An EPIC Degree of Soul Loss

The practice of medicine has undergone yet another change. Over the past several years, it has gone electronic. Those of you who have experienced electronically recorded medicine have had to adapt to the profound change that this brought to the physician visit. Physicians, already stressed from adapting to the corporatization of medicine, now have to adapt to data entry during their time with their patients. I, for one, resisted this as long as I was able.  I intuitively knew what this would do to the sacred essence of the physician-patient encounter.  Last year, I was forced to succumb.  I was not really given a choice. Implementing the electronic medical record (EMR) in my practice was not only extremely expensive for a primary care physician in private practice, it was extremely stressful for one who practices “patient centered” medicine. For a physician who relishes spending time with my patients, listening for clues in their stories to help them problem solve and heal, this was deeply intrusive.

When I used paper charts to record patient encounters, I was able to look at my patients, be in their presence and receive their stories while using my technical and intuitive skills. Most importantly, I could hold sacred space for every patient who I promised to help and heal.

After the electronic medical record became a part of my practice, I grieved the presence of a machine in my exam room that interfered with this connection. Surprisingly, I found myself in constant heart ache struggling through the day to try and capture the sacred essence of my beloved patient encounter. I realized the “mill” medicine had now become was a data collecting one that no longer valued humanistic listening and caring.  I had to learn how to enter patient data quickly and efficiently in order to maintain connection with my patients, so vital for their healing.

Given the level of my grief, I was curious if other physicians felt like I did. I explored internet conversations and blogs about how others felt since this implementation. One physician accounted that the stress of implementing EMR caused him to suffer a heart attack.  Could this be symbolic of his heart break from not being able to engage with his patients like he used to, combined with the stress of learning this heartless system of data entry?  It is certainly a cause for wonder.

Our current corporate system of medicine has been in crisis for nearly two decades. Patients and physicians are disillusioned by what today’s health care system has become. It is obvious that it suffers from a great degree of “soul-loss.” Rather than finding ways to fix and heal it to improve patient care, I believe the implementation of the EMR has furthered its dis-ease.

We were told that this method of documentation would make health care seamless, more collaborative and save paper and time. It has done the opposite. Different health care systems are not able to access the records of shared patients; it has created more paper waste and has taken up more physician time. Physicians who are unable to balance the EMR with patient contact opt to complete their charting after work into the late hours of the night. This compromises their work-life balance, adding to their stress and rendering them vulnerable to mental and physical illness.  We have all heard of numerous

physicians who opted to retire before their intended time when EMR was implemented. They were unwilling to compromise the art of healing for data entry.

Many patients do not realize that physicians had no say in this decision to implement EMR. They were merely required to adapt to this mandate.

As a patient, when you visit your private practitioner who is now electronically linked, please have patience. And physicians, please know you are not alone in your frustration with yet another intrusion in the exam room, our sacred sanctum. We will have to adapt in a way that preserves the sanctity of our vocation, despite the stress this has created for us.

Our precious field of medicine cannot continue to lose its soul in the many ways it already has. At some point it will have to transform and reclaim its true purpose and restore the sacred contract between physician and patient.

Till then, as physicians, we must carry the flame of healing in our hearts for our patients with continued love for our craft, and patients must carry patience in their hearts for their beloved physicians who struggle to remain connected with their heart and feelings while trying to adjust to the presence of the EMR.

Chana Dal Curry Soup

For dinner tonight, I had an organic green salad with cucumbers and carrots, Chana dal (yellow lentils) and organic Jasmine rice.
Chana Dal is a lentil from India that has a low glycemic index and tastes incredible as a curry.


Chana Dal Curry Soup



1 cup of chana dal (available at any Indian grocery store - it probably won't be organic)
3 cups of water
1 whole finely chopped onion
2 cloves garlic minced
1/2 inch ginger root, minced
2 tsp of ghee or clarified butter
1 tsp of salt
1 tsp black mustard seeds
1 tsp cumin seeds
1/2 tsp of tumeric powder
1 tsp of coriander powder
1/2 tsp of cumin powder
1/4 tsp cayenne powder
1 tablespoon curry leaves
1/4 tsp asafoetida powder
1 tablespoon powdered coconut or 1 tablespoon of coconut milk
juice of half a lemon
cilantro leaves to garnish if desired

Heat ghee in a saucepan and add mustard seeds, cumin seeds, asafoetida, curry leaves, garlic and ginger till mustard seeds begin to pop and turn gray. Then add onion and fry for 2 to 3 minutes. You may need a bit more ghee to coat this onion/spice mixture. Add washed chana lentils, the coriander, cumin and cayenne powder, salt and water and boil till soft (about 20 minutes). Add powdered coconut. Garnish with chopped cilantro leaves and a squeeze of lemon juice. Serve with rice and enjoy!

A prepared cup of this exotic and delicious lentil soup with half a cup of rice makes a filling and nourishing meal especially when accompanied with stir fried chopped kale or collards. It has great cancer fighting and antioxidant properties as well.

Asafoetida is an anti-flatulant, digestive aid and anti-inflammatory. It is used in Indian curries and settles the stomach especially if the curries are spicy. It has a smoky flavor and can overpower a dish so only a pinch fried in oil is needed to flavor a dish.

Many of these ingredients are available at your neighborhood organic grocery store or an Indian grocery store.

What Are The Odds?

I love The Bay Area in California. Even though I now live in Wisconsin, I am still drawn to the beauty of the sun and the warmth with the smell of eucalyptus and the misty feeling of the ocean on my face. I used to run the hills of SF at 4:30 am during my internship and residency and felt the full sensation of the natural beauty of that beautiful place.

I was also in the Loma Prieta earthquake in 1990.

Today, I was talking about how beautiful the sun felt to Jeannie at the pet store in Pewaukee this morning where I was getting cat food for my cat. It reminded me of the way the sun shined in the Bay Area. Jeannie told me that she too lived in the Bay area and she too was in the Loma Prieta earthquake, and yes, the sun today reminded her of when she lived there. At this point, another customer walked in to buy a dog cookie and heard our conversation. Turns out she was born and raised in the Bay Area and was also in the Loma Prieta earthquake!

So here we were, three women in Pewaukee, WI, who all shared a deep love the Bay Area and were all in the 1987 earthquake.

It was a surreal and magical moment. I didn't want it to end!  The numinosity was palpable.

What are the odds of us meeting in that moment in time in the middle of the midwest with our shared experiences from the same moment from our past in the Bay Area?

In any case, we parted ways intimately connected to each other through our love for San Francisco. Maybe we will get together periodically and share a cup of California coffee, tell stories, share memories and photographs of our home from the past far away from our home in Wisconsin...

I certainly hope so!

There must be a word in the English language to describe moments like these.

"Synchronicity" falls short of the magical precision that moments like these hold.

Isn't life amazing?

                                                                    

The Hope of Transforming Health Care

In the words of Martin Luther King Jr., “Of all forms of inequality, injustice in healthcare is the most shocking and inhumane.”

My past few articles have been on the unhealthy infrastructure in health care today and how it adversely affects patients as well as physicians, nurses and those who work within it to serve.

Over the past few weeks, I have seen an inordinate number of patients who are hurting because of the way they are treated by administrative practices within this system.  The patterns of conditioning through ‘learned helplessness’ are pervasive and worsening as the systems continue to compete with each other for market share out of greed. 

We all comprise their ‘market’.  What they forget is that money is not a substitute for care.  Care is a choice born of intent.  But when physicians and nurses are ‘boiling frogs’, they are unable to provide the care they intended to offer.  Their care cannot be limited to a 15 minute office visit done under pressure.  When physicians take longer to problem solve, they are reprimanded and punished as it reduces revenue and threatens quarterly profits. 

A ‘boiling frog’ is a frog who is heated in water till it dies.  The teaching point is - because the torture is started in cold water and heat is applied slowly, the frog does not realize it is being boiled alive.  Its senses are sensitized to greater levels of heat.  As morbid as this analogy is, this is used to describe how people adapt to abuse.  This is no different in health care. 

Today’s physicians are no longer seen as healers.  On the contrary, they are viewed as tools that serve health care administration in all its extractive methods, merely generators of revenue, likened to Pavlov’s dog.  Today’s physicians have lost heart and meaning.  The mandates that grind them down demoralize and wound them in deep ways. 

I left corporate health care 15 years ago when this behavior was escalating.  I was unable to live under patriarchal rules.  Today, this treatment is being normalized by ‘the powers that be’.  For me, this is unacceptable.  For others, adapting is their only hope. 

It is important to lift the veil, to view the shadow beneath the blanket of illusion projected in marketing ads, with terms like ‘health’ and ‘care’.  We must wake up to what is really happening.  This is a system that purports to serve.   It offers neither health nor care. 

When patients wake up and demand authentic care, and physicians gain the courage to speak their truth, transformation will be the inevitable outcome. 

“Health care needs to be examined from the inside out, from the top down and the bottom up. There must not be any stone left unturned. When physicians analyze the current system in ways in which they were trained to analyze the body, they will be able to identify the pathology that keeps it sick. They will have to reach deep inside and stand in the face of criticism and rejection, with courage and heart to transform their system that has lost its soul.”

                                                    ~Becoming Real, 2011, by Rose Kumar M.D.

Health care is in crises.  In Southeast Wisconsin, both patients and physicians are struggling to make sense of the lack of consciousness that has taken over the health care system.  Morale is at an all-time low. 

I implore you all to awaken to what the reality of today’s health care system.  Nothing can transform without holding the light to it, including the shadow.  It is the only way to transform this system into one that actually serves the mission of its vocation.  When a critical mass of conscious consumer’s expects real care, the system will be forced to deliver what is expected.   

 I believe this is the only hope we have to transform health care.  This is also how it will ultimately recover its soul.

A DEEPER KIND OF HEALTH CARE REFORM

Many of us are disheartened by the state of health care today.  The solutions being proposed to repair and reform it are not sustainable for physicians or patients.  Every system functions from operating principles that govern and direct its mission.  In order for us to understand why health care is dysfunctional, we need to analyze and understand its business model as it relates to is mission.

Nearly two decades ago, physicians delegated the business of health care to administrators and accounting experts to manage and run it.  Unfortunately, their mission was in conflict with that of the health care system. Theirs was profit centric rather than patient centric.  They believed that patient care interfered with generation of profit.  They began to see time spent with patients as a compromise of their mission.  They began to value numbers over people. Health care’s mission became disjointed when two contrasting missions were being served. Profit became the dominating mission for health care as business managers established control over physicians and regulated and limited their time with patients for maximal revenue.

When I worked in this system, I was unable to find meaning in my work.  I was also unable to sacrifice my mission as a physician for the mission of health care administrators.  I was told that my work in their health care system was a conflict of interest to their mission.  My patients were staying well and not generating enough hospital dollars.  I left traditional health care to create my own business model.  As a physician who remains devoted to my patients I wanted to create a model that generated value for both my patients and my business creatively.   I have never sacrificed mission for profit. I run my business with good business savvy, all the while devoted to my purpose as a physician.  A health care business model risks losing its way when it becomes profit centric.  For healthcare to be successful and sustainable, mission must never be compromised for profit. Our health care system has lost its way.

We have many examples of profit driven health care in our country today and especially in southeastern Wisconsin.  These systems purport to care about health, but on closer examination, we see otherwise – they rely on sick care.  Health care is a conflict of financial interest. Currently, the highest expense in health care are administrative costs.  Many layers deep, administrators manipulate and control physicians, nurses and employees  serve their mission of profit over health or care.  This has demoralized physicians and nurses and driven away patients. Moreover,  it has increased the incidence of medical errors, placing patients and physicians at risk. 

Author and president of Business Ethics Magazine, Marjorie Kelly, defines a business model that functions with this type of focus as ‘extractive.’  Its’ purpose is merely financial – maximization of profits.  Worth is extracted from workers to generate profit by layers of administrative hierarchy.  The extractive business model is prevalent in most corporations today.  Outsourcing work to Third World countries for cheap labor to increase profit-margin is extractive.  Extractive economics are bad for our country’s economy.  It displaces domestic workers and extracts as much work as it can from the remaining workforce to serve profit margin.  Extractive economics deplete meaning from work.  Employees find themselves working merely to pay the bills for survival.  They lose pride and meaning in their work. As a result their physical and mental health suffers.  We all pay the price for extractive economics.  The state of our country’s middle class is a result of extractive economics. 

The majority of health care systems function from this extractive model.  Health care employees are currently working merely to meet quarterly projections.  For health care to operate in this manner is unethical.  Health care’s mission is to serve and heal.  When the vulnerability of patients is used to generate profit, they are deeply harmed. The ‘care’ they receive is motivated by the drive to maximize testing and treatment.  Physicians are unable to diagnose and treat cost-effectively when working for an administrative system based on extractive economics.  They must follow the rules of the game to keep their jobs.  Patients are left with super-sized bills for mere symptom management.  Administrative bonuses depend on this.

A ‘generative’ business model provides services that generate value.  Health care based on generative economics focuses on health and healing rather than maximization of profit.  The focus shifts from one of greed to one of service. Patient care is not provided at the cost of profit, and there is a balance between both without compromising either.  A health care model based on generative economics operates from the principles of sustainability.  There is a fair exchange between doctor and patient. 

What this would look like in the health care system is already visible at The Ommani Center for Integrative Medicine.  Patient care as well as sound business principles are utilized to serve patients cost effectively.  In addition, the most cost-effective diagnostics available in the community are recommended to patients.  Small businesses in the community, such as organic grocers, complementary practitioners and businesses dedicated to health and sustainability that operate from a high standard-of-care, receive support and collaboration by practitioners through patient referrals.  Education and empowerment are of foremost value and achieving optimal health at all levels is served.  All retail profits are used to subsidize business overhead to keep health care visits affordable for patients.

Practitioners work collaboratively with patients to uncover the causes of illness and empower patient responsibility.  The mission of health care is served and all profits are reinvested to support the staff and employees of the Center.  The business is also dedicated to the health of the environment and recycles to reduce its carbon footprint. 

The Ommani Center is a generative business. 

Those who administer the business of traditional health care state that a mission centric model cannot succeed financially, that a generative business model is not profitable.  Nothing could be further from the truth.  Shifting the focus of a business from profit to mission, from extractive to generative can actually draw in more revenue in service of its patients.  In addition, in a model like this, patients are truly served by physicians practicing from heart without the demoralization they currently experience within an extractive model of health care.

This is health care reform at the level of its core mission.

I believe this is one of the key solution’s to healing our broken system of health care.  This can also restore the soul of our sacred vocation.  

LOVE is here on Earth

LOVE is here on Earth

I have often felt that LOVE is what we are here to feel and give to each other.

Many share how I feel so why don’t we have stories of LOVE everywhere?

Ever since I was little, I felt it often and deeply.  It was inspiring and a bit frightening but warming, a bit overwhelming yet comforting.  I was raised to hold my feelings in, medical training tried reinforcing this, but that didn't work very well for me. I didn't adapt well and do as I was told. I felt LOVE every time I witnessed a simple act of kindness – you know, that sensation that wells up your tears and feelings. That is LOVE

LOVE makes us FEEL.

I feel it every day with my patients and staff, my dogs, my cat, my family and friends and even with total strangers - it is ever present and sustains life.  It awakens joy and the will to live.  It brings depth and meaning to the simple moments that make life worth living.

Last week when the snow fell heavy and deep, I was on the freeway on my way to work.  A snow plough entered the on ramp, ploughing and salting, clearing the path.  I was overcome with gratitude for the driver, a total stranger to me whose act of kindness saved us from skidding, who was up early, making it safe for us to go wherever we needed to go.  Yes, this was his job, but I chose to see it as an act of kindness.  I chose to see it directed at me and the others on the road at that moment in time. My heart felt warm, my tears welled. I was so thankful.  I saw his work also as an act of LOVE.

 Then, I stopped at the coffee shop and the owner had been there early on that cold morning making sure the hot coffee was ready and waiting, to warm me on my drive to work.  She was grateful for my presence and I was grateful for her efforts – again, LOVE. 

When I arrived at work, the sidewalk was already salted by a stranger who made sure I didn't fall on my way to the front door.  Yet, another act of LOVE and

As I walked in the door, I was greeted by my beloved patient who came early to fill out paperwork so we had our time together without it being cut short by protocol – an act of LOVE.

This was all on one day before 9.a.m.!

Before my day even started, I felt loved.  I felt that all the LOVE was directed at me.  I took it in and it filled me up.

If we remember to be grateful for the many ways we LOVE each other every day, and hold this sacred, our world will change.  What matters will be valued more than not mattering.

Think about this.  It can make all the difference in our experience on Earth.

LOVE is present everywhere we choose to see it.

Make sure your day is filled with gratitude for the many acts of LOVE that come your way that you may otherwise miss.

The Intention Behind The Ommani Center

How does one adapt to being uprooted and unearthed?  The human spirit strives to survive, to continually move towards its destiny to carve out a course that reclaims ones sense of meaning.  My mother is a person who experienced this.  At the age of 10, her parents were killed in the India-Pakistan partition, leaving her orphaned and terrified.  As life presented her with gateways, she was able to walk through some, and not others, due to the fears resulting from the acts of violence she had experienced that had been imprinted upon her.  She engaged her courage as she grew large at the wounded places and carved a course for her life that offered her meaning and purpose.  Over the history of the human race, millions like her have been left with varying levels of paralysis in our world with little emotional context. The context with which the unknown was encountered for them was through the experience of terrifying loss.
We may think that our generation is protected from this level of loss, that it is from a more distant time, but this is far from the truth. Our world has been warring for decades, leaving casualties of violence and encounters with the terrifying unknown embedded in our collective psyches.  We are living in a virtual reality.  We have learned to cover up our feeling function and learned to deny our deep emotions with creature comforts, with superficial solutions, none of which endure.  Eventually we must stand naked before ourselves, confront our gateways and step into our largeness, reclaiming what was taken from us and redirect our course consciously into the unknown.  This is what midlife expects of us.  In the areas my mother was unable to choose, due to her circumstances, I must.  Where she could not reclaim, I must.  We, the children of the last generation, now in midlife, must find the courage to engage our consciousness in the areas where we become stuck, and live  from our superficial yet familiar cultural framework and believe in the potential of our souls.  To redefine health from this context is our sacred task.  This is how REAL Health Care can be accessed.
The Ommani Center for Integrative Medicine was born from my strong intention to create a context for health that is deeper than just the physical level.  Health is more than just symptom management through integrative methods.  As important and vital as this is, it does not access true health or healing.  Being conscious of how and where one lives and relates to life from may be the more important and deeper context that determines one’s state of true health.  This can and must be evoked.
If those that killed my grandparents and irrevocably changed the course of my mother’s life had this level of consciousness and asked the important and REAL questions, needless suffering could have been averted.  We cannot go back in time and change history.  We can, however grow strong at the places where we have been wounded.  We can use our wounds to acknowledge our humanness and engage our courage to grow in consciousness and health.  We must engage our wounds in order to offer ourselves a larger context for empowerment, reclamation and ultimately for healing.  This will uncover a deeper sense of meaning in our lives.
A Health Care System that can hold this level of space from a context such as this, inclusive of modern technological advances with high-standard –of –care, is what we all deserve.  It is a place where meaning is restored.  Cultivating and supporting a system like this is sacred work.  For me, it is a vocation.  Where my vocation aligned with my mother’s biography is where I found meaning and an opportunity to create a larger context in the form of The Ommani Center where true health and meaning could be accessed that was inclusive of my love of medicine and my devotion to high quality health care.
If we want a system that cares and offers us more than what our current system offers, this needs to be our collective work.  Together, we must  support and expect health care to be REAL for us so it can  address our REAL needs and ask the REAL questions of us, questions that we can live out in our destinies from a place of health and meaning.  I encourage all of you to expect this from our Health Care System.  Our expectations of what is REAL will truly change our world for the better.