Wednesday, October 25, 2017

My Poem for Physicians Who Care

As I continue to learn as a physician leader, it is clear that the public needs to be educated as to what's happening in healthcare. For instance, did you know that there are now ten administrators for every physician in this country? This explosion of administrators means that a greater portion of every healthcare dollar goes to paying for staff who have nothing to do with direct patient care. Yet, these administrators dictate and control much of what physicians can and must do (from time spent with each patient to supervisory responsibilities for others in the healthcare team, and an unfair burden of liability). Physicians are forced to see more patients in less time, many of whom are sicker than ten years ago and on more medications. Despite mounting and exhausting obstacles to excellent, compassionate care, we strive to care for people every day according to our high standards, placing patients first.

Interestingly, as medical care continues to grow in complexity with the epidemic of obesity, diabetes, cancer, and many other chronic illnesses, the standard of care has been dropping, with an explosion of non-physician providers with significantly less training than physicians being given clinical responsibilities for which they are not adequately trained. Although these providers have an important role to play as valued members of the healthcare team, in many settings they simply don't have adequate supervision. And while the growth in physician numbers has been stunted for more than forty years (see graph below), we have exponentially rising levels of non-clinical (and very expensive!) administrators and non-physician providers.

In 2017, physicians have less and less control with more responsibility and liability. No wonder physician burnout is at an all-time high. What's truly remarkable is that it isn't higher, and I believe that is due to our high levels of resilience, commitment, and dedication to our profession and to our patients. Although this poem is different from most of what I typically post here, I was inspired to write it after becoming a patient and experiencing the "other side" of healthcare. Like most physicians I know, I long for the day when healthcare returns to placing patient care at the center of all we do, with the high standards of care that are a foundational part of physician training in medical school, medical residency training, and medical fellowships.

Here's my poem, written to inspire my colleagues to say, enough is enough, and stand up for patients and a high standard of care. Yes, this takes courage, and it is precisely what's needed. (An explanation of the many acronyms is included below.)

A New Lexicon for Physicians

by: Amaryllis Sánchez Wohlever, MD

Imagine if PQRS and ICD-10,
EHRs and the looming MACRA,
MIPS and APMs
all stood for something else,
like measures of meaning and care
aligned with what patients need
and with who we are:
true servants at heart.

These sly abbreviations
champion some other dream
that hijacked our profession
and disrupts the healthcare team.

But we refuse to abbreviate care,
cut corners, detach,
and forget who we are.

I dream of autonomy
and its friend, common sense,
and that sacred relationship we all still defend.

I dream of scaling that fence
built by faceless EHRs
that split
my vocation … from … the human person
I vowed to assist.

So why not rename
the despised click-click-clicker
that keeps us  a – u – t – o – m – a – t – e - d
and every misnomer that traps us
‘til we’re duly subordinated.

Here’s a new dictionary of medical terms
born of our noble dream — not theirs.

Physician, Arise! This is my earnest plea.
Quit playing someone else’s maddening game.
Rules that hinder, intrude, disrespect, and inflame.
Success is, now, L I S T E N — up to you and me.

Mandates and regulations keep choking.
Administrators blindly add more stress.
Care suffers while we smolder, too busy to voice our distress.
Remember your Hippocratic Oath?
Anyone else take that pledge?

We know what matters most.
Our patients are first.

Make another vow, for the future’s at stake.
It’s time to stand up; we must stay wide awake.
Patients deserve much less haste, something better.
Sacred relationships front and center — forever.

I believe in you,
Colleague. You’re ready!
Dare to speak your truth and to STAND!
10 thousand more voices all over this land.

A new future requires a return to the basics.
Practice your craft. We cannot be complacent.
Make everything count for you and your patient.

It is time to heal our profession. 
Let’s scrub in and start healing our nation.

Let us all work together to see
Everyone’s
Health
Restored.

Including our own.

 Physician colleagues, stand up!

Dr Mari


PQRS: Physician Quality Reporting System 
ICD-10: International Classification of Diseases and Related Health Problems 
EHR: electronic health records 
MACRA: Medicare Access and CHIP Reauthorization Act of 2015 
CHIP: Children's Health Insurance Program 
MIPS: Merit-based Payment Incentive System 
APM: Advance Payment Model

Click here for my website. For more on modern trends in healthcare (with encouragement), see Hope for Physicians: A New Paradigm. 

© 2017 Amaryllis Sánchez Wohlever, MD. All Rights Reserved. 
 

Tuesday, October 10, 2017

A Poem for Borinquen (and a Message of Hope)

I wrote this simple poem as a teenager growing up in the metropolitan city of San Juan, Puerto Rico. I wrote it while driving to San Sebastián with Mami to visit my beautiful Abuelita Patria and the rest of our family on the western side of the island. Many of those familiar, picturesque roads to San Sebastián are now gone, swept away by hurricane María. I'm so thankful that they live on in my mind, where I continue to enjoy the landscapes while we all await their return in time.

My heart longs for my island and its people. The images are tough to assimilate so, every day, I turn my longing into fervent prayers. This poem I wrote so long ago is about my patria (my homeland) and the love in my heart for the jíbaro in the mountains, inland, where they live surrounded by the beauty of God's creation yet, at times, lacking luxuries of modern life like cement roofs and walls. This, of course, makes them more vulnerable to the destruction brought on by hurricanes.

The jíbaro is the backbone of our culture and the birthplace of island hospitality. They are beautiful and kind, always giving cheerfully of what little they have ... and now they desperately need us to be generous to them. I know they continue to work tirelessly every day to restore the land, try to salvage crops, and (especially) to help and support their neighbors, regardless of the cost. I am so thankful for the outpouring of generosity and good will toward the people of Puerto Rico, and I pray it continues until every need is met.

Here is my simple poem of love for the kindness, generosity, and simplicity of every jibarito who stole my heart years ago, and taught me that joy and contentment are birthed by giving...

Mi Borinquen

Es mi patria
un sueño,
un destello,
un paraíso.
Es mi gente
tierra adentro
humilde, hermosa.
A ellos extraño
cuando estoy lejos
y nunca he vivido
entre ellos.

Photo credit Héctor M Semidey (photo of his drawing in pencil, ©1998)

As we all continue to process the ongoing events in Puerto Rico, the message of hope in this short sermon helps comfort the heart and settle the soul. May it help us all as we continue to do what we can in the midst of this tragedy, for we know and trust that "God weaves goodness into every story" (Fr. Russell).

In Hope,

Dr Mari


* Borinquen is the name the native Taíno Indians gave the island of Puerto Rico. It means "Land of the Valiant Lord." 


Overflow from the damaged Guajataca River Dam in San Sebastián on Sept. 23, 2017, following passage of Hurricane María. (Credit: Hector Retamal / AFP / Getty Images)

Translation of my teenage poem

My Borinquen

My homeland 
is a treasure,
a bright star,
a paradise.
And my people,
inland,
so beautiful,
so humble.
It is them I miss
when afar,
though I've not lived
among them.

I always lived in the city in Puerto Rico, though my heart belongs inland. I love you, jibarito! 
May God bless you and keep you.


Friday, October 6, 2017

¡Te Amo, Boricua! (I Love You, Boricua!)

by Amaryllis Sánchez Wohlever, MD

As the days and weeks go on, my heart and prayers remain in Puerto Rico, where I grew up, where I learned to walk, talk, and pray. On the island, I experienced firsthand the fellowship of family, the hope and joy of faith, the hospitality and generosity of my people. As I picture what's happened there on my Isla del Encanto I am heartbroken, like so many of us who love our island and its people. We are all still grieving, and we need to grieve, for that is how one adapts to change and loss. The losses are unimaginable, and thousands of people are still suffering.

Yet, in the midst of the emotional and literal darkness (90% of the island remains without power two weeks after the storm), kindness, goodness, and love continue to rise unabated. Generosity, perseverance, and hope are displayed daily in countless ways, and this is where I choose to focus my eyes, my mind, and my heart.

Yes, there is hope, though not without you and me!

As I see images of the destruction left behind, countless memories of a happy childhood on the island emerge as if to wash away the reality of the present moment. These memories fill me with joy and hope for my people there, and inspire me to continue to do what I can to help them rebuild and heal. Though we are all heartbroken, the way through the heartbreak is unceasing prayer coupled with action. I have found that as I pray and do something to help someone each day, my heart heals a bit more, and hope endures.

Many people have asked me how to help and where to donate (I thank you from the bottom of my heart!). I had previously shared about Unidos por Puerto Rico, a non-profit started by First Lady Beatriz Rosselló.

Follow this link to donate to Unidos por Puerto Rico
Lin-Manuel Miranda, beloved boricua and creator of the Broadway hit Hamilton, assembled artists like Juan Luis Guerra, Rita Moreno, Marc Anthony, and many others to produce a song for Puerto Rico titled Almost Like Praying. In an inspired tribute, they mention every municipio in Puerto Rico by name, from Fajardo to San Sebastián to Mayaguez, and including the smaller islands of Vieques and Culebra ... not a single town or their people forgotten. At the end of this new music video is another opportunity to donate to help feed the people and rebuild the island of Puerto Rico. Listen for a little treat of a song at the very end (music to my ears!). Keep listening after the song for an interview where Lin-Manuel explains how the song was produced in such a short amount of time.

May our songs of praise never cease (pictured is our native coquí!)
Relying on God's mercy displayed throughout the world in the generosity and love of His people,

Dr Mari

Open the gates that the righteous nation may enter, the nation that keeps faith. You will keep in perfect peace him whose mind is steadfast, because he trusts in You. Trust in the Lord forever, 
for the Lord, the Lord, is the Rock eternal.
Isaiah 26:2-4 

Abran las puertas, para que entre la nación justa que se mantiene fiel. Al de carácter firme lo guardarás en perfecta paz, porque en Ti confía. Confíen en el Señor para siempre, porque el Señor es una Roca eterna.
Isaías 26:2-4

For a hopeful message during anxious times, read Be Still and Know ... Know What?

* Photo of coquí from Spanish Simply *

Monday, September 25, 2017

Central Florida Helps Puerto Rico After Hurricane Maria

by: Amaryllis Sánchez Wohlever, MD

When I wrote the most recent blog post (Hope for the Storms of Life), I had no idea that a much worse disaster would follow so soon. Hurricane Irma passed through central Florida more directly than anticipated, yet the impact could have been much worse. Even with the relatively small impact on my immediate community, the storm brought together our neighborhood. I am so grateful for the gift of community and fellowship.

Since then, an unprecedented storm ravaged my home island of Puerto Rico. The category 4 storm (with gusts of category 5 winds) left the entire island without power, many without water, and most without internet or phone access. Many towns remain completely out of reach due to collapsed bridges and communication towers, and thousands of people remain vulnerable to further damage from ongoing rain days after the storm. A humanitarian crisis has ensued, and although much help continues to arrive, distribution remains a challenge.

As you know, as a family physician and pastor's wife in central Florida, I love to serve as a bridge between ministries that serve the needy, the poor, and the underserved. I recognize the need to prepare our city for the influx of people with urgent medical, social, emotional, and spiritual needs in the coming weeks and months. I recognize the need to come together now to maximize the current resources and create new ones as specific needs are anticipated and recognized.

Thus, I'd like to use this blog as well as my Twitter page (@faithfulMDcoach) to connect ministries and efforts so we can collaborate without reinventing the wheel, and so we can help the most people efficiently and well--including meeting their spiritual and emotional needs as they arrive.

Here is a list of items to donate with drop-off locations in central Florida (see below for more).

We will help you rebuild. Puerto Rico, you are not alone!
A few other excellent resources:

United for Puerto Rico

Mental Health/Emotional Support Resource

Puerto Rico Federal Affairs Administration 

Central Florida Medical Ministries (scroll down on the right side of this blog for links)

Please spread the word and let me know of other resources and evolving relief efforts in central Florida. I will do all I can to update information as needed.

¡Puerto Rico se levanta con nuestra ayuda! (Puerto Rico will rise with our help!)

Blessings and Peace,

Dr Mari

So we fix our eyes not on what is seen, but on what is unseen, since what is seen is temporary, but what is unseen is eternal.
2 Corinthians 4:18

Hear, Lord, and be merciful to me; Lord, be my help.  
Psalm 30:10


Sunday, September 10, 2017

Hope for the Storms of Life

As I write, we are waiting for hurricane Irma, the category 5 storm that devastated the Caribbean just a few days ago. Our house is boarded up, and we feel as safe as one can feel while in the path of a powerful storm. Our weather radio is on my favorite station, Z88.3, which injects weather warnings between songs of hope and peace to help us prepare. I can't think of a better way to remain hopeful and ready for a storm.

© 2017 Amaryllis Sánchez Wohlever, MD
Below are a few songs that are particularly relevant during times like these.




These songs remind us that praising God in the midst of our storms is powerful. The Lord inhabits the praises of His people. As we pray and lift up His name, He blesses us with His presence, comfort, and peace. 

Praise is a fountain of life and peace.  

As praise rises, blessings descend.

May we all experience this in greater measure as we place our trust in Him, seeing every trial as an opportunity to learn to trust God more. And may these words of the psalmist become our prayer during the storms of life, for our God is the place of safety, joy, and peace.

 I will extol the Lord at all times; His praise will always be on my lips.
I will glory in the Lord; let the afflicted hear and rejoice.
Glorify the Lord with me; let us exalt His name together.
I sought the Lord, and He answered me;
    He delivered me from all my fears....
The angel of the Lord encamps around those who fear Him,
    and He delivers them.
Taste and see that the Lord is good;
    blessed is the one who takes refuge in Him.
Psalm 34:1-4, 7-8 

Please join me in praying for everyone on the path of this hurricane as well as the thousands of people who are now homeless or whose lives will never be the same again. I am thankful for the relief efforts already underway and for the many ways we can all help one another during such times. God bless you all, and thank you for your prayers.

Praising God in the storm,

Dr. Mari

Saturday, February 4, 2017

A Physician's Detour on the Journey Toward Simplicity

by: Amaryllis Sánchez Wohlever, MD

I start every year by choosing a theme. Usually the theme emerges over weeks, as I sense God leading me in a new direction. Last year, I chose a theme of simplicity. I felt led to begin by decluttering our home, focusing on one small space at a time. So I re-read Contentment (a book by my friend, Dr. Richard Swenson) and followed a few websites that inspire a journey toward simplicity. Our decluttering began with my bedroom closet and moved to the kitchen cabinets, bookshelves, kids' rooms, and so on. Slowly, 2016 became the year of simplifying, removing clutter, and reclaiming physical spaces to gain spaciousness of mind and spirit.

Halfway through the year, this physical decluttering was interrupted abruptly by a need for surgery and, later, some physical therapy for my arm. What began as an external process shifted into an internal restructuring, cleansing, and rebirth. A physician-turned-patient, I had to rely on others for daily tasks and also for inner strength, at times, with an even greater reliance on God through prayer.

Now that I'm back to decluttering our home, the inner journey to greater simplicity seems effortless. The immense gratitude that expands as you regain your strength and realize you're filled and surrounded by love is, at times, overwhelming. Although I could write about difficult moments, long waits for needed care, mistakes by well-meaning and very human medical personnel, and more, these memories keep fading. They've been overtaken by experiences of loving care that are cemented in my soul as reminders that I am loved deeply, and that God's love is powerful, tender, and healing.

What I remember most vividly is the kindness, the compassion, and the love I've received.

For years, I've spoken to healthcare professionals about Mother Teresa, the role model that drew me to medicine. She speaks of the power of a smile, of kindness, and of loving the person in front of you. We may not all do great things in this world, she says, but we can all do small things with great love. She's so right!

Small acts of kindness and love may seem insignificant, but they matter greatly. Though they are small, their impact can be far-reaching, for they touch the core of who we are and, often, our deepest needs.


Mother Teresa's wisdom took on a new dimension as I've lived the truth of her words this past year. As healthcare professionals, we must never underestimate the power of a smile, of appropriate touch, of silence, of positive words, of hope. These are the moments I remember, and they continue to bear fruit months later. These moments have power to bless, and to heal.

As physicians, we rely heavily on medications and various treatments while sometimes neglecting the power of empathy, of simple gestures, of love. As a physician and leader in healthcare who understands the impact of excessive regulatory burdens and the countless stressors that continue to threaten our profession, I know how critical it is for us to fight back. We need more time to care for the human being in front of us, and we need to take back control of how we do this. At stake is the very heart of medicine, and the sacredness of our profession.

We have much work to do in healthcare, and the road ahead is tough. I, for one, will continue to teach about the blessings and necessity of kindness and love in the exam room, for they have the power to transform the toughest journeys, one person at a time.

Spreading hope through kindness, forgiveness, and such not-so-small things,

Dr Mari

A few relevant reads: 

Purpose: An Antidote to Burnout

Hope for Physicians: A New Paradigm

Wisdom from Mother Teresa

Thursday, April 14, 2016

A Story, A Prayer, and a Song

A Story

Last month I helped someone. It was so cool. We had one of those moments of connection that surprise. Words that can't quite be planned. They just seem to form and emerge at just the right time in just the right way.

In those moments, words can heal. Words are powerful.

That day, my words landed. They reached another human being's heart as I shared mine. And then I knew the person in front of me would leave knowing she was heard. Understood. Loved.

I live for those moments. It's part of why I am now a coach. I love how coaching focuses on the positive. On possibilities. On a future yet unknown that we can begin to create now. A tomorrow that is brighter than our present reality and, perhaps, our past. Very cool.

A Prayer

This week I spoke to someone else. Someone with trouble letting go. Listening helped. Words helped. A certain lightness began to fill the room. And, yet, I hoped for more for her. So much more.

So ... as she spoke ... as she shared her heart ... I shared mine with my God. Though she didn't know it, I lifted her up so high.   S o  v e r y   h i g h.

There is no gift like prayer. The one who prays is as blessed as the one lifted up to the One who hears like no one else. Cares like no one else. Loves like no one else. And can answer like no one else.

Through prayer, we live in God's presence. We are lifted higher. We connect with our Creator, and rest.

My hope for her ... is God. God's blessing. God's joy. God's rest. And I know He will answer.


A Song

My daughter played a song for us tonight. It rocks. It's by Matthew West, and it's titled Do Something. You will find it here. Enjoy, sing it out loud, and don't forget to...

Live!
Dr Mari

Be still and know that I am God. 
Psalm 46:10

For more on the power of prayer, read Prayer: A Way of Life.