Wednesday, October 25, 2017

My Poem for Physicians Who Care

As a physician leader, I recognize the public needs to be educated as to what's happening in healthcare, for the crisis we're experiencing impacts everyone. For instance, there are now ten non-clinical administrators for every physician in this country. This means 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 with 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, physicians strive to care for people every day according to our high standards, placing patients first.

As medical care becomes increasingly complex 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 team members with significantly less training than physicians being given clinical responsibilities for which they are not adequately trained. Although they 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 over forty years (see graph below) and there are not enough residency spots for every graduating, well-trained medical student, the numbers of non-clinical (and very expensive!) administrators and non-physician team members continue to rise exponentially.

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 *