A Follow-Up Visit With A Country Doctor
LIANE HANSEN, host:
During this last year, as the host of this program, I've had the chance to interview people who are on my bucket list - people I'd not yet had the chance to interview. I also wanted to check back on some guests who appeared in the early years of the show. One in particular is David Loxtercamp. He's a family doctor in Belfast, Maine.
In 1997, he had published "A Measure of My Days: The Journal of a Country Doctor." His father was a general practitioner, who died when Loxtercamp was 13. But in this excerpt from that 1997 interview, he explained that he was gently pushed into becoming a doctor by his mother.
Dr. David LOXTERCAMP (Family Practitioner/Author, "A Measure of My Days: The Journal of a Country Doctor"): She said, David, I just want you to know that if you decide not to become a doctor, I'll feel as if you let your father down.
(Soundbite of laughter)
Dr. LOXTERCAMP: And then, I suppose like an arranged marriage - or like any marriage in which you get into for perhaps all the wrong reasons - you have to then come to terms with that commitment you've made. So really, the decision to become a doctor is probably been less important to me than the decision to stay a doctor.
HANSEN: David Loxtercamp is still a doctor and a writer. He's working on a new book. And he is in the studio of WMEH in Bangor, Maine.
Welcome back to the program, David.
Dr. LOXTERCAMP: Thank you very much, Liane. It's great to be here.
HANSEN: Are you still making house calls in Belfast, Maine?
Dr. LOXTERCAMP: I do. Probably not as many as I used to but I still visit shut-ins and people who have a very difficult time moving around. It's also nice to be out of the office and into the community.
HANSEN: How has your practice changed over these past 14 years?
Dr. LOXTERCAMP: It's grown. Recently, we had a good fortune of recruiting three young, new practitioners - two family physicians and a physician assistant. And it's very difficult these days to find graduates of family medicine residency programs who are willing to take the risk of coming to a small community. We were very fortunate to do so. And the infusion of their energy, their curiosity, their flexibility, their presence has just been a wonderful reawakening for our office.
HANSEN: What effect did the publication of "A Measure of My Days" have on your life?
Dr. LOXTERCAMP: Well, first of all, it was a surprise. I never imagined myself as someone who engaged patients in an artistic way, until I realized how important stories were for myself and for the reader; to tell the tale, to tell some of the episodes in people's lives, was surprisingly very powerful. I think it was Rudyard Kipling who said: If history were taught in the form of stories it would never be forgotten.
HANSEN: What is the thrust of the new book you're writing?
Dr. LOXTERCAMP: Well, the most important thing I want to communicate is that medicine in America is really on the verge of a great sea change. And I want to talk about that from the point of view of someone who has seen the old general practitioner - my father and his contemporaries - who has seen my early practice. I saw patients in my exam room, I saw patients at the hospital, I visited them in the nursing home, I went to their homes, but it was really the doctor-patient relationship that I focused on.
Now we're at a point where that model doesn't work very well anymore. Society has changed, medicine has changed and primary care is adjusting to that change. I want to tell the story of how we came to be where we are through the lives of my father and a couple of his colleagues, through my own beginnings in the community of Belfast. And finally through my participation in some early experiments and the change that we foresee - the patient-centered medical home.
HANSEN: What's a patient-centered medical home?
Dr. LOXTERCAMP: It's an old term, actually. It began in the discipline of pediatrics for special needs children. But it's been rehabbed, promoted and marketed, and reconfigured to be a kind of practice that takes into account the need for patients to be seen by a doctor when they need to be seen, on the day they need to be seen, on the day they call in; to extend office hours, to make ourselves available regardless of the patient's finances, cultural barriers, transportation needs; and certainly what used to be the absence of acute-care visit openings in our practice.
So we've restructured our practice now to have open access, that when a patient calls, we have enough openings in the day to see them that day for what they need. So this is one component of the patient-centered medical home.
A second component is communication. And I think the most visible aspect of that component is the electronic health record. And I focus on communication as the greatest asset of the EHR, because it can be shared, not just with other people in my office, but with colleagues at the hospital or consultants that I send my patients to. And even now with patients, they can have access to their electronic health record from home, just the same way that I can for my home.
I used to think that this was not very important to patients. But when we first introduced this a couple of years ago, patients signed up for it in droves. And so it's very, very exciting that now there are two sets of eyes, two sets of invested parties looking over this record that I've created for the patient's behalf.
HANSEN: You sent me a list of 14 aphorisms. I'd love to end with you reading them.
Dr. LOXTERCAMP: Sure. I probably think too much...
(Soundbite of laughter)
Dr. LOXTERCAMP: ...about what I've learned over the years. And I try to condense these thoughts into the old notion of the Hippocratic aphorisms, created in the School of Hippocrates on the island of Kos, 400 BC. I tried to distill what I've learned. And what I've come up with is it could be 20, it could be five; these 14s are important to me and so I'll present them to you for your reflection.
(Reading) Health is not a commodity. Risk factors are not disease. Aging is not an illness. To fix a problem is easy, to sit with another suffering is hard. Doing all we can is not the same as doing what we should. Quality is more than metrics. Patients cannot see outside their pain, we cannot see in, relationship is the only bridge between. Time is precious; we spend it on what we value. The most common condition we treat is unhappiness. And the greatest obstacle to treating a patient's unhappiness is our own. Nothing is more patient-centered than the process of change. Doctors expect too much from data and not enough from conversation. Community is a locus of healing, not the hospital or the clinic. The foundation of medicine is friendship, conversation and hope.
HANSEN: Dr. David Loxtercamp, he is the author of "A Measure of My Days: The Journal of a Country Doctor." The tentative title of his new book is "Conversation, Friendship and Hope." Dr. Loxtercamp spoke to us from the studio of WMEH in Bangor, Maine.
Best of luck to you.
Dr. LOXTERCAMP: Thank you very much, Liane. And best of luck to you on your new journey.
HANSEN: Thank you.
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