RE: Spreading the word (locally and nationally)

[Guest guest]

good job , Brady!!!!

Group,

I have received word today that McClatchy News services has

picked up and will be releasing the 3 part op-ed which I wrote last month. (I

have attached all three so you can reread them if you like). If you find these

helpful or insightful in any way, or if you think that they might be helpful to

the people of your community, I ask you to forward the letter below to the

editors of your local paper encouraging them to run one or all of them. Note:

The letter below is a suggestion. Please edit it however you like. Thanks for

your help in spreading the word.

Dear Editor,

I have received word that a three part-op ed

piece written by Dr. Brady in Newport

News, VA was

released through the McLatchy News Services today. The first one deals with

issues surrounding primary care, the second one details what is involved in the

doctor-patient relationship, and the third discusses Doctor Brady's

practice but also the Ideal Medical Practices movement of which I am a part. As

health care is one of the most important and complex issues facing Americans, I

encourage you to pick up and run these editorials. For the sake of our own

health, we must change.

Thank you for your time.

-- If you are a patient please allow up to 24 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD

ph fax

[Guest guest]

Yes! Great news , I’ll

send it on to local papers.

G

From: [mailto: ] On Behalf Of Brady, MD

Sent: Tuesday, December 23, 2008

6:55 AM

To:

Subject:

Spreading the word (locally and nationally)

Group,

I have

received word today that McClatchy News services has picked up and will be

releasing the 3 part op-ed which I wrote last month. (I have attached all three

so you can reread them if you like). If you find these helpful or insightful in

any way, or if you think that they might be helpful to the people of your

community, I ask you to forward the letter below to the editors of your local

paper encouraging them to run one or all of them. Note: The letter below is a suggestion.

Please edit it however you like. Thanks for your help in spreading the word.

Dear Editor,

I have

received word that a three part-op ed piece written by

Dr. Brady in Newport

News, VA

was released through the McLatchy News Services today. The first one deals with

issues surrounding primary care, the second one details what is involved in the

doctor-patient relationship, and the third discusses Doctor Brady’s

practice but also the Ideal Medical Practices movement of which I am a part. As

health care is one of the most important and complex issues facing Americans, I

encourage you to pick up and run these editorials. For the sake of our own

health, we must change.

Thank you

for your time.

[Guest guest]

can't re-read - they all say:

Attachment(not stored)

op-ed#1.pdf

Type:

application/pdf

am i missing some facile way of opening docs on this site? i can't

count the number of attachments-not-stored i've missed.

[Guest guest]

RE guest editorial

Way to go -- liked your reasoning that the administrative trivia, even if technology based, is not helpful, and the discussion of the more providers that provide care, no matter what the technology, dilutes the relationship.

Doc-pt relationship the key.

Matt in Western PA

Solo x 4 years.

Getting closer to ave 10 pts a day, if so, will be fine, but not there yet.

FP since residency 1988

Spreading the word (locally and nationally)

Group,

I have received word today that McClatchy News services has picked up and will be releasing the 3 part op-ed which I wrote last month. (I have attached all three so you can reread them if you like). If you find these helpful or insightful in any way, or if you think that they might be helpful to the people of your community, I ask you to forward the letter below to the editors of your local paper encouraging them to run one or all of them. Note: The letter below is a suggestion. Please edit it however you like. Thanks for your help in spreading the word.

Dear Editor,

I have received word that a three part-op ed piece written by Dr. Brady in Newport News, VA was released through the McLatchy News Services today. The first one deals with issues surrounding primary care, the second one details what is involved in the doctor-patient relationship, and the third discusses Doctor Brady’s practice but also the Ideal Medical Practices movement of which I am a part. As health care is one of the most important and complex issues facing Americans, I encourage you to pick up and run these editorials. For the sake of our own health, we must change.

Thank you for your time.

[Guest guest]

Yes. , would you mind putting a copy in the Files section for us

digest-format holdouts? Thanks.

Haresch

>

> can't re-read - they all say:

>

> Attachment(not stored)

> op-ed#1.pdf

> Type:

> application/pdf

>

> am i missing some facile way of opening docs on this site? i can't

> count the number of attachments-not-stored i've missed.

>

[Guest guest]

Just sent copy to my local paper. We will see what happens.

Nice work, .

Durango, CO

Yes. , would you mind putting a copy in the Files section for usdigest-format holdouts? Thanks. Haresch >> can't re-read - they all say:> > Attachment(not stored)> op-ed#1.pdf> Type:> application/pdf> > am i missing some facile way of opening docs on this site? i can't

> count the number of attachments-not-stored i've missed.>

[Guest guest]

Ok

I have posted the pdfs of the op-eds to

the files section of the list-serve. Hopefully you guys can view them there. If

not, I’m not sure what else to do, but let me know. Thanks!

Re: Spreading the word (locally and nationally)

Yes. , would you mind putting a copy in the Files section for us

digest-format holdouts? Thanks.

Haresch

>

> can't re-read - they all say:

>

> Attachment(not stored)

> op-ed#1.pdf

> Type:

> application/pdf

>

> am i missing some facile way of opening docs on this site? i can't

> count the number of attachments-not-stored i've missed.

>

[Guest guest]

I use ConstantContact to create periodic e-mail letters/bulletins to my patients. 's well written article will be in my next issue. Thank you for speaking so eloquently for many of us.

Alla

In solo family practice and struggling to survive

Alla Kirsch, M.D.Travel Clinics of America6559 Mills Road, Suite 107, Mayfield Village, OH 44143 | cell | fax | www.travelclinicsofamerica.com

[Guest guest]

Got 'em. Thanks, . They look great. I'm sending them on.

BTW, any chance you're going to the VAFP winter weekend CME at

Wintergreen?

Haresch

>

> Ok

> I have posted the pdfs of the op-eds to the files section of the

> list-serve. Hopefully you guys can view them there. If not, I'm not sure

> what else to do, but let me know. Thanks!

>

[Guest guest]

,

I wanted to go but for right now it does

not look like I’m going to make it up there.

Re: Spreading the word (locally and nationally)

Got 'em. Thanks, . They look great. I'm sending them on.

BTW, any chance you're going to the VAFP winter weekend CME at

Wintergreen?

Haresch

>

> Ok

> I have posted the pdfs of the op-eds to the files section of the

> list-serve. Hopefully you guys can view them there. If not, I'm not sure

> what else to do, but let me know. Thanks!

>

[Guest guest]

I received an unexpected e-mail this morning, and this was my response, any suggestions?

Dr. Ballester -I

read Brady's piece in the Vindy today, and found you to be the

closest physician involved with the movement, and wondered if you might

give me some info on where I can investigate this option for my

practice. I am an Orthopaedic Surgeon in Youngstown, who is very

concerned with the digression of the practice of medicine away from the

relationship basis I value. My previous exploration of the " boutique "

style of practice showed it to be incompatible with those of us who

perform procedures that are either emergencies (trauma, fractures) or

deemed too expensive (elective joint replacements) by the average

patient, and so are unfortunately doomed to rely on third parties for

reimbursement. The idea of significantly curtailing overhead in order

to survive on draconian reimbursement, while allowing time to maintain

the physician - patient relationship may have merit however, especially

in a practice such as mine wherein the procedures are definitely of

secondary importance, to both me and my patients.If you have any contact info, either to Dr. Brady or to any of the training seminars, I would be most appreciative.I

have attached an essay I wrote for the Mahoning County Medical Society

Bulletin last year - I am the Editor - for your perusal. It summarizes

my feelings and approach to the care of my patients.Thank you for your time and interest.Tom Bonifacetsb@... cel office

My response:

A place to start could be:http://www.idealmedicalpractices.org/

There is a project from Dartmouth Medical School that is the foundation:http://www.howsyourhealth.org/Consider joining the list-serve for http://health.groups.yahoo.com/group/IMPListserv/

http://health.groups.yahoo.com/group//This will give you another perspective, there are some specialists like yourself involved in the IMP concept:

http://www.aafp.org/fpm/20070900/20thei.htmlThe

bottom line is that we all are working for the patient, it is obscene

for Health Insurance Executives to make millions in bonuses and stock

options by restricting care and paying physicians less.

,_._,___

-- Pedro Ballester, M.D.Warren, OH

[Guest guest]

This is very exciting. , your series could really start something.I recall someone mentioning another IMP orthopod out there. Does anyone remember who that is? It would be great to hook these two up.

Dr. Ballester -I

read Brady's piece in the Vindy today, and found you to be the

closest physician involved with the movement, and wondered if you might

give me some info on where I can investigate this option for my

practice. I am an Orthopaedic Surgeon in Youngstown, who is very

concerned with the digression of the practice of medicine away from the

relationship basis I value. My previous exploration of the "boutique"

style of practice showed it to be incompatible with those of us who

perform procedures that are either emergencies (trauma, fractures) or

deemed too expensive (elective joint replacements) by the average

patient, and so are unfortunately doomed to rely on third parties for

reimbursement. The idea of significantly curtailing overhead in order

to survive on draconian reimbursement, while allowing time to maintain

the physician - patient relationship may have merit however, especially

in a practice such as mine wherein the procedures are definitely of

secondary importance, to both me and my patients.If you have any contact info, either to Dr. Brady or to any of the training seminars, I would be most appreciative.I

have attached an essay I wrote for the Mahoning County Medical Society

Bulletin last year - I am the Editor - for your perusal. It summarizes

my feelings and approach to the care of my patients.Thank you for your time and interest.Tom Bonifacetsbneoucom (DOT) edu cel office

My response:

A place to start could be:http://www.idealmed icalpractices. org/

There is a project from Dartmouth Medical School that is the foundation:http://www.howsyour health.org/Consider joining the list-serve for http://health. groups.yahoo. com/group/ IMPListserv/

Practiceimprovement 1yahoogroups (DOT) com

http://health. groups.yahoo. com/group/ Practiceimprovem ent1/This will give you another perspective, there are some specialists like yourself involved in the IMP concept:

http://www.aafp. org/fpm/20070900 /20thei.htmlThe

bottom line is that we all are working for the patient, it is obscene

for Health Insurance Executives to make millions in bonuses and stock

options by restricting care and paying physicians less.

,_._,___

-- Pedro Ballester, M.D.Warren, OH

[Guest guest]

Good work Pedro.

We’re looking to make www.IMPCenter.org into a single portal to

our stuff but it is still rudimentary.

It is also nice to see yet another

specialist who has his eyes on same goals as those on this list. It

reminds me that there are good people out there from all specialties and how I

wish we had a way to weave us all together more closely and help me find like

minded folks in my own community.

I have made strong statements regarding

primary care. I cringe when I think of how this must come off at times as

a naked attack on all specialists. I mean to rail against the inequities

of the system, the abject failure of true “system-ness” in the US,

not against those willing and able to be part of a coordinated spectrum of

care.

If I have caused offense I am truly sorry

and hope that my passion for a high performing health system based on effective

primary care can be understood as including specialists and hospitals willing

to work toward the common goal.

Happy New Year all, and thank you for

being such a vibrant community.

Gordon

From: [mailto: ] On Behalf Of Pedro Ballester

Sent: Saturday, December 27, 2008

9:21 AM

To:

Subject: Re:

Re: Spreading the word (locally and nationally)

I received an unexpected

e-mail this morning, and this was my response, any suggestions?

On Fri, Dec 26, 2008 at 11:48 PM, Boniface <tsbneoucom (DOT) edu>

wrote:

Dr. Ballester -

I read Brady's piece in the Vindy today, and found you to be the closest

physician involved with the movement, and wondered if you might give me some

info on where I can investigate this option for my practice. I am an

Orthopaedic Surgeon in Youngstown,

who is very concerned with the digression of the practice of medicine away from

the relationship basis I value. My previous exploration of the

" boutique " style of practice showed it to be incompatible with those

of us who perform procedures that are either emergencies (trauma, fractures) or

deemed too expensive (elective joint replacements) by the average patient, and

so are unfortunately doomed to rely on third parties for reimbursement.

The idea of significantly curtailing overhead in order to survive on draconian

reimbursement, while allowing time to maintain the physician - patient

relationship may have merit however, especially in a practice such as mine

wherein the procedures are definitely of secondary importance, to both me and

my patients.

If you have any contact info, either to Dr. Brady or to any of the training

seminars, I would be most appreciative.

I have attached an essay I wrote for the Mahoning County Medical Society

Bulletin last year - I am the Editor - for your perusal. It summarizes my

feelings and approach to the care of my patients.

Thank you for your time and interest.

Tom Boniface

tsbneoucom (DOT) edu

cel

office

My response:

A place to start could be:

http://www.idealmedicalpractices.org/

There is a project from Dartmouth

Medical School

that is the foundation:

http://www.howsyourhealth.org/

Consider joining the list-serve for http://health.groups.yahoo.com/group/IMPListserv/

http://health.groups.yahoo.com/group//

This

will give you another perspective, there are some specialists like yourself

involved in the IMP concept:

http://www.aafp.org/fpm/20070900/20thei.html

The

bottom line is that we all are working for the patient, it is obscene for

Health Insurance Executives to make millions in bonuses and stock options by

restricting care and paying physicians less.

,_._,___

--

Pedro Ballester, M.D.

Warren, OH

[Guest guest]

Thanks

and I hope so. Pedro, I think you gave a really solid answer. If he wants my

e-mail, you can certainly send it on, though it might be best to reach me

through my website: www.thevillagedr.com

and hit the “contact us” section.

Re:

Re: Spreading the word (locally and nationally)

This is very exciting. , your series could

really start something.

I recall someone mentioning another IMP orthopod out there. Does anyone

remember who that is? It would be great to hook these two up.

Dr. Ballester -

I read Brady's piece in the Vindy today, and found you to be the closest

physician involved with the movement, and wondered if you might give me some

info on where I can investigate this option for my practice. I am an

Orthopaedic Surgeon in Youngstown, who is very concerned with the digression

of the practice of medicine away from the relationship basis I value.

My previous exploration of the " boutique " style of practice showed

it to be incompatible with those of us who perform procedures that are either

emergencies (trauma, fractures) or deemed too expensive (elective joint

replacements) by the average patient, and so are unfortunately doomed to rely

on third parties for reimbursement. The idea of significantly

curtailing overhead in order to survive on draconian reimbursement, while

allowing time to maintain the physician - patient relationship may have merit

however, especially in a practice such as mine wherein the procedures are

definitely of secondary importance, to both me and my patients.

If you have any contact info, either to Dr. Brady or to any of the training

seminars, I would be most appreciative.

I have attached an essay I wrote for the Mahoning County Medical Society

Bulletin last year - I am the Editor - for your perusal. It summarizes

my feelings and approach to the care of my patients.

Thank you for your time and interest.

Tom Boniface

tsbneoucom (DOT)

edu

cel

office

My response:

A place to start could be:

http://www.idealmed

icalpractices. org/

There is a project from Dartmouth Medical School that is the foundation:

http://www.howsyour

health.org/

Consider joining the list-serve for http://health. groups.yahoo. com/group/ IMPListserv/

Practiceimprovement 1yahoogroups (DOT) com

http://health. groups.yahoo. com/group/

Practiceimprovem ent1/

This

will give you another perspective, there are some specialists like yourself

involved in the IMP concept:

http://www.aafp. org/fpm/20070900 /20thei.html

The

bottom line is that we all are working for the patient, it is obscene for

Health Insurance Executives to make millions in bonuses and stock options by

restricting care and paying physicians less.

,_._,___

--

Pedro Ballester, M.D.

Warren, OH

[Guest guest]

I forwarded Gordon's and 's messages-- Pedro Ballester, M.D.Warren, OH

[Guest guest]

Good job, Pedro. You might also let

him know there are specialists doing this type of work, including a pediatric

orthopod in CA (I think), Aenor Senor or similar name. He used to be

active on the list serve, but I haven’t seen him post in awhile. Referring

him to the impmap may also be helpful, but he can probably get that from the

other sites you gave him.

A. Eads, M.D.

Pinnacle Family Medicine, PLLC

phone fax

P.O.

Box 7275

Woodland

Park, CO 80863

www.PinnacleFamilyMedicine.com

From:

[mailto: ] On

Behalf Of Pedro Ballester

Sent: Saturday, December 27, 2008

10:21 AM

To:

Subject: Re:

Re: Spreading the word (locally and nationally)

I received an unexpected

e-mail this morning, and this was my response, any suggestions?

On Fri, Dec 26, 2008 at 11:48 PM, Boniface <tsbneoucom (DOT) edu>

wrote:

Dr. Ballester -

I read Brady's piece in the Vindy today, and found you to be the closest

physician involved with the movement, and wondered if you might give me some

info on where I can investigate this option for my practice. I am an

Orthopaedic Surgeon in Youngstown,

who is very concerned with the digression of the practice of medicine away from

the relationship basis I value. My previous exploration of the

" boutique " style of practice showed it to be incompatible with those

of us who perform procedures that are either emergencies (trauma, fractures) or

deemed too expensive (elective joint replacements) by the average patient, and

so are unfortunately doomed to rely on third parties for reimbursement.

The idea of significantly curtailing overhead in order to survive on draconian

reimbursement, while allowing time to maintain the physician - patient

relationship may have merit however, especially in a practice such as mine wherein

the procedures are definitely of secondary importance, to both me and my

patients.

If you have any contact info, either to Dr. Brady or to any of the training

seminars, I would be most appreciative.

I have attached an essay I wrote for the Mahoning County Medical Society

Bulletin last year - I am the Editor - for your perusal. It summarizes my

feelings and approach to the care of my patients.

Thank you for your time and interest.

Tom Boniface

tsbneoucom (DOT) edu

cel

office

My response:

A place to start could be:

http://www.idealmedicalpractices.org/

There is a project from Dartmouth

Medical School

that is the foundation:

http://www.howsyourhealth.org/

Consider joining the list-serve for http://health.groups.yahoo.com/group/IMPListserv/

http://health.groups.yahoo.com/group//

This

will give you another perspective, there are some specialists like yourself

involved in the IMP concept:

http://www.aafp.org/fpm/20070900/20thei.html

The bottom

line is that we all are working for the patient, it is obscene for Health

Insurance Executives to make millions in bonuses and stock options by

restricting care and paying physicians less.

,_._,___

--

Pedro Ballester, M.D.

Warren, OH

[Guest guest]

Aenor Sawyer is the orhto pod If you go to the home front page of practiceimprovement1 and hit members to the left you can search and send him an email PAnzer in Denver is endocrineKAtie and are neuro in VT

Mutt up in Montana is psychiatry I think?Chrissie Ott is peds

Good job, Pedro. You might also let

him know there are specialists doing this type of work, including a pediatric

orthopod in CA (I think), Aenor Senor or similar name. He used to be

active on the list serve, but I haven't seen him post in awhile. Referring

him to the impmap may also be helpful, but he can probably get that from the

other sites you gave him.

A. Eads, M.D.

Pinnacle Family Medicine, PLLC

phone fax

P.O.

Box 7275

Woodland

Park, CO 80863

www.PinnacleFamilyMedicine.com

From:

[mailto: ] On

Behalf Of Pedro Ballester

Sent: Saturday, December 27, 2008

10:21 AM

To:

Subject: Re:

Re: Spreading the word (locally and nationally)

I received an unexpected

e-mail this morning, and this was my response, any suggestions?

On Fri, Dec 26, 2008 at 11:48 PM, Boniface

wrote:

Dr. Ballester -

I read Brady's piece in the Vindy today, and found you to be the closest

physician involved with the movement, and wondered if you might give me some

info on where I can investigate this option for my practice. I am an

Orthopaedic Surgeon in Youngstown,

who is very concerned with the digression of the practice of medicine away from

the relationship basis I value. My previous exploration of the

" boutique " style of practice showed it to be incompatible with those

of us who perform procedures that are either emergencies (trauma, fractures) or

deemed too expensive (elective joint replacements) by the average patient, and

so are unfortunately doomed to rely on third parties for reimbursement.

The idea of significantly curtailing overhead in order to survive on draconian

reimbursement, while allowing time to maintain the physician - patient

relationship may have merit however, especially in a practice such as mine wherein

the procedures are definitely of secondary importance, to both me and my

patients.

If you have any contact info, either to Dr. Brady or to any of the training

seminars, I would be most appreciative.

I have attached an essay I wrote for the Mahoning County Medical Society

Bulletin last year - I am the Editor - for your perusal. It summarizes my

feelings and approach to the care of my patients.

Thank you for your time and interest.

Tom Boniface

tsb@...

cel

office

My response:

A place to start could be:

http://www.idealmedicalpractices.org/

There is a project from Dartmouth

Medical School

that is the foundation:

http://www.howsyourhealth.org/

Consider joining the list-serve for http://health.groups.yahoo.com/group/IMPListserv/

http://health.groups.yahoo.com/group//

This

will give you another perspective, there are some specialists like yourself

involved in the IMP concept:

http://www.aafp.org/fpm/20070900/20thei.html

The bottom

line is that we all are working for the patient, it is obscene for Health

Insurance Executives to make millions in bonuses and stock options by

restricting care and paying physicians less.

,_._,___

--

Pedro Ballester, M.D.

Warren, OH

-- If you are a patient please allow up to 24 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD

ph fax

[Guest guest]

Can we change this topics title from "speading the word" to something else...seems we've lost track of the origianl subject...Next to reply is "it"!

To: Sent: Saturday, December 27, 2008 4:26:40 PMSubject: Re: Re: Spreading the word (locally and nationally)

Aenor Sawyer is the orhto pod If you go to the home front page of practiceimprovement 1 and hit members to the left you can search and send him an email PAnzer in Denver is endocrineKAtie and are neuro in VTMutt up in Montana is psychiatry I think?Chrissie Ott is peds

On Sat, Dec 27, 2008 at 3:21 PM, Eads <michelle.eads@ worldnet. att.net> wrote:

Good job, Pedro. You might also let him know there are specialists doing this type of work, including a pediatric orthopod in CA (I think), Aenor Senor or similar name. He used to be active on the list serve, but I haven't seen him post in awhile. Referring him to the impmap may also be helpful, but he can probably get that from the other sites you gave him.

A. Eads, M.D.

Pinnacle Family Medicine, PLLC

phone fax

P.O. Box 7275

Woodland Park, CO 80863

www.PinnacleFamilyM edicine.com

From: Practiceimprovement 1yahoogroups (DOT) com [mailto:Practiceimprovement 1yahoogroups (DOT) com] On Behalf Of Pedro BallesterSent: Saturday, December 27, 2008 10:21 AM

To: Practiceimprovement 1yahoogroups (DOT) comSubject: Re: [Practiceimprovemen t1] Re: Spreading the word (locally and nationally)

I received an unexpected e-mail this morning, and this was my response, any suggestions?

On Fri, Dec 26, 2008 at 11:48 PM, Boniface <tsbneoucom (DOT) edu> wrote:Dr. Ballester -I read Brady's piece in the Vindy today, and found you to be the closest physician involved with the movement, and wondered if you might give me some info on where I can investigate this option for my practice. I am an Orthopaedic Surgeon in Youngstown, who is very concerned with the digression of the practice of medicine away from the relationship basis I value. My previous exploration of the "boutique" style of practice showed it to be incompatible with those of us who perform procedures that are either emergencies (trauma, fractures) or deemed too expensive (elective joint replacements) by the average patient, and so are unfortunately doomed to rely on third parties

for reimbursement. The idea of significantly curtailing overhead in order to survive on draconian reimbursement, while allowing time to maintain the physician - patient relationship may have merit however, especially in a practice such as mine wherein the procedures are definitely of secondary importance, to both me and my patients.If you have any contact info, either to Dr. Brady or to any of the training seminars, I would be most appreciative.I have attached an essay I wrote for the Mahoning County Medical Society Bulletin last year - I am the Editor - for your perusal. It summarizes my feelings and approach to the care of my patients.Thank you for your time and interest.Tom Bonifacetsbneoucom (DOT) edu cel office

My response:

A place to start could be:http://www.idealmed icalpractices. org/There is a project from Dartmouth Medical School that is the foundation:http://www.howsyour health.org/Consider joining the list-serve for http://health. groups.yahoo. com/group/ IMPListserv/Practiceimprovement 1yahoogroups (DOT)

comhttp://health. groups.yahoo. com/group/ Practiceimprovem ent1/This will give you another perspective, there are some specialists like yourself involved in the IMP concept:http://www.aafp. org/fpm/20070900 /20thei.htmlThe bottom line is that we all are working for the patient, it is obscene for Health Insurance Executives to make millions in bonuses and stock options by

restricting care and paying physicians less.,_._,___

-- Pedro Ballester, M.D.Warren, OH

-- If you are a patient please allow up to 24 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax

[Guest guest]

I don't mean to derail this further, but here is the missing attachment from Dr. Boniface:

Dr. -

Just want to touch base about cases done after hours. I heard some grumbling about a case done last night with staff being called in at 7pm that ended up starting later and finishing at 1230. I get the feeling the staff is being stretched thin and still on the verge of burnout. The system I set up for fracture care and trauma was designed to help both surgeon and institution so that off hour work would be minimized….it would seem to me that bringing staff in for 5 hours at night for non-emergent cases would be …. misutilization of resources…. the trauma room would have been available the next day for a 0730 posting as the priority…. If you were not available the next day, either Jim or myself are usually able to accommodate most such cases….

Director of Orthopaedic Trauma

What's In a Name?

I was home for the first evening in what seemed like weeks, looking forward to spending it with my family, without the phone ringing. But it did – "Sorry to be calling you, know you are not on call, but Grace is here…" the PA in the Emergency Department was saying. "She missed a step down the stairs and probably has a femur fracture – x-rays are pending, but she wanted me to call only you."

If you looked up the word stoic in the dictionary, you might find a picture of Grace. She had endured more than her share of suffering, losing a child to suicide, being diagnosed and treated for rheumatoid arthritis, fracturing her other femur a year ago (despite proper anti-resorptive therapy), and now burying her husband, after a two week cardiac demise, on the very morning of the day she missed the fateful step. Having known her for years, I had regretted it the day before when I did not go to calling hours, due to work obligations. I thought I would express my condolences the next week, knowing she was to see me then to remove the cast from her right wrist, now 6 weeks out from her Colles' fracture.

"I'll be right in – when did she last eat?" I expected she would be impatient with this injury, wanting to put it behind her so she could get back in the game, and finish handling her husband's affairs. I had spoken with the OR desk a little earlier, lining up the details of a case scheduled for the next day, and I knew they were slow that night. The nurse on the phone had even asked if I had something they could do that night as they were bored.

The whole family was with Grace in the ER, as those from out-of-town were still here after the funeral. They looked spent; the only emotion they had left was one of hope, that someone might help them clear this latest, unexpected, and undeserved hurdle. Grace was her usual self: "sure it hurts", "glad to see you Dr. Tom", "how's your family", "just like the other side?", "can you fix it tonight?" Her internist knew Grace very well and had no objection. The OR was willing and able, and it would save her perhaps a day or two in the hospital – most importantly, she knew what was involved and it was what she wanted to do.

The procedure was technically ordinary, but one I'll never forget. Thanks to symmetry, we knew the implant dimensions and specs before induction, referring to last year's Op Note. Grace's general health and medium stature presented no challenges, and the marvels of modern technology and engineering allowed us to perform the procedure through two small punctures yet achieve anatomic, secure fixation which would speed recovery to normal function. These objective details were taken for granted, and will be forgotten over time.

With our minds free from the mundane decisions about technique, the resident, staff, and I were able instead to reflect upon what it was we were really doing there that night. Discussions revolved about the recent events of Grace's life, the impact that suffering has at some point in every life, and especially what possesses any of us to put one's individual needs aside, in the interest of those who need our help. This particular discussion was especially significant, as the resident I was with was himself recently diagnosed with leukemia, and was working a full schedule despite his own therapies and side effects thereof. Believing it might help him to understand his circumstance as both physician and patient, I had previously given him a copy of Arthur 's The Renewal of Generosity (1), which reasons that contemporary medicine can and should be founded on the basis of relationships, true dialogue, and generosity toward others, and toward oneself. I personally found the book to be profound, as I sense many of us are compelled by the current business of "providing health care" that we can forget the essence of why we chose this profession in the first place – to serve the needs of others. I was pleased (but not surprised) that he too found meaning in its pages, and that its ideas were most pertinent to understanding our own place in helping others, regardless of circumstance. In short, as a student, teacher, and physician, that night was an opportunity to understand and learn the difference between the mere laborer, or even craftsman, and instead behave as the artisan that this young man was clearly becoming.

Grace's recovery has been uneventful, and throughout she has been her usual self – humble and appreciative of everyone's efforts on her behalf. My only concern is perhaps a disappointment that our system of health care can allow us to get lost in the detail of protocols, technology, objective measures of cost, and arbitrary definitions of outcome. We are increasingly being asked to substitute statistical evidence for the more universal constant of one person putting the other's needs ahead of their own. My comfort though will come from people like Grace, who do cherish our relationships, and who teach us about ourselves. It will also come from the knowledge that there are, and will be after I am gone, people like the resident, my fellow physician, who will rightly see patients as people rather than procedures.

S. Boniface, MD

Associate Professor, Clinical Orthopaedics, NEOUCOM

Fellow, Institute for Professionalism Inquiry, SUMMA/Akron City Hospital

1. , AW. The Renewal of Generosity: Illness, Medicine, and How to Live. Chicago: university of Chicago Press; 2004.-- Pedro Ballester, M.D.Warren, OH

[Guest guest]

Please

encourage him to join the movement. He would fit right in. Great write up.

Re:

Re: Spreading the word (locally and nationally)

I don't mean to derail this further, but here is the missing attachment

from Dr. Boniface:

Dr. -

Just want to touch base about cases done after hours. I heard some grumbling

about a case done last night with staff being called in at 7pm that ended up

starting later and finishing at 1230. I get the feeling the staff is being

stretched thin and still on the verge of burnout. The system I set up for

fracture care and trauma was designed to help both surgeon and institution so

that off hour work would be minimized….it would seem to me that bringing staff

in for 5 hours at night for non-emergent cases would be …. misutilization of

resources…. the trauma room would have been available the next day for a 0730

posting as the priority…. If you were not available the next day, either Jim or

myself are usually able to accommodate most such cases….

Director of Orthopaedic Trauma

What's In a Name?

I was home for the first evening in what seemed

like weeks, looking forward to spending it with my family, without the phone

ringing. But it did – " Sorry to be calling you, know you are not on

call, but Grace is here… " the PA in the Emergency Department was

saying. " She missed a step down the stairs and probably has a femur

fracture – x-rays are pending, but she wanted me to call only you. "

If you looked up the word stoic in the dictionary, you might find a

picture of Grace. She had endured more than her share of suffering,

losing a child to suicide, being diagnosed and treated for rheumatoid

arthritis, fracturing her other femur a year ago (despite proper

anti-resorptive therapy), and now burying her husband, after a two week cardiac

demise, on the very morning of the day she missed the fateful step.

Having known her for years, I had regretted it the day before when I did not go

to calling hours, due to work obligations. I thought I would express my

condolences the next week, knowing she was to see me then to remove the cast

from her right wrist, now 6 weeks out from her Colles' fracture.

" I'll be right in – when did she last

eat? " I expected she would be impatient with this injury, wanting to

put it behind her so she could get back in the game, and finish handling her

husband's affairs. I had spoken with the OR desk a little earlier, lining

up the details of a case scheduled for the next day, and I knew they were slow

that night. The nurse on the phone had even asked if I had something they

could do that night as they were bored.

The whole family was with Grace in the ER, as those

from out-of-town were still here after the funeral. They looked spent; the only

emotion they had left was one of hope, that someone might help them clear this

latest, unexpected, and undeserved hurdle. Grace was her usual self: " sure

it hurts " , " glad to see you Dr. Tom " , " how's your

family " , " just like the other side? " , " can you fix it

tonight? " Her internist knew Grace very well and had no objection.

The OR was willing and able, and it would save her perhaps a day or two in the

hospital – most importantly, she knew what was involved and it was what she

wanted to do.

The procedure was technically ordinary, but one

I'll never forget. Thanks to symmetry, we knew the implant dimensions and

specs before induction, referring to last year's Op Note. Grace's general

health and medium stature presented no challenges, and the marvels of modern

technology and engineering allowed us to perform the procedure through two

small punctures yet achieve anatomic, secure fixation which would speed

recovery to normal function. These objective details were taken for

granted, and will be forgotten over time.

With our minds free from the mundane decisions

about technique, the resident, staff, and I were able instead to reflect upon

what it was we were really doing there that night. Discussions revolved

about the recent events of Grace's life, the impact that suffering has at some

point in every life, and especially what possesses any of us to put one's

individual needs aside, in the interest of those who need our help. This

particular discussion was especially significant, as the resident I was with

was himself recently diagnosed with leukemia, and was working a full schedule

despite his own therapies and side effects thereof. Believing it might

help him to understand his circumstance as both physician and patient, I had

previously given him a copy of Arthur 's The Renewal of Generosity

(1), which reasons that contemporary medicine can and should be founded on the

basis of relationships, true dialogue, and generosity toward others, and toward

oneself. I personally found the book to be profound, as I sense many of

us are compelled by the current business of " providing health care "

that we can forget the essence of why we chose this profession in the first

place – to serve the needs of others. I was pleased (but not surprised) that he

too found meaning in its pages, and that its ideas were most pertinent to

understanding our own place in helping others, regardless of

circumstance. In short, as a student, teacher, and physician, that night

was an opportunity to understand and learn the difference between the mere

laborer, or even craftsman, and instead behave as the artisan that this young

man was clearly becoming.

Grace's recovery has been uneventful, and

throughout she has been her usual self – humble and appreciative of everyone's

efforts on her behalf. My only concern is perhaps a disappointment that

our system of health care can allow us to get lost in the detail of protocols,

technology, objective measures of cost, and arbitrary definitions of

outcome. We are increasingly being asked to substitute statistical

evidence for the more universal constant of one person putting the other's

needs ahead of their own. My comfort though will come from people like Grace,

who do cherish our relationships, and who teach us about ourselves. It will

also come from the knowledge that there are, and will be after I am gone,

people like the resident, my fellow physician, who will rightly see patients as

people rather than procedures.

S. Boniface, MD

Associate Professor, Clinical Orthopaedics, NEOUCOM

Fellow, Institute for Professionalism Inquiry,

SUMMA/Akron City Hospital

1. , AW. The Renewal of Generosity: Illness,

Medicine, and How to Live. Chicago: university of Chicago Press; 2004.

--

Pedro Ballester, M.D.

Warren, OH