals, families and a society.
  • show you how physicians think , feel and act , both as persons and professionals
  • will educate and challenge you.

These blogs open a window into the medical community.  You may be surprised that physicians have the same concerns about health and medical care as you , and some that you are unaware of. Most importantly, you will find they are on your side; they care about you,their patients,  probably a lot more than you care about them.

 

These bloggers’ viewpoints often surprise and challenge me; I don’t always agree with them and you may not either.  By recommending them, I don’t endorse their opinions, nor do I benefit financially.  

We’ll explore these 10 over several days so check back often, or subscribe by email to make it easy to keep up.

The accompanying photos are illustrative only, and are not necessarily affiliated with the blogs or bloggers mentioned.

 

James Marroquinn, M.D.

Dr. Marroquinn writes on health, bioethics and the practice of medicine.

He practices internal medicine in Austin, Texas, is  fellowship-trained/board certified in palliative care and works from time to time at an inpatient hospice facility.

Battleship Texas sign
The last of the battleships to participate in World War I and II, Battleship Texas became the first battleship memorial museum in the U.S. in 1948.

the Battleship Texas
The Battleship Texas State Historic Site is in Houston.

 

 

His goals for his self-titled blog are

“to inform people (including myself) about health science, ponder philosophical, political, theological issues associated with medicine, and make sense of my experience as a physician.”

Dr. Marroquinn posts infrequently; his posts are timely, articulate and informative.

Here is a post I especially enjoyed about Boxing and Parkinson’s Disease. He discusses a video about 60 Minutes news correspondent  Leslie Stahl and her husband who has Parkinson’s Disease.

In this post, he offers three reasons why physicians and other health practitioners should recognize and address the spiritual component of their patients’ lives. 

 

medicine for real– Navigating the healthcare system

is written by  blogger Dr. Shirie Leng, an anesthesiologist, who writes,

“I have worked in health care both as a nurse and as a doctor for 15 years.  The health care industry is just that, an industry.  As such it doesn’t have a whole lot of concern for the “customer”.  I write about the processes, redundancies, red-tape and pure pointlessness of much of medicine, so that you can make decisions and navigate for yourself.”

pre-op area of hospital
I suspect Dr. Leng spends much time in places similar to this.

 

 

Besides healthcare, she writes about education, insurance, end-of-life issues, motherhood, and the history of medicine.

Dr. Leng had not posted in awhile because, as she explains it, “nothing health-care related has outraged me recently.  And I definitely write better when agitated about something.”

But she did post  this piece recently, Health Is For Us, Not you , in which she touches on mass shooters, Syrian refugees and ISIS.

 

 

freud & fashion

BECAUSE IT’S STYLISH TO TALK ABOUT MENTAL HEALTH, ESPECIALLY HOW WE MAINTAIN OUR OWN.

THE WRITINGS OF A YOUNG, MODERN & NEWLY-GRADUATED PSYCHIATRIST

You’ve met Vania Manipod, D.O when I shared her post about New Year’s Resolutions.

In this post, Dr. Manipod gives tips on recognizing and controlling anger

 

musicians on California beach
Dr. Manipod comes from California , which I found to be an interesting place.

flowers along the Pacific Ocean shore
And beautiful.