what if
PREFACE
INTRODUCTION
“You will write, if you will write,
without thinking of the result in terms of a result,
but think of the writing in terms of discovery,
which is to say that the creation must take place
between the pen and the paper,
not before in a thought or afterwards in a recasting.
Yes, before in a thought, but not in careful thinking.
It will come if it is there and if you will let it come.”
“Writing is the only thing that, when I do it,
I don’t feel I should be doing something else.”
Gertrude Stein ( 1874 – 1946 )
PERSONAL ANGST
Before retirement in 2016, I was a Primary Physician and belonged to a small, group practice along with two other physicians and a nurse practitioner. Our group started in 1975 and closed 41 years later. Its street address had moved 10 blocks west in 1992. Both locations were less than 1/2 mile from the northwest edge of the city in 1975. By 2016, the nearly unchanged location of our office was near the geographic center of Omaha.
Thirty years before closing, our practice added 20-30 newborns a month. During the last 5 years, we offered our Primary Healthcare to about 3 newborns a year. These changes represent a snapshot of our practice during its 41 years. In spite of the demographic changes, the total number of active patients had been stable from year to year, variably around 2,500 to 3,000. For the clinic, an active patient was someone who had been seen for at least one office encounter within the previous 18 months. The number of people who were seen once, never to return, was nearly equal to the number of people who were seen once every two to three years.
During my career, I became increasingly saddened by the governance deficiencies within our nation’s healthcare industry. But to a larger degree, I became especially saddened by the concerns and frustrations of our patients as they experienced their healthcare. These concerns represent the aspirations of our patients who had individually invested in their HEALTH with our practice for extended periods of time. Many of these patients, maybe 2/3, were members of extended families known by our office for more than 30 years. Above all else, I dedicate any value of this Blog to these families as a recognition of their contribution to the therapeutic community of our office.
It is my hope that each resident person and every Primary Physician could experience the privilege of contributing to a similar therapeutic community. Eventually, healthcare reform should create the basis for an increasingly adaptable, healthcare industry. This reform process should assure that each resident person has a caring relationship with a Primary Physician who is associated with an enhanced Primary Healthcare clinic. I invite you to share my belief that this Blog describes a possible means to this end, community by community.
WHY NOW!
The initial impetus for this Blog occurred in 2007. In November of 2007, I attended a ‘community lecture’ here in Omaha given by Henry Aaron, Ph.D., an economist then with the Brookings Institute in Washington, D.C. His projections for the future of health spending we pay for our nation’s healthcare led me to one conclusion. The future cost of our nation’s healthcare industry could not be sustained by our nation’s economy. So in 2008, it was time for me to learn more. I wrote several short essays for myself about healthcare reform in 2009. One of them can be found on the FIVE HEALTH STORIES Sub-Page of the APPENDIX Page.
Soon, my search for information and new ideas began to assume its own momentum. Eventually, I began to perceive that a solution, based on old ideas newly revisited, could unlock the paradigm paralysis afflicting our nation’s healthcare industry. This Blog first appeared in November of 2008. It is now regularly revised, usually in fitful spurts. Over and over, my experience with this Blog affirms the view of Gertrude Stein about writing. For me, she was and continues to be correct.
Paul Nelson, M.D.
Omaha
P.S.: The ubiquitous stethoscope, shown above, became 200-year-old technology in 2019. For perspective, blood pressure measurement using a sphygmomanometer, viz blood pressure cuff, originated in 1881. The thermometer is somewhat older, estimated at about 1617. Considering the measurement of time, the century of about 1500 B.C. seems to be the consensus for its origin.
I vote for a new test that would accurately assess a person’s resiliency in real-time to maintain stable homeostasis. It could be used at any time during a person’s life, beginning with perinatal survival. How about 2025 as a goal date? HINT: The test results would be available using the results of a Fourier transform analysis.
pjn