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Recently I attended a psychiatry conference at OHSU (Oregon Health Sciences University). There was so much to learn! It is a special event when you go with friends who are also colleagues in medicine. The two doctors I travelled with were excellent companions. It’s always interesting when doctors come together. It is a bonding and cathartic experience, or at least it is for me. You share knowledge, frustrations, challenges and general amazement at humanity and the human body.

At this conference I learned about diagnosis, treatment and care for psychiatric issues. The most helpful and eye opening information was learning about the book: “Feeling Good: The New Mood Therapy” by David D Burns. This is a book that can help most people recover from depression and general mood disorders through cognitive behavioral therapy. It’s as effective as many medications and the effects are long lasting. I wish I could buy a copy for everyone I knew! If you haven’t read it, read it. If you have read it, read it again.

Recently I have been reading “God’s Hotel” by Victoria Sweet. It is a book about the last almshouse in America, Laguna Honda hospital in San Francisco. In it she describes how the house of recovery is slowly transformed into a 21st century machine prided for its efficiency. Efficiency has its toll. Prior to its transformation into the current medical institution doctors had time to sit with their patients, to observe, to provide wholesome food, pleasant surroundings and a clean environment. These are all things that help people heal but are not considered efficient and in the name of budget constraints are cut out altogether. There are now early discharges, sterile environments, meals prepared in large quantities. Nourishment is considered fuel.

I liken the hospital in its original almshouse form to a garden. As many of you know I love to garden and am planning out my vegetable garden for the upcoming year. Prior to putting out the seeds the soil has to be prepared. The temperature has to be right, the weeds need to be pulled, the soil has to be restored with nutrients. Then there is the planning of what to plant. In what order. Peas, Swiss chard, radishes, kale in the cooler months. Starting some seedlings indoors so they will be ready to plant in the summer months. Which plants survive in the spring, summer, fall and winter? How much to water and when. How much light does each plant need. Everyday I visit the garden to see if there are diseases on the plants. Are there predators or harmful bugs, how do I protect my harvest? What will keep the plants their healthiest, to grow the most fruit, to bring out their best.

I tend to think of my patients similarly to my garden. Each one needs to be tended to each one’s special needs. There is a lot of information to process but if given the time growth and healing will take place. Individuals need to be tended to, even when not requiring treatment, similar to the garden. Life will carry on but truly flourishes when it is tended to.

The other day I received an email from one of my patients, Donna. She wanted a medication refilled. She also wanted to know if I could refer her to the Ophthalmologist because she thought she had a piece of glass in her eye for the past 2 days. Upon reading the email I immediately picked up the phone and called her. We talked about the details about what had happened. I needed to see her right away, this could not wait. Could she come in now since it was her lunch hour? Sure!

Timeline:

• 12:02 PM: Donna emails about her refill and the eye problem
• 12:03 PM: I call Donna to discuss the eye and ask her to come in immediately
• 12:30 PM: Donna shows up at the office, we do an eye exam and find a tear along the lower white part of her eye (conjunctival tear)
• 12:35 PM: Donna leaves the office with eye drops from the in-clinic pharmacy (so no trip to go pick up another prescription!)

The next day Donna gets in to see her Ophthalmologist and has another follow up appointment in 2 weeks for recheck.

This and so many similar stories make me proud to be a DPC doc!

2017: What a year! It was the best of times, it was the best of times. That isn’t to say it wasn’t nerve-racking or scary or just plain hard. Yet, when you truly believe that what you are doing is right thing to do, nothing seems to hold you back.

I started the year knowing that I would be leaving my job. It was terrifying. So why do it? Because there are times in our lives we look back at who we have become and who we wanted to be… and sometimes the reflection surprises us.

I remember the exact moment I knew I was going to make a change. I came home from work and while standing in the kitchen talking to my husband, Dave, I was again disenchanted with the bureaucracy of medicine. My son, age 7 at the time, was sitting at the table. He turned to me and said “Mom, you should really quit your job”. Wow. I stopped and took a step back. A mirror was being held up to me and I had no choice but to reflect. I can remember that moment as if it were yesterday.

Since then things have been a crazy roller-coaster ride. I took the summer off to be with my husband and kids. These are the people who love and support me everyday but received very little of my time. My daughter and I were out the other day when she said “Mom, I like that you you get to spend time with me now”. The gift of time is one of the biggest gifts you can give. And now I get to give that gift to my family and my patients.

This past year I have made changes that have improved the lives of my patients, my family, and myself. It was a tough year but I came out stronger and happier than I have ever been. Here’s to looking forward to 2018. For all those that have been with me on this journey, thank you for hanging on for the ride!

I recently came across this term and it really exemplifies the way that I’ve begun to practice medicine. Slowing down during our daily lives is really hard. We go from one activity to the next without much time to be mindful of the events that are happening. Our society values “multitasking” as a skill that all employers seek. Not only do we have to do one thing, we are expected to do many things at the same time and at top speed! It’s time to slow down and take a deep breath.

I have learned so much in the past few weeks. It has been busy! Although with each patient I have had the time to slow down. Having an hour to spend with patients is unheard of in our current medical model. I get to do this everyday. In that time not only do I get to take care of all the medical issues someone has but I learn more about them as people. Who they are, who their families are, what is getting in their way to make them the healthiest versions of themselves. And people are making progress! At each visit we review everyone’s wellness plan and how to keep them healthy as long as possible so that they can enjoy life for the longest period of time. It takes time to heal. To be a healer takes time. And time is a great healer. Slow medicine is the best medicine.

I awoke with a feeling of excitement, hope, pride and fear. How would it go? Was everything ready? Had I forgotten any details? Who knows. Nevertheless, this was mine. This was my clinic, and these were my patients. People who had a choice to see whomever they wished yet chose to follow me as their doctor to my new practice.

On the drive to work, I had tears of joy. It was finally happening…. a dream being fulfilled. I opened the door to my new clinic and carried in my paperwork, a laptop, and my always faithful friend, the stethoscope. Today there would be no white coat.

As I was getting ready for my first patient, I tried printing a document and the printer didn’t work. I laughed. Nothing was going to get me down today. I walked around nervously getting ready, placing a cotton sheet on the exam table, getting the blood pressure cuff, finding paper to write notes on.

Then I saw her, my first patient, walking up the steps. She rode her bike to the appointment! Patricia! I originally met Patricia 5 years ago, and she helped us buy our house. Later, she became our neighbor and then later still she signed up to be my patient.  One day as she was passing by on a walk with her dog, I told Patricia I was leaving my then medical practice to start my own clinic. She yelled “I’m going with you!”. And here she was. I gave her a big hug as she entered and showed her to the room. Our hour long appointment passed by in a flash. I had just seen my first patient in my own medical practice. At the end of the visit I asked if I could take a picture of us together as this was momentous occasion for me. She obliged.

In my clinic I didn’t feel rushed and neither did my patients. There were no insurance requirements to meet, no billing to do afterwards. The only thing I had to concentrate on was my patient. The way medicine was meant to be. As I walked Patricia to the front door and she rode away on her bike I had a giant smile on my face. Yes! It was happening!!!

Today I felt like the doctor I always wanted to be, for the first time, in a very long time.

When I tell those around me about my plans on starting my own, independent clinic, the word that keeps coming up again and again is: BRAVE. Wow! Being referred to as brave has mixed feelings for me. It is a word that I would not use for myself. I have been told I was brave many times in life, under different circumstances. One of those times was when I ran away from home at the age of 21 with nothing but a suitcase to escape having an arranged marriage. So, in comparison this does not seem that brave. Although on it’s own it is an act that could be considered brave. The definition of brave is:

Noun: ready to face and endure danger or pain; showing courage.

Adjective: people who are ready to face and endure danger or pain.

Verb: endure or face (unpleasant conditions or behavior) without showing fear.

I read somewhere that being brave doesn’t mean not being afraid. Being brave means being afraid and doing what you need to do anyway. It may not be the correct definition per se but it seems to resonate the most.

As I begin this new chapter in my life I go forward knowing that those who know me think of me as brave. And that’s a good feeling…. Brave.

As many of you know, I handed in my resignation a few months ago. Since then every office visit led to me saying good bye to patients I had taken care of for years. They came to me in their most vulnerable moments, with the belief that I would be able to make them better, ease the pain or just listen for a while. They let me into their lives, shared their secrets and thanked me for being there. The final visits were filled with tears, hugs, and laughs. I was emotionally exhausted by the end of each day.

I started off after completing my residency thinking I had all the tools I needed to make the right medical decisions… and then my patients taught me the true art of medicine. One of my mentors in training told me “If you really, truly listen to your patients, they will give you the answers”. There are moments in our lives when someone says something and it really sticks. This was one of those moments. I have always tried to listen. Tried to help. Tried to do my best for all of the lives I was entrusted with.

My patients have formed me into the doctor I am today and for that I am thankful. Thank you for the stories you shared, the trust you had in me. To the patients who thanked me after I gave them their cancer diagnosis, I am humbled. Thank you for letting me cry with you, for sharing in your joys and your sadness, and for believing in me. I am forever grateful.

This just aired on tonight’s news! Dr Carden and I will be sharing this space together. In this news story she shares her experience.

http://nbc16.com/news/local/patients-say-they-get-more-for-their-money-with-direct-primary-care