More Like Birds than Rocks

SUSAN CARR
Editor, susan.psqh@gmail.com

At the beginning of Rx: The Quiet Revolution, Doug Eby, MD, vice president of medical services at Southcentral Foundation in Alaska, tells a parable about a physician, a rock, a bird, and a target painted on a wall. If the physician throws the rock at the target, eventually, with practice, determination, and perhaps some luck, he will hit the bullseye. If the physician has a bird, he can aim and nudge it toward the target, but only the bird can decide to land on it. The physician can further influence the bird by making sure the target is relevant and valuable, but in the end, it’s up to the bird.

Eby points out, “This is healthcare; people are more like birds than rocks.” Physicians can teach, coach, and persuade, but ultimately, patients are in control of their own healthcare decisions. The physician’s effectiveness and the health of patients and communities depend in large part on the quality of relationships and how people feel about themselves and each other.

The film offers four examples of healthcare rooted in meaningful relationships between clinicians and the communities they serve, among clinicians within those communities, and between individuals and their health. The film sees a “quiet revolution” in models of care delivery that emphasize collaboration, partnership, empathy, and compassion.

The first story is about David Loxterkamp, MD, and his primary care practice in Belfast, Maine. Against the picturesque background of coastal Maine, the film shows some of the challenges Loxterkamp faces: recalcitrant patients with chronic diseases, homebound patients with few resources, and a community struggling with addicition. The film also shows Loxterkamp meeting with his practice colleagues as they discuss the emotional effects of a recent patient death. In addition to sadness, they voice frustration about limitations of the medical system, the results of which they feel responsible for even when much is out of their control. It is a supportive, respectful conversation among colleagues who seem truly to care about each other and their patients.

In that scene, Loxterkamp’s practice demonstrates the kind of caring Hirschinger, Scott, and Hahn-Cover describe in “Clinician Support: Five Years of Lessons Learned,” the lead feature in this issue (pg. 26). The article reports data, wisdom, and practical advice collected by the forYOU team at University of Missouri Health Care. The team offers support to all professionals and staff members who feel the emotional effects of stressful or painful clinical events, including harm or death caused by medical error. The program is based largely on trained peer support and requires an open, humane environment.

Traditional and social media offer many examples of people in healthcare avoiding difficult conversations or treating each other badly. Anger and resentment are evident in anecdotes about dysfunctional relationships among administrators, clinicians, patients, and families. There are even truly shocking reports of extreme violence, such as the fatal shooting of surgeon Michael Davidson by a patient in Boston in January.

Against that background, it is a pleasure to have the opportunity to publish the forYOU Team’s article and to recommend Rx: The Quiet Revolution, both of which focus on relationships among people who are able to engage around difficult issues and foster health for all.