Jonathan Weinkle – Page 2 – watercress words by Dr Aletha

A goodbye to healers who listened-Squirrel Hill mourns and heals

I was horrified by news that another mass shooting had occurred, this time at a synagogue in a community called Squirrel Hill. A few days later, I realized I had seen that name before. I had met someone who lives and works there.

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In early October of 2018 I received an email from a physician I had never met. He had written a book and asked me to read and review it on my blog. I agreed and soon received another email with a PDF copy. I read it and posted a review here.

A couple of weeks later I was horrified by news that another mass shooting had occurred, this time at a synagogue in a community called Squirrel Hill. A few days later, I realized I had seen that name before.

The physician who wrote to me, Dr. Jonathan Weinkle, practices at the Squirrel Hill Health Center. And he is Jewish.

Pitchwerks podcast - #115:Dr. Jonathan Weinkle

Squirrel Hill, Pittsburgh, Pennsylvania

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.

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.

And as I had feared, some of the victims were friends and colleagues.

I’m not going to repeat the details of the horrific event as it was widely reported in the news. Here is a link to a news report.

How a deadly shooting unfolded at the Tree of Life synagogue

One of the victims I had learned about through our professional organization, the American Academy of Family Physicians, AAFP. Dr. Jerry Rabinowitz’s death was reported on the organization’s Facebook page. He was a friend and colleague of Dr. Weinkle.

Also killed was dentist Dr. Rich Gottfried who worked at the Squirrel Hill Health center where Dr. Weinkle practices.

a building with sign-Squirrel Hill Health Center — THE SQUIRREL HILL HEALTH CENTER

Dr. Weinkle eulogizes his friends

Dr. Weinkle wrote reflections about his two friends and colleagues, shared them with me, and graciously consents to my sharing with you.

This message was posted on the Squirrel Hill Health Center Facebook page

Dr. Rich Gottfried

The Hebrew letters often hint at a common object: bet hints at bayit, a house. Gimel hints at gamal, a camel. And shin? Why, shen, of course – tooth.

I like to think that the reason for this is that shin, or rather sin, which is the same letter with the dot moved to the other side, is also the first letter in sameach, happy. And what do we do when we are happy? We smile and show our teeth.

My colleague Rich Gottfried smiled all the time; as people spoke at his funeral, or around the office this week, almost all took note of his smile. He was the Hines Ward of dentists, it would seem – always smiling.

Rich brought happiness to people through their own teeth, too. Poor dentition is a major source of shame for people, afraid to smile or look someone in the eye for fear of having their decayed teeth be the only thing the other person will see. For a person without dental insurance, or without substantial means, dental work or even preventive care can be prohibitively expensive. A Hobson’s choice – shame, or bankruptcy?

Rich listened to that struggle. Even when he was in full time private practice, he blocked off time to do pro bono work for the uninsured . And as he and his wife Peg Durachko, who was not only his life partner but his dental partner, wound down their practice as they approached retirement, they brought their services to us, at a community health center that treated many people who had never seen a dentist in their lives.

They overcame the fear that one dental cleaning might lead to all the teeth falling out, and got things set right for the first time ever. Culturally competent dentistry – now those are healers who listen.

Shin stands for something else, too – Shadai, the almighty God. It is the letter on every mezuzah on every Jewish door, reminding us that God has our backs, and that we need to refresh ourselves on what God wants from us every time we enter or leave a room. And for Rich Gottfried, what God wanted from him was to be a blessing to others around him, through his talents in taking care of their shin-ayim.

a Jewish passover seder plate with a lit cancle — photo from the Lightstock.com collection, an affiliate link

Dr. Jerry Rabinowitz

“Do not console a person whose deceased relative lies before him” Pirke Avot 4:23

Well, now we have begun to bury them; the time of consolation for the families and community of my murdered friends has begun. They are no longer lying before us and we must begin to fix their memories in our minds.

Among the dead October 27^th were two men who epitomized the title of this site: “Healers who Listen.” A third still clings to life and with God’s help may recover to help the rest of us heal. Over the next three days I will remember each of them.

Jerry Rabinowitz was laid to rest yesterday, October 30^th. In the hour before the funeral I was with a friend who told me that Jerry had been his doctor. With a wry smile, he told me,

“The first time I went to him we were in there for an hour and a half – and the first thirty minutes had nothing to do with my health.”

He listened to get to know the person sitting in front of him before diving into the rabbit hole of the purely physical.

At the funeral, Jerry’s partner Ken Cieselka spoke of “their finest hour” as a practice – the late 1980s, when they began caring for patients with HIV/AIDS. The disease was then incurable, and the people suffering from it were then considered by many to be untouchable.

But not by Jerry and Ken. They listened to the voice of suffering that no one else would ease, and understood it was their responsibility to do so.

At the synagogue, Jerry heard gunfire. In that sound, he did not hear a warning to get out. He heard people being hurt, of people who would need his help.

There is a Jewish concept that the choleh l’faneinu, the ill person in front of us, should get our attention first. For Jerry even being aware of that person’s illness or suffering, even in danger, even where he could not see them, put them l’fanav, right in front of him, where he had to help them.

He listened, and met his end as he lived his life, caring for people.

I assume Jerry did not have a chance to read Healing People, Not Patients; it was only published a month ago and he was as busy as I was. The truth is that he did not need to read my manifesto of compassionate, personal healing. He lived it; he could have written it himself.

a male doctor talking to a middle aged woman — Dr. Weinkle with a patient

Here are profiles of Dr. Gottfried, Dr. Rabinowitz, and the other nine victims of this attack.

Tree of Life Congregation Shooting Victims

Dr. Weinkle concluded his note to me, writing,

“ The good news is that unlike other pogroms that have afflicted my people over the centuries, this one was carried out by a lone wolf and the majority of our neighbors are on our side, not the side of the perpetrators. There is strength and hope in that beyond measure.”

Visit Dr. Weinkle’s website , Healers Who Listen

sharing the HEART of health

Thank you for joining me to honor Dr. Weinkle’s colleagues. Please share this post and my review of his enlightening book, HEALING PEOPLE, NOT PATIENTS.

HEALING PEOPLE, NOT PATIENTS- a book review

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.

Creating Authentic Relationships in Modern Healthcare.

This post has been updated October 2020.

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 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.

That was 2 years ago. Little did we know or imagine how different medicine, and everything else in our world would be by late 2020. In a blog post, Dr. Weinkle reflected on how the SARS-CoV-2 pandemic has changed his approach to his medical practice and to his faith.

Two years ago that doctor (himself) had just published a new book about listening to people, finding the person within the patient, and overcoming systems and stigmata to provide them with kind, respectful, compassionate and excellent care. That doctor had no idea that over the next two years, the world would fall apart again, and again, and again. That doctor has changed, because he is exhausted.
Unfortunately, that’s how most of the world is feeling these days, and how a lot of the people I care for feel much of the time. Shocked and confused. “Why me?” God created a universe, and it is going to pieces around me. God gave me a body and it’s going to pieces on me.
Dr. Weinkle

Why our healthcare system is broken

In the book, he identifies the EHR -electronic health record, as part of the problem, because it 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

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.

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. ”

What he sees beyond COVID-19

In the blog post I referenced earlier, Dr. Weinkle sees hope there too.

Two years ago, I approached… from the view that wholeness, completeness, was our natural state,… I believe the opposite now – the world began as chaos, as shock and confusion. The miracle of the universe is that anything beyond that even exists – anything we have is a gift. The comfort I take is that the one thing older …, the thing that hovered over even the unformed universe, was the rucha d’rachamin, divine mercy, and it shines light even before anyone has “let there be light.”
Dr. Weinkle

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 and find a link to his blog post Winds of Mercy

Healers Who Listen

An unexpected connection

You may recognize Dr. Weinkle’s practice location as one that made headline news a few years ago.

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.

More of that story is at this link.