Doctors and Their Patients: Commitments to Caring

January 12, 2015
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Root of the Problem

Humility

Contrasts can be startling. The contrasts in physicians’ commitment to patients in our money-soaked system can be particularly stark. Even to those of us inured to unfairness, some contrasts hit full force when you least expect them. Drinking morning coffee and minding your own business. Whap! Can’t ignore this one.

Root of the Problem

Humility

Contrasts can be startling. The contrasts in physicians’ commitment to patients in our money-soaked system can be particularly stark. Even to those of us inured to unfairness, some contrasts hit full force when you least expect them. Drinking morning coffee and minding your own business. Whap! Can’t ignore this one. So it was as I read an article in the New York Times shortly after reading two posts in The Health Care Blog (THCB).

The first piece posted on THCB by Dr. Martin Samuels, appeared the day after Christmas. Like a forgotten gift, overlooked in a mountain of crumpled wrapping paper. In “Rediscovering Medical Professionalism”, Dr. Samuels tells his story of the doctor who led him to medicine and inspires him still.

Dr. J.W. Epstein was the pediatrician who cared for Michael Samuels in Cleveland back in the fifties. Dr. Epstein trained in Vienna and emigrated  to this country to escape the Nazis. He made house calls in a “broken-down jalopy” that no Cleveland police ever ticketed, no matter where he parked it.

Doctor Epstein would examine young Michael and pronounce a diagnosis. Then he’d reassure Mrs. Samuels that her son was not in the grip of serious illness. All soon would be well. The “enormous feeling of relief…had me on the mend in no time.” Michael Samuels wanted to do this, to give comfort and care for ill people as Dr. Epstein did.

Michael grew to be a doctor that would have had J.W. Epstein glowing with pride. Dr. Samuels is a nationally recognized neurologist and professor. Yet his writing shows the humility typical of the finest clinicians. He thinks often of the doctor who sparked his choice of medicine. He asks physicians to “recapture the spirit of Dr. J.W. Epstein” by committing themselves to constant learning in service of patients. And never giving patients cause to question their doctors’ motivations, knowledge or duties.

Hubris

Functional medicine is a sleek name for a concoction of old nonsense. Take large portions of naturopathy, mix with equal parts of detox supplements and chiropractic. Throw in bio-identical hormones. Season with nutraceuticals, prolotherapy, energy balancing and craniosacral therapy. Toss in a dash of biomagnetism with ZYTO and…voilà! Functional medicine as served at The Morrison Center.

The Institute for Functional Medicine website gives persuasive reasons why functional medicine is a “new paradigm”. (When will the word police banish “paradigm”? Especially new ones.)

  • Its practitioners claim to spend more time with patients.
  • Functional medicine uses a patient-centered approach, concentrating on the whole person.
  • Functional medicine considers the patient’s environment, lifestyle and genetic factors.
  • It emphasizes prevention of chronic disease and helps people look after their health.

Each of those principles should form the foundation of all clinical practice. Each will guide people to healthier lives. When combined with scientifically verified treatments and care. But functional medicine practitioners are selling snake oil, not practicing medicine.

Dr. Robin Berzin posted “Why I’m Starting a Radically Different Kind of Medical Practice” on the THCB several days after the Samuels post. The piece reads like an advertisement for her new practice, Parsley Health, opening in Manhattan this month. Dr. Berzin will practice functional medicine at Parsley in a “tech driven, modern and affordable way”.

Dr. Berzin graduated from Columbia University College of Physicians and Surgeons, a fine medical school. She began an internal medicine residency at Mount Sinai Hospital in New York City but quit. According to her LinkedIn profile, she completed a year of the three-year program. Her website bio gives the impression she’s a fully trained internist.

Dr. Berzin then moved to the Morrison Center for a year. Mount Sinai doesn’t include biomagnetism, energy balancing or craniosacral therapy teaching in its internal medicine residency. Equipped with unfinished training, skills in detox and “botanical medicine”, plus savvy self-promotion, Robin Berzin was ready to launch her “radically different kind of medical practice”.greedy doctor

Radically different it is. Patients must buy memberships. Eighteen hundred bucks a year on the barrelhead, please, before you walk in the door. For five visits with the doctor. After that, visits are $250 a pop. Dr. Berzin keeps bankers’ hours. Have an emergency? Call 911. Need simple after-hours care? Tough. (Must not be any biomagnetism emergencies.)

How about routine primary care? Find another doc. She doesn’t do that either. And don’t plan on using insurance. Berzin doesn’t accept it.

Her refusal to handle emergencies or accept insurance is likely more than intransigence. Doctors need to finish residencies and be board-certified in their chosen fields for hospital privileges. It’s difficult to help patients in emergencies without hospital privileges. Likewise, most insurance companies require doctors be board-certified for acceptance to their “panels”. Dr. Berzin put up a shingle without two building blocks of medical practice; hospital privileges and insurance participation. Her choice creates steep barriers for patients. Especially as she touts being affordable.

What does eighteen hundred dollars buy you? Dr. Berzin will “…address the root causes of disease [color emphasis hers] to understand the complex web of factors that contribute to your health…”. Apparently, to do this, she will “use the latest lab testing [cost not included]…view you as an integrated system…and engage you in an authentic relationship”. Then sell you supplements.

Hope

If Dr. Samuel’s post was a gift and Dr. Berzin’s a farce, Dan Barry’s story in the Times was grounds for hope in our harsh medical system.

Dan Barry wrote “An Oasis of Care for People With Intellectual Disabilities”. It appeared in the print edition of the paper on New Year’s Eve. (The video embedded in the online version is a revelation.) With Dr. Berzin’s approach to medicine fresh in my mind, the struggles of families at the Lee Specialty Clinic  pricked my eyes with tears.

The article focuses on Mimi Kramer and her son Trey. Trey is 33 years old. He is profoundly disabled by cerebral palsy, autism and intellectual difficulties. Many sounds send him lashing out in violent rages. When frustrated, he bites his hands until they bleed.

Ms. Kramer recounts years of misery trying to find adequate medical and dental care for her son. Physicians’ offices turned her down when she described Trey’s problems. If she snagged an appointment, she was usually told not to return. Trey was “too disruptive”. Her luck was no better with dentists.

The Lee Specialty Clinic is in Louisville, Kentucky. Founded by Henry Hood, DMD and his son-in-law, Matthew Holder, MD, the clinic is the first center in the nation devoted to the care of people with intellectual and developmental disabilities (IDD). The men knew people burdened by IDD needed expert, compassionate care, but that such help was almost impossible to find. So, working with Kentucky state legislator Jimmie Lee (for whom the clinic is named), they first opened a dental clinic in 2002. The full, combined medical/dental center opened last year.

The clinic is well-staffed with health professionals. Doctors, dentists, nurses, physical therapists and psychologists work in concert to make life better for patients and their families.

The Lee Specialty Clinic doctors also work to find root causes.

For example, Drs. Holder and Hood talk about an inclination some clinicians have to attribute all abnormal behavior in patients with IDD to their disabilities. It’s easier than searching for an underlying problem. Cheaper too. Without speech, head slapping becomes communication. The clinic doctors find such actions as head slapping may actually point to a painful ear or dental infection. Disorders remedied with antibiotics.

Mimi Kramer is a small woman of enormous dignity. She has worked as a housecleaner for thirty years so she has flexibility to care for Trey. She hopes to find a place for him before she’s too old to manage. She’s 52 now and Trey has been on one waiting list for fifteen years.

Commitment to Care     

Caring for healthy people is easy. And lucrative. Caring for sick people is hard. And demanding. Caring for disabled sick people is exhausting, stunningly difficult and uses more patience than most of us can claim. Only the most dedicated clinicians have the fortitude for it day after day.

Parsley Health and Lee Specialty Clinic are new. Each has doctors looking for the root causes of disease. Each clinic treats people holistically, helping them attain the best health possible.

Yet, if Mimi Kramer were asked, it’s close to a sure bet which clinic she would call a “radically different kind of medical practice”.

Dr. Samuels asks physicians to recommit to the spirit of medicine embodied by Dr. Epstein. Dr. Hood and Dr. Holder already take commitment to their patients beyond the border where most of us go.

Dr. Berzin, your turn.

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