“I’m watching the line of young MDs file past me to be hooded, I’m feeling a range of emotions. Happy for them, of course, that they succeeded in a difficult and important endeavor. But also sad that many of them, especially those going into family medicine, have little idea what’s in store for them working in “the system.” It is nearly certain that they will quickly feel overwhelmed, frustrated and maybe even deceived, just like so many family docs working in “the system” today.” – Gayle Brekke
Hello – Wow! Time is flying and Summer is here. I hope everyone has a chance to get away and do something fun this Summer.
This is Gayle Brekke with Primary Care Mindset. I was “hooded” for my PhD several weeks ago – yay! (I’m not sure why we say “hooded” when it would be easier just to say we graduated.)
As my program is in a medical school, the ceremony was dominated by the hooding of new MDs. I happened to be sitting on the end of the row on the side of the auditorium with the queue to go on stage. As names are being called and I’m watching the line of young MDs file past me to be hooded, I’m feeling a range of emotions. Happy for them, of course, that they succeeded in a difficult and important endeavor. But also sad that many of them, especially those going into family medicine, have little idea what’s in store for them working in “the system.” It is nearly certain that they will quickly feel overwhelmed, frustrated and maybe even deceived, just like so many family docs working in “the system” today.
I felt like a mama grizzly who wanted to protect my cubs – the MDs are the age of my kids – and they are not prepared for how devalued and powerless they are going to feel. We all deserve better, and that’s why I’m here.
What’s Wrong is Driven by our Thinking
The root of why our health care “system” treats doctors so badly and otherwise fails to deliver on its promises is our mindset. We talk about the same problems year after year. We pass more laws and implement more reforms every year. Yet access worsens, spending climbs, and physicians are more and more burdened and frustrated every year. The only way for a clash, a contradiction of this magnitude to persist is that we’re doing something wrong at the most fundamental level, our thinking. Direct Primary Care (DPC) is the solution and DPC physicians provide important clues as to why.
What DPC Doctors Teach Us
I attended the DPC Summit in Minneapolis earlier this month. As always, it was a wonderful experience. This meeting is what originally got me interested in DPC, and it’s only gotten much bigger and better over the years. You can start to get a sense for the meeting here. But the real magic is talking to doctors, NPs, nurses and others who are doing DPC. They are excited, relieved and proud. The levels of camaraderie and encouragement of each other and those who are DPC-curious or planning their exodus from “the system” are phenomenal.
As I reflected on the Summit afterwards, I realized that the reason it’s so powerfully uplifting to talk to DPC docs is that they convey CONCORDANCE and ALIGNMENT and HARMONY between their inner-most identity and values as physicians and human beings, and the way they practice.
For several years, the term moral injury has been used to describe the plight of physicians working in “the system.” From a 2018 article by Simon G. Talbot and Wendy Dean:
The term “moral injury” was first used to describe soldiers’ responses to their actions in war. It represents “perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations.” Journalist Diane Silver describes it as “a deep soul wound that pierces a person’s identity, sense of morality, and relationship to society.”
DPC doctors exhibit not just a lack of moral injury, they exhibit its complete opposite. They are overwhelmingly positive about how it feels to be able to take care of patients the way they dreamed when going to med school. DPC restores, nourishes and nurtures both the givers and the receivers of care.
The Mission of Primary Care Mindset
The “health care system” is full of great people working hard to do the best they can for patients in a broken and deeply dysfunctional “system.” Despite how difficult things are, I’m hopeful, excited even! More and more people every day – physicians and other care-givers, patients and families, business owners, policy makers, researchers – more and more people are re-thinking health care, re-thinking how people engage with others to receive or provide medical services and re-thinking how to pay for services.
My mission is to foster the Primary Care Mindset that leads us to much better results – cost, quality, health, satisfaction – by embracing Direct Primary Care and restoring the doctor-patient relationship. By doing what works! This is important not only because we are all suffering so much in this “system” that works well for almost no one, but also because fixing primary care delivery and financing has big benefits for all types of patients and all downstream health care. Fixing primary care requires that first we fix our Mindset.
Are You Ready?
I hope you’re ready to hit the gas with me! With my dissertation out of the way, my full focus is on Primary Care Mindset. Some of you have been with me since the beginning, since the first Primary Care Mindset Newsletter last October. Many of you have connected with me and joined the mailing list in the last couple months. I appreciate you all and I’m looking forward to engaging more with you going forward. I hope you’ll bring some mama or papa grizzly bear attitude!
As you may be aware, my podcast Nurturing the Heart of Family Practice is geared to family physicians while this Newsletter is geared to a more general audience, anyone interested in or concerned about health care. On the podcast, we’ve examined foundational assumptions and considered top-down vs bottom-up solutions to our health care problems.
Pass the Word
Please stay tuned for more content coming your way soon. And please pass this newsletter along to family, friends and colleagues who may be interested. The link to subscribe to the mailing list is here. Thank you!
Gayle Brekke – Primary Care Mindset – email@example.com