The problem with primary care

This morning has been spent poring over data for work – interview transcripts that talk, broadly, about the primary care system in the US. It’s understaffed, broken and full of tension. To me, a lot of the tension, at least from what I can tell in my brief time studying this, comes from juggling the priorities of meeting metrics and standards that fund the practice and actually wanting to help patients. Of course, there is substantial overlap between providing quality care in terms of following care guidelines and treating patients as individuals, but it seems as the former gains traction through the power of insurance companies and funding mechanisms, the latter suffers. We all know that doctor visits are painfully short  – just a few minutes of time is all we can get with our primary care/family doctor to get out all our questions and concerns, and hope to get at least a few answers back. And the answers the doctor’s give us are more likely going to be in the form of a prescription – because that’s something that can be accomplished in the little time allotted.

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While the subject matter may not be pretty, at least the view is. OHSU campus.

Where is the time to have a doctor and patient understand each other? To develop a relationship so that trust builds over time, so that when something big happens, a doctor is a comfortable person to turn to? It’s not available in our current healthcare system, thanks to fee-for-service models, which pay better when doctors see more patients, not spend quality time with fewer. And the time doctors do have with patients are often spent focusing on one or two billable things (though thanks to the new ICD-10 codes, the options are endless! Or read this for a more serious look into the importance of coding in financing primary care practices), not checking in to see if your dog is doing well, or if your child still loves playing the clarinet.

People are complicated. They aren’t machines where one part is broken and then easily fixed. They have lives and those lives impact their health, and one condition impacts another. Being overweight causes back or knee pain and heart problems. Having diabetes can impact one’s sexual health. Needing surgery can stir up anxiety. Then there are all the ways that medication side effects cause more health problems. And these are just the ways “one medical condition” impacts an individual; it says nothing about how family and friends also are affected.

I am fortunate enough to have read a series of interviews from a practice in a rural community in New England that’s trying very hard not to forget the patient. They set up programs for patients and work odd schedules all in the name of true patient care. Yet, because they are an officially-designated Federally Qualified Health Center, there is a lot of documentation and care protocol that follows. While the added financial security has its benefits, and allows the clinic to stay open while supporting a large portion of publicly-funded patients, one doctor admitted that this change in status “certainly changed the way we enjoy taking care of patients.” Enjoy. I wonder how many doctors can say that? And I wonder how much longer this one will.

A writing retreat

Trigger warning: Some acquaintance rape references in a research context.

Yesterday we were fortunate to arrive before sunset. The sky wasn’t completely greyed over – an anomaly for the Oregon Coast in November. We drive to the beach and walk along the low-tide waves as the sky turns from pink to orange to red to dark. The clouds turn the sky into an abstract painting. Both of us fall in love with the dead trees that enhance the scene.

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Dusk in Oceanside, Oregon

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I love dead trees.

Driving back to the house we rented for this escape, we discuss the plan for the next day – how to turn a mass of data into something that matters. How to convey the idea that when young people grapple with a scenario about sex and alcohol and popularity, that the word “rape” is relevant, yet barely reaches awareness. How “victim blaming” ideology still plagues our culture. Objectives for the next day set, we take our minds off of the work and indulge in a hot tub soak. Conversation turns to the data again; we are optimistic about our goals. Sleep comes easily that night.

The next morning brings the expected Pacific Northwestern rain and ten hours of work. The fire burned all day, filling the storming outdoors with piney smoke. We analyzed, deconstructed, reconstructed, and finalized an analysis plan. Wrote, deconstructed, and reconstructed again. A better plan. Writing was slow, but steady. It feels good, even though the material is heart breaking.

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This fire made everything better.

We finally take a break from reading difficult phrases uttered by youth: “Well I think she put herself in that situation first of all, and if she didn’t want that to happen, then she should’ve said, ‘No.’” and “how she could have prevented it” to cook a Thai meal. Onions, summer squash, baby bok choy, red peppers and tomatoes in a curry sauce. I over-cook the rice noodles but it still tastes good. The break from the sadness and frustration over the youth voices feels good, but it’s time to go back.

We notice flaws in the analysis, and begin again. A few more hours of struggle. The hot tub waits patiently. Finally, we put the computers, printouts, and pens away and soak out all the difficult thoughts. We talk about our dreams and fears. A couple of stars shine through the black cloud cover. The rain is light and cool.

Tomorrow we will dive into the work again for a few more hours. It won’t be as completed as we had hoped, but we’ll continue to make sense of something that shouldn’t exist in the first place.

Am I a Writer? Blog Roll

I’m participating in a blog hop with other writers in which we answer questions about what and how we write. Before I answer these questions, I’d like to thank Tom Doyle for inviting me to participate. I’ve known Tom for over 20 years (gasp); we met at Stanford when I was an undergrad and he was in Law School. He has now just published his first novel, American Craftsmen, which is out May 6th. Check out his blog here

So, here’s what’s up with me as a writer as I feel today. But, like any writing (and life), it’s a work in progress:

1) What am I working on?
I am battling two ideas in my head right now and am wondering if it’s possible to combine them. The first is a book for youth about healthy relationships; I think it’s very important to weave social networking into this book. Books on healthy relationships for teens exist (actually very few do – they are mostly about sex, not relationships, though relationship issues are included), and sometimes they include a chapter on social networking. Books about “cybersafety” exist, and sometimes they talk about relationships in a chapter or two. But rarely are the two combined, which doesn’t make sense since young people’s social lives are not artificially separated into online and offline worlds. It makes more sense to acknowledge the wholeness of their social worlds by addressing healthy relationships in the context of online and offline interactions simultaneously.

The other idea is to write about my recent understanding and respect for both Zen and Shambhala Buddhism. There are tons of books and even more inspirational blogs and editorials on the importance of slowing down, appreciating the moment, and not working towards an end, but for the now and each other. The rise of popularity of mindfulness plays a role in this attitude as well. I have been on a partial sabbatical (they call it a “personal leave” for those of us who don’t have tenure) for almost a year and have had the wonderful opportunity to travel, SLOW DOWN and reflect on what matters to me and why. I’ve been able to form my own sense of spirituality when before I honestly thought I had none.

I don’t think that my memoir or specific contributions to this already saturated market would make any waves on their own, but because they are a part of my belief system and the way I think the world works, I want to be able to incorporate (directly or indirectly) my experiences into whatever I write next. Unless I can figure out the right spin that makes my experience particularly unique — then it could be a book unto itself. I don’t see the unique angle though, which means no book sales. I know enough to know that’s the key.

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Just another ex-pat exploring new things in a new land (and in herself)

 

So, my question becomes: Can I write a book for teens about healthy relationships and well-being from a Buddhist perspective? What the hell would that look like? Is that even what I want to do? I think it might be. Stay tuned.

2) How does my work differ from others of its genre?
In my writings for/about youth I take a very anti-fear-based approach. I believe young people are smart and can make their own decisions. I believe they can make mistakes and not only survive them, but learn from them. Remember all the crazy shit you did when you were young? And now you are in a position to read this blog? Yup. Me too. In academe, this can sort of be considered “positive youth development,” but not quite. So many books and articles about youth relationships, social networking, and sexuality are all based in a “discourse of danger,” to quote Carol Vance. This, frankly, sucks. It rings of insincerity and adult power and I hate that.

As far as my blog goes, I am not sure how it is different from other ex-pat blogs. I like that I present a combination of both my external and internal traveling experiences. I’m on a literal and psychological journey and I enjoy sharing experiences from both those realms. Is that unique? Not sure.

3) Why do I write what I do?
In my blog, I write what comes into my head. Sometimes that happens after I meditate or exercise. Sometimes it happens after a particularly salient (and by salient, I can also mean mundane) experience. I write when I feel a connection to the experience or to a friend who I think would enjoy hearing what happened.

In my writing about and for youth, sometimes I write because that is my job as a researcher – I have a PhD in Child and Adolescent Development and my scholarship is on youth well-being, broadly speaking (mental health, healthy relationships, sex education…). It’s been a while since I wrote something about youth that isn’t related to my job. I think I want that to change, but right now I am focusing more on my blog and my own journey. I think that’s clogging my head now and preventing the other stuff from presenting itself. But every day I feel that there might be room in my head someday soon for all the partial thoughts I have to shape themselves more fully.

4) How does my writing process work?
I sort of alluded to that above. I do a small free write after each meditation session, and sometimes after exercise. I write about experiences that inspire me when those come along. I try to write every day, but don’t beat myself up if that doesn’t happen. I only post a small fraction of the writing that I do. The rest is just to get myself used to the idea that I can be a writer (again). I have several recent academic publications, but it’s been almost 10 years (ack!) since I wrote a book. I started and stopped a current event type blogs to bridge the academic with the accessible (something I think is extremely important); it was on how the internet impacts youth sexuality. But I grew tired of it and it now lies dormant. Felt like I was writing the same damn thing with every entry. Still getting back into the swing of things — seeing myself as a writer. Trying to figure out what to do with that.

Now, to introduce the next roller! Note: If you want to be added to this list, I have room. Feel free to contact me or leave a comment and I will add you to my list and we can go from there :-).

Meagen Voss is a fiction writer (short and novel length). I met her through my writer friend, Tom, who got me into this process. Thanks Tom! By day Meagen does communications for the School of Nursing at UNC-Chapel Hill. At night, she writes and performs standup and improvisational comedy (which is totally cool. I used to do improv too!). She also has two super-adorable cats. Her blog, Assorted Chaos, taps into her life and musings.