All Pain Eventually Stops
You look at me incredulously.And indeed, what I've just said has probably shocked you. That was not my purpose. You see your loved one in the ICU, medical floor, or nursing home. There may be tubes or IVs affixed in their proper places. You see suffering.Your loved one is dying and you are crippled by your own incapacity, my incapacity. But look closely. There is no sweat on the brow. The heart rate is measured and steady. In fact the room is calm. This death will be quiet and subdued. It is your suffering that I worry about.I repeat myself, and watch your eyes closely ...
Source: In My Humble Opinion - January 12, 2014 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
Is Medicine Giving You PTSD?
I immediately noticed upon awakening that the intense jaw pain was gone. I guess the TMJ was on hiatus. Than I reached my hand down to my waist to make sure that the pager hadn't fallen off during sleep (as I do every morning); it wasn't there! It took a few moments for me to remember that I had dispensed of it the day before. For the first time in years, the buzzing, beeping, insistent mistress had been silenced.And the rest of the week has been just like this. No headaches, no jaw pain. When I see a patient for a visit there is no ringing or buzzing interrupting my thoughts. Ther...
Source: In My Humble Opinion - January 7, 2014 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
The Home Visit
I guess it shouldn't have been a surprise. Her house was exactly as I expected it to be. The door couldn't have been more fitting; red wood with a green holiday wreath attached perfectly in the center. The carpet was so white that I almost took off my shoes on the front porch before entering through the threshold. The room was warm. The ambient temperature was accentuated by a plethora of colors and fabrics in contrast to the stark carpet.I stepped into her living room and unloaded my bag. I took out my equipment carefully: computer, stethoscope, blood pressure cuff. I glanced up at the ...
Source: In My Humble Opinion - January 3, 2014 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
Just A Small Town Girl
Just a small town girl.Livin' in a lonely world.It's funny how your mind can be in two places at once. The boat is bouncing up and down off the coast of Puerto Vallarta. The music blares from the speaker above my head. My daughter is face down on a towel. She writhes back and forth complaining about her stomach and the rocking motion of the ocean. I am a world away. Sitting in my brother's room on a brown bean bag listening to the Journey album that he just purchased. It's the eighties, and I probably am no more than ten years old. We listen to the song over and ove...
Source: In My Humble Opinion - December 25, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
Almost Everything
Everything is beautiful in Puerto Vallarta. Almost everything.The kids have left a half finished virgin strawberry daiquiri on the small lounge table next to us on the beach. I sit with a book lilting in my hands in the mid afternoon sun. The bugs come and go. A bee sniffs around the opening of the glass. He hovers ever so gently above the sugary brew unaware that he is about to falter. He lands nonchalantly on the froth but flutters his wings frantically when he realizes that he is stuck.And I think that this death. One moment you are parading your freedom in search of what ever drives a little bee's mind and the n...
Source: In My Humble Opinion - December 23, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
It's Time To Land This Bird
I have been doing a lot of travelling lately. Each trip begins in the planning phase. Usually there is a burst of energy. An idea flowers. Road blocks form and are hurdled over. This is the most critical moment. It only takes a light wind to blow us off course, to decide that the whole idea is a farce. How many jaunts have spanned the mind only to stumble when pen reaches for paper, when concrete overtakes the ephemeral. But once the wheels have left the ground, once a comfortable cruising altitude is reached, a transition takes place. Now the journey has indeed started. The initial gusto gives way to a much cal...
Source: In My Humble Opinion - December 21, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
Cognitive Dissonance
I am in love with the old ways. The wheels of my car struggle to grip the powdery snow of the unplowed highway. The sun's absence attests to the premature beginning of my Saturday morning. My wife and children are asleep quietly in their beds. Most of the world is in fact sleeping. Already, my dance card is full. Between two hospitals and three nursing homes, a number of crises are brewing. By the mornings end, I will sit by the bedside as one patient dies. I will have family meetings, make critical decisions, review labs and talk to specialists.Unlike many of my colleagues, I still practice in the office, nursing home, an...
Source: In My Humble Opinion - December 15, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
Silly Rules Made In Ivory Towers
Why must everything be so difficult?Soni pushed her mother quickly into the building from the parking lot, she wore a strained look on her face. The wheel chair appeared preposterously large for the aged figure cowering under the haggle of blankets. They were enjoying the brisk air, taking a walk around the facility, when the elderly woman called out. Her lips curled and she moaned deeply.Now Soni's mother had stopped talking months ago, but the devoted daughter had become adept and interpreting the grunts and groans. The sound her mother was presently making, however, was different, alarming. ...
Source: In My Humble Opinion - December 12, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
#DOTMED13 Wrap Up
In conclusion, I got so much from #DOTMED13. While sometimes we spoke of different subjects: technology, social media, art, and story telling. We all were trying to use our unique passions to bridge the gap with our fellow humans, to take better care of each other.I can't think of a better way to spend a Friday afternoon. I have tons to say about @RonanTKavanagh and @muirishouston who hosted the event but I fear it would take to long. I will have to save it for another blog post. (Source: In My Humble Opinion)
Source: In My Humble Opinion - December 7, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
Once Again, The Pound Of fat Comes From The Primary Care Physician
My dear medicare patients. The government has just screwed you. Did you know it? Probably not, probably you have no idea about what the government is proposing to do. But it is going to have profound effects on the quality of the care you are about to receive. You are confused? You are surprised? Let me explain. The government is proposing to change the way it pays doctors for outpatients visits. According to modern healthcare, medicare intends to pay physicians a flat rate for each visit. That's right, a healthy sixty five year old with a cold will lead to physician charges that a...
Source: In My Humble Opinion - November 30, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
Do Mechanics Have More Freedom Than Doctors?
So a guy has his car towed to the mechanic. All four tires are slashed. He has a simple request.Please replace the tires.But this is one of those comprehensive care mechanics. He not only examines the tires, he does a full once over. He pops the hood and immediately knows that the engine is shot. It's fried. The cost of fixing the engine is more than the value of the car. It's a zero sum game. The owner shouldn't replace the tires, he shouldn't work on the engine, this car belongs in the scrap heap. He saunters out to the waiting room, and delivers the bad news to his eager customer. The mechanic is utterly stunn...
Source: In My Humble Opinion - November 24, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
I Am Not A Mark
I am not a disease.Although when I enter your hospital, or office, or outpatient center, you may refer to me as one. You may lump me together with an odd set of symptoms, or signs. You will define me with those antiquated terms. You will pretend that you will know how I, my body, will react when placed under certain stressors. You will prescribe treatments for my disease, and yet leave me out of the equation.You know, me, the me that the rest of the world sees when I am outside the obtuse boarders you have created. Only a milifraction of my life occurs in your realm. The labels you give, the actions you take, have conseque...
Source: In My Humble Opinion - November 18, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
Colleagues
Roger struggled with various maladies that came with growing older. His blood was occasionally too sweet, his pressure stumbled upwards, at times perilously. But it was the colon cancer that gave him pause. It started rather innocently. At first he noticed a little blood on the toilet paper, later, a touch of abdominal pain. He put off the appointment for a few weeks, but eventually he showed up in my examining room.We talked about the pros and cons of colonoscopy. Roger liked to think deeply about his medical problems. A few days later, he underwent the procedure. The cancer was l...
Source: In My Humble Opinion - November 14, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
Are We Waiting For Godot?
Ten reasons I feel pessimism about our current healthcare environment (in brief):
Process vs Product
Computers are just machines. I repeat, they are just tools. Health information technology is a shell which houses knowledge and human ability. It is nothing more . Electronic medical records may either streamline our thought processes or make them more cluttered. They will not, however, lead to better or more perfect care. They haven't yet, and they won't in the future. And they are prone to be adulterated by commercial intentions. Looking for an answer to our complex healthcare p...
Source: In My Humble Opinion - November 11, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
Introducing The Palliative Care ICU
Conclusion
Conversely, if Tom had a limited infection like a UTI, he may have responded quickly to antibiotics and recovered uneventfully in the nursing home. Either way, he was given high quality, judicious care that allowed nature to declare itself.
The future of healthcare is here.
We have to learn to drop our preconceived labels and adapt more hybridized models.
With this intention,
I introduce the Palliative Care ICU. (Source: In My Humble Opinion)
Source: In My Humble Opinion - November 7, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
