Patient Centered Care Quotes

When we play it safe, we sabotage our chance to make our mark in a memorable, authentic way. Health care organizations confront pressures to provide more responsive, personal care with cost efficiency, striving to provide the industry’s “patient-centered care” goal. However, when every hospital system and specialty clinic cautiously claims to provide “patient-centered care”— because all of their competitors claim to provide “patient-centered care”—their claim becomes so safe that they disappear into the din of their competitors’ identical claims.

One patient got up and used his wound care supplies to tape his hospital door shut.

What if we, all of us, had access to health care that centered on the patients, not the money? Systems like this actually exist on this planet, in this time. Why is America so tethered to punishment and judgement, to one life mattering and another not?

At first she did nothing, waiting for her husband to wake, which he did not, because that wasn’t a thing he ever did. She waited longer than she usually did, waited and waited, the boy wailing while she lay as still as a corpse, patiently waiting for the day when her corpse self would miraculously be reanimated and taken into the Kingdom of the Chosen, where it would create an astonishing art installation composed of many aesthetically interesting beds. The corpse would have unlimited child-care and be able to hang out and go to show openings and drink corpse wine with the other corpses whenever it wanted, because that was heaven. That was it. She lay there as long as she could without making a sound, a movement. Her child’s screams fanned a flame of rage that flickered in her chest. That single, white-hot light at the center of the darkness of herself—that was the point of origin from which she birthed something new, from which all women do. You light a fire early in your girlhood. You stoke it and tend it. You protect it at all costs. You don’t let it rage into a mountain of light, because that’s not becoming of a girl. You keep it secret. You let it burn. You look into the eyes of other girls and see their fires flickering there, offer conspiratorial nods, never speak aloud of a near-unbearable heat, a growing conflagration. You tend the flame because if you don’t you’re stuck, in the cold, on your own, doomed to seasonal layers, doomed to practicality, doomed to this is just the way things are, doomed to settling and understanding and reasoning and agreeing and seeing it another way and seeing it his way and seeing it from all the other ways but your own. And upon hearing the boy’s scream, the particular pitch and slice, she saw the flame behind her closed eyes. For a moment, it quivered on unseen air, then, at once, lengthened and thinned, paused, and dropped with a whump into her chest, then deeper into her belly, setting her aflame

And Kate thought about a time, long ago, when she had witnessed an ongoing romance between two mental patients. As a teenager watching their unlikely relationship unfold in front of her, she had understood that people did whatever they needed to do to be happy, regardless of their unfortunate circumstances. She supposed her mother’s day care center was born out of the desire to feel needed, while making use of the skills that were practically all she had managed to acquire during decades of battling a debilitating illness.

Risch points out that taxpayers spent $660 million building field hospitals across the country.44 Democratic Governor Andrew Cuomo and other Democratic governors kept these facilities empty to maintain bed inventories in anticipation of the flood of patients inaccurately predicted by the fear-mongering models, ginned up by two Gates-funded organizations, IMHE and Royal College of London, and then anointed as gospel by Dr. Fauci—seemingly as part of the crusade to generate public panic. With those quarantine centers standing empty, those governors sent infected elderly back to crowded nursing homes, where they spread the disease to the most vulnerable population with lethal effect. Risch points out that, “Half the deaths, in New York, and one-third nationally,45 were among elder care facility residents.

Because nobody brought that up to you?” “No, we had no idea that there were any problems that would suggest that.” Besides, as she pointed out later in her testimony, she was not an expert on poison. Dr. Henry testified that Peru was not mentioned in papers on tropical sprue, and that even where the disease was common, those who contracted it had lived in the area for a long time, at least a year. Typhoid fever didn’t fit either. “Even though it’s an acute infection, [it] does not cause a tremendous elevation of the white blood cell count.” Dr. Henry believed that Mike had been septic more than once during his three hospitalizations. Dr. Pam McCoy, the ER physician at the UK Medical Center, testified next. “I work with residents and medical students. I teach them how to work in an emergency department. And usually . . . I go see patients, they go see patients with me; we talk about how you see a patient in the emergency department, how you take care of people, how you put in stitches, that sort of thing.

We may find ourselves in a role similar to that of a gardener as we cultivate a space in which healing can naturally unfold. In terms of neurobiology, this stance encourages us to lean into the reassuring awareness that our systems already contain seeds awaiting our attention. For some examples, we humans are always seeking the warmest possible attachments we can imagine (Cozolino, Siegel), our brains are continuously yearning for the arrival of a co-organizing other (Badenoch, Cozolino, Schore), emotional regulation flows naturally from being in the presence of someone we trust (Beckes & Coan) and even our nervous systems have a preference for the social engagement circuitry that sustains connection (Porges). With this kind of support from the biology inherent in both practitioner and patient, our bodies may begin to open into a welcoming state as others come towards us, with a sense of partnership being established rather than someone doing something to us. However this also means letting go of the potential certainty that comes from feeling we are in charge.

I know. I think they probably just want to see you performing the full load of a chief. It’s because they like you. Seriously.” I realized it was true: For the past few months, I had been acting merely as a surgical technician. I had been using cancer as an excuse not to take full responsibility for my patients. On the other hand, it was a good excuse, damn it. But now I started coming in earlier, staying later, fully caring for the patients again, adding another four hours to a twelve-hour day. It put the patients back in the center of my mind at all times. The first two days I thought I would have to quit, battling waves of nausea, pain, and fatigue, retreating to an unused bed in down moments to sleep. But by the third day, I had begun to enjoy it again, despite the wreck of my body. Reconnecting with patients brought back the meaning of this work. I took antiemetics and nonsteroidal anti-inflammatory drugs (NSAIDs) between cases and just before rounds. I was suffering, but I was fully back. Instead of finding an unused bed, I started resting on the junior residents’ couch, supervising them on the care of my patients, lecturing as I rode a wave of back spasms. The more tortured my body became, the more I relished having done the work. At the end of the first week, I slept for forty hours straight. But I was calling the shots:

Several recent studies (Bliss, 1980; Boon & Draijer, 1993a; Coons & Milstein, 1986; Coons, Bowman, & Milstein, 1988; Putnam et al., 1986; Ross et al., 1989b) are largely consistent in terms of the general trends that they demonstrate. At the time of diagnosis (prior to exploration) approximately two to four personalities are in evidence. In the course of treatment an average of 13 to 15 are encountered, but this figure is deceptive. The mode in virtually all series is three, and median number of alters is eight to ten. Complex cases, with 26 or more alters (described in Kluft, 1988), constitute 15-25% of such series and unduly inflate the mean. Series currently being studied in tertiary referral centers appear to be more complex still (Kluft, Fink, Brenner, & Fine, unpublished data). This is subject to a number of interpretations. It is likely that the complexity of the more difficult and demanding cases treated in such settings may be one aspect of what makes them require such specialized care. It is also possible that the staff of such centers is differentially sensitive to the need to probe for previously undiscovered complexity in their efforts to treat patients who have failed to improve elsewhere. However, it is also possible that patients unduly interested in their disorders and who generate factitious complexity enter such series differently, or that some factor in these units or in those who refer to them encourages such complexity or at least the subjective report thereof.

He gripped the sides of her body carefully, keeping her in place as he parted her with his tongue and stroked the sides of the soft furrow. Entranced by the vulnerable shaper of her, he lapped at the edges of softly unfurled lips and tickled them lightly. The delicate flesh was unbelievably hot, almost steaming. He blew a stream of cooling air over it, and relished the sound of her moan. Gently he licked up through the center, a long glide through silk and salty female dampness. She squirmed, her thighs spreading as he explored her with flicks and soft jabs. The slower he went, the more agitated she became. He paused to rest the flat of his tongue on the little pearl of her clitoris to feel its frantic throbbing, and she jerked and struggled to a half-sitting position. Pausing, Keir lifted his head. "What is it, muirninn?" Red-faced, gasping, she tried to pull him over her. "Make love to me." "'Tis what I'm doing," he said, and dove back down. "No- Keir- I meant now, right now-" She quivered as he chuckled into the dark patch of curls. "What are you laughing at?" she asked. "At you, my wee impatient bully." She looked torn between indignation and begging. "But I'm ready," she said plaintively. Keir tried to enter her with two fingers, but the tight, tender muscle resisted. "You're no' ready," he mocked gently. "Weesht now, and lie back. 'Tis one time you won't be having your way." He nuzzled between her thighs and sank his tongue deep into the heat and honey of her. She jerked at the feel of it, but he made a soothing sound and took more of the intimate flavor he needed, had to have, would never stop wanting. Moving back up to the little bud where all sensation centered, he sucked at it lightly until she was gasping and shaking all over. He tried to work two fingers inside her again, and this time they were accepted, her depths clenching and relaxing repeatedly. As he stroked her with his tongue, he found a rhythm that sent a hard quiver through her. He kept the pace steady and unhurried, making her work for it, making her writhe and arch and beg, and it was even better than he'd imagined, having her so wild beneath him, hearing her sweet little wanton noises. There was a suspended moment as it all caught up to her... she arched as taut as a drawn bow... caught her breath... and began to shudder endlessly. A deep and primal satisfaction filled him at the sounds of her pleasure, and the sweet pulsing around his fingers. He drew out the feeling, patiently licking every twitch and tremor until at last she subsided and went limp beneath him. Even then, he couldn't stop. It felt too good. He kept lapping gently, loving the salty, silky wetness of her. Her weak voice floated down to him... "Oh, God... I don't think... Keir, I can't..." He nibbled and teased, breathing hotly against the tender core. "Put your legs over my shoulders," he whispered. In a moment, she obeyed. He could feel the trembling in her thighs. A satisfied smile flicked across his mouth, and he pressed her hips upward to a new angle. Soon he'd have her begging again, he thought, and lowered his head with a soft growl of enjoyment.

Develop a rapid cadence. Ideal running requires a cadence that may be much quicker than you’re used to. Shoot for 180 footfalls per minute. Developing the proper cadence will help you achieve more speed because it increases the number of push-offs per minute. It will also help prevent injury, as you avoid overstriding and placing impact force on your heel. To practice, get an electronic metronome (or download an app for this), set it for 90+ beats per minute, and time the pull of your left foot to the chirp of the metronome. Develop a proper forward lean. With core muscles slightly engaged to generate a bracing effect, the runner leans forward—from the ankles, not from the waist. Land underneath your center of gravity. MacKenzie drills his athletes to make contact with the ground as their midfoot or forefoot passes directly under their center of gravity, rather than having their heels strike out in front of the body. When runners become proficient at this, the pounding stops, and the movement of their legs begins to more closely resemble that of a spinning wheel. Keep contact time brief. “The runner skims over the ground with a slithering motion that does not make the pounding noise heard by the plodder who runs at one speed,” the legendary coach Percy Cerutty once said.7 MacKenzie drills runners to practice a foot pull that spends as little time as possible on the ground. His runners aim to touch down with a light sort of tap that creates little or no sound. The theory is that with less time spent on the ground, the foot has less time to get into the kind of trouble caused by the sheering forces of excessive inward foot rolling, known as “overpronation.” Pull with the hamstring. To create a rapid, piston-like running form, the CFE runner, after the light, quick impact of the foot, pulls the ankle and foot up with the hamstring. Imagine that you had to confine your running stride to the space of a phone booth—you would naturally develop an extremely quick, compact form to gain optimal efficiency. Practice this skill by standing barefoot and raising one leg by sliding your ankle up along the opposite leg. Perform up to 20 repetitions on each leg. Maintain proper posture and position. Proper posture, MacKenzie says, shifts the impact stress of running from the knees to larger muscles in the trunk, namely, the hips and hamstrings. The runner’s head remains up and the eyes focused down the road. With the core muscles engaged, power flows from the larger muscles through to the extremities. Practice proper position by standing with your body weight balanced on the ball of one foot. Keep the knee of your planted leg slightly bent and your lifted foot relaxed as you hold your ankle directly below your hip. In this position, your body is in proper alignment. Practice holding this position for up to 1 minute on each leg. Be patient. Choose one day a week for practicing form drills and technique. MacKenzie recommends wearing minimalist shoes to encourage proper form, but not without taking care of the other necessary work. A quick changeover from motion-control shoes to minimalist shoes is a recipe for tendon problems. Instead of making a rapid transition, ease into minimalist shoes by wearing them just one day per week, during skill work. Then slowly integrate them into your training runs as your feet and legs adapt. Your patience will pay off.

I call time-outs like these “vigilance breaks”—brief pauses before high-stakes encounters to review instructions and guard against error. Vigilance breaks have gone a long way in preventing the University of Michigan Medical Center from transmogrifying into the Hospital of Doom during the afternoon trough. Tremper says that in the time since he implemented these breaks, the quality of care has risen, complications have declined, and both doctors and patients are more at ease.

Water: They were restless, creative, flighty, and persuasive. Like water, they eroded people’s wills away. If you knew a water witch, chances were they’d be the ones that everyone tended to agree with. They were deeply charming and could change people’s minds. Their symbol was Bilios, the world tree, which sat in a circle representing the universe. Fire: They protected people. They were strength. Confidence. Power. They could usually fight. They were natural leaders. Their symbol was a thick cross with tapered ends inside a circle. Air: The seers. They told the future and could see the truth of the present. They were the ones most used as consultants by powerful people, and that was how they made their living and their money. The site speculated that Gwydion was an air witch. They were very susceptible to mental attack and tended to be extremely sensitive individuals. Their symbol was a three-pronged rod inside a circle. Earth: They were the practical witches, well-versed in herb lore. They took care of the everyday necessities of the witch, such as health products and medicines, home protection, magicked food. They got none of the glory, but they were the most essential of all witches; often the head of the family. They were grounded, patient, loving, and forthright. Their symbol was a five-pointed star, representing the five senses, usually with a gem studded in the middle to symbolize themselves, at the calm center of all things.

People will continue to be critically important in the improved health care delivery systems of the future, but not always in the same roles as today. Emotionally and socially astute care coordinators, rather than brilliant diagnosticians and other HiPPOs, might move to center stage. Earlier, we told the old joke about the two employees—person and dog—in the factory of the future. We suggest a slight tweak for health care: the medical office of the future might employ an artificial intelligence, a person, and a dog. The AI’s job will be to diagnose the patient, the person’s job will be to understand and communicate the diagnosis, and to coach the patient through treatment, and the dog’s job will be to bite the person if the person tries to second-guess the artificial intelligence.

Besides, I’ve … er, dealt with a case of rape once before. There isn’t a great deal you can do, externally. Maybe there isn’t a great deal you can do, period,” I added. I changed my mind and picked up the cup again. “Perhaps not,” Raymond agreed. “But if anyone is capable of reaching the patient’s center, surely it would be La Dame Blanche?” I set the cup down, staring at him. My mouth was unbecomingly open, and I closed it. Thoughts, suspicions, and realizations were rioting through my head, colliding with each other in tangles of conjecture. Temporarily sidestepping the traffic jam, I seized on the other half of his remark, to give me time to think. “The patient’s center?” He reached into an open jar on the table, withdrew a pinch of white powder, and dropped it into his goblet. The deep amber of the brandy immediately turned the color of blood, and began to boil. “Dragon’s blood,” he remarked, casually waving at the bubbling liquid. “It only works in a vessel lined with silver. It ruins the cup, of course, but it’s most effective, done under the proper circumstances.” I made a small, gurgling noise. “Oh, the patient’s center,” he said, as though recalling something we had talked about many days ago. “Yes, of course. All healing is done essentially by reaching the … what shall we call it? the soul? the essence? say, the center. By reaching the patient’s center, from which they can heal themselves. Surely you have seen it, madonna. The cases so ill or so wounded that plainly they will die—but they don’t. Or those who suffer from something so slight that surely they must recover, with the proper care. But they slip away, despite all you can do for them.” “Everyone who minds the sick has seen things like that,” I replied cautiously.

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the motivational metamorphosis for most of us is more like a series of seemingly endless surgeries on a patient with massive orthopedic deformities. God carefully assesses, breaks, cuts away, implants, and reshapes why we do what we do—in repeated and lifelong resolve. Jesus is determined to help and heal us so that we will walk with integrity, intentionality, and Christ-centered endurance.

The mother's and the father's attitudes toward the child correspond to the child's own needs. The infant needs mother's unconditional love and care physiologically as well as psychically. The child, after six, begins to need father's love, his authority and guidance. Mother has the function of making him secure in life, father has the function of teaching him, guiding him to cope with those problems with which the particular society the child has been born into confronts him. In the ideal case, mother's love does not try to prevent the child from growing up, does not try to put a premium on helplessness. Mother should have faith in life, hence not be overanxious, and thus not infect the child with her anxiety. Part of her life should be the wish that the child become independent and eventually separate from her. Father's love should be guided by principles and expectations; it should be patient and tolerant, rather than threatening and authoritarian. It should give the growing child an increasing sense of competence and eventually permit him to become his own authority and to dispense with that of father. Eventually, the mature person has come to the point where he is his own mother and his own father. He has, as it were, a motherly and a fatherly conscience. Motherly conscience says: 'There is no misdeed, no crime which could deprive you of my love, of my wish for your life and happiness.' Fatherly conscience says: 'You did wrong, you cannot avoid accepting certain consequences of your wrongdoing, and most of all you must change your ways if i am to like you.' The mature person has become free from the outside mother and father figures, and has built them up inside. In contrast to Freud's concept of the super-ego, however, he has built them inside not by incorporating mother and father, but by building a motherly conscience on his own capacity for love, and a fatherly conscience on his reason and judgment. Furthermore, the mature person loves with both the motherly and the fatherly conscience, in spite of the fact that they seem to contradict each other. If he would only retain his fatherly conscience, he would become harsh and inhuman. If he would only retain his motherly conscience, he would be apt to lose judgment and to hinder himself and others in their development. In this development from mother-centered to father-centered attachment, and their eventual synthesis, lies the basis for mental health and the achievement of maturity. In the failure of this development lies the basic cause for neurosis.

comprehensivist.” (IBM’s Grundy coined this term. He’s also president of the Patient-Centered Primary Care Collaborative, a set of large employers, provider groups, and private insurers looking to transform health care.) Comprehensivists are skilled project

The program is grounded in 10 design principles, the aim of which is to create innovative solutions to intractable health problems....In other words, do not be content with the status quo. The remaining principles include several obvious but often overlooked themes in routine patient care: value each person, be human, be human-centered, codesign, facilitate connections, treat with dignity, and provide a stage from which the hardest, most important stories may be told.

transporter? It is important for leaders to demystify language so that every member of the team understands the goal and can have the authority to achieve it. “Patient-centered care” can be summed up as the way I want my parents to be treated in a hospital. Period.

Ours is a technologically proficient but emotionally deficient and inconsistent medical system that is best at treating acute, not chronic, problems: for every instance of expert treatment, skilled surgery, or innovative problem-solving, there are countless cases of substandard care, overlooked diagnoses, bureaucratic bungling, and even outright antagonism between doctor and patient. For a system that invokes “patient-centered care” as a mantra, modern medicine is startlingly inattentive—at times actively indifferent—to patients’ needs.

This is also known as patient-centered health care, rather than disease-focused medicine, and it is a fundamental underpinning of functional medicine—a revolutionary new way to understand the underlying causes of disease and how our genes, our environment, and our lifestyle interact to determine health or disease.

Creation of a new patient-centered outcomes research institute Establishment of a new nonprofit corporation, the Patient-Centered Outcomes Research Institute, along with a research agenda

Jesus, the gospel should be all the motivation I need for living as a compassionate, kind, humble, gentle, and patient man—especially when I consider this is how you relate to me 24/7, in full view of my ill-deserving ways. I’ll never experience you as insensitive, unkind, proud, harsh, or impatient. Indeed, through the gospel, I’ve become a member of God’s chosen, holy, dearly loved people. Yet it does take more: sometimes it takes pain. Today is just such a day. As I pray, I’m hurting big-time. Today it will be easier for me to clothe myself with compassion than with cotton. Yesterday afternoon I forgot that exercising at the gym doesn’t qualify me to be a refrigerator mover. But as I hurt, I’m moved to pray today for chronic sufferers—those who cry, “How long, O Lord?” for better reasons and with more tears than I have. Jesus, I pray for people with unrelenting pain in their bodies—those who no longer get any relief from physical therapy or medication. I pray for people with emotional and mental diseases, who live in the cruel world of delusional thinking and sabotaging emotions. I pray for their families and caregivers. I pray for the unconscionable number of children in the world who are suffering from hunger and malnutrition and for their parents who feel both shame and helplessness. Lord, these and many more stories of great suffering I bring before you. I also pray for the worst chronic suffering of all: for those who are “separate from Christ, excluded from citizenship in Israel and foreigners to the covenants of the promise, without hope and without God in the world” (Eph. 2:12 NIV). Come, Holy Spirit, come, and apply the saving benefits of Jesus to the religious and the nonreligious alike—to those who may be in the church or in the culture but who are not in Christ. Jesus, I anticipate getting over this back pain pretty soon, but I don’t want to get over compassionate praying and compassionate living. I pray in your kind and caring name. Amen.

abortion will continue. Many opponents claim to be taking the moral high ground. However, by depriving them of their civil rights, opposition to abortion hurts women and is thus unethical. It condemns women to mandatory motherhood. This attitude is not new. The systematic maltreatment of women has been institutionalized by governments and religions for several millennia.56 57 58 The clarity and cogency of the argument against abortion should be sufficient to sway public opinion. However, over the past four decades, this has not been the case. Opponents of abortion have resorted to eight murders,59,60 arson, firebombing,61 intimidation of women and clinicians,62 governmental intrusion into the physician-patient relationship,63 imposition of obstacles that deter and delay abortion, and increased costs.64,65 A broad campaign of deception and chicanery, including crisis pregnancy centers and disinformation sites on the Internet,66 has influenced decisions about abortion and its safety. Without the smokescreen about abortion safety, the ongoing attack on women and health care providers might be recognized for what it is: misogyny directed against our wives, sisters, and daughters. Ironically, the same political conservatives who oppose “big government” and its interference in our daily lives are sponsoring anti-abortion legislation mandating more intrusion of government into the private lives—and bodies—of American women. While the ethical dimensions of abortion will continue to be debated, the medical science is incontrovertible: legal abortion has been a resounding public-health success.18,19 The development of antibiotics, immunization, modern contraception, and legalized abortion all stand out as landmark public-health achievements of the Twentieth Century.

So we fix our eyes not on what is seen, but on what is unseen, since what is seen is temporary, but what is unseen is eternal. (NIV) What does Scripture mean when it tells us to fix our eyes on what we can’t even see? How do we begin to do that? Even though as Christians we affirm the reality of the spiritual realm, sometimes we succumb to naturalistic assumptions that what we see is real and what we don’t see isn’t. Many people conclude that God can’t be real, because we can’t see Him. And Heaven can’t be real, because we can’t see it. But we must recognize our blindness. The blind must take by faith that there are stars in the sky. If they depend on their ability to see, they will conclude there are no stars. Sitting here in what C. S. Lewis called the Shadowlands, we must remind ourselves what Scripture tells us about Heaven. We will one day be delivered from the blindness that obscures the light of God’s world. For many people—including many believers—Heaven is a mysterious word describing a place that we can’t understand and therefore don’t look forward to. But Scripture tells us differently. What we otherwise could not have known about Heaven, God says He has revealed to us through His Spirit (1 Corinthians 2:10). God tells us about our eternal home in His Word, not so we can shrug our shoulders and remain ignorant, but because He wants us to anticipate what awaits us and those we love, and because it has the power to transform the way we live today. Life on earth matters not because it’s the only life we have, but precisely because it isn’t—it’s the beginning of a life that will continue without end. It’s the precursor of life on the New Earth. Eternal life doesn’t begin when we die; it has already begun. With eternity in view, nearly any honest activity—whether building a shed, driving a bus, pruning trees, changing diapers or caring for a patient—can be an investment in God’s kingdom. God is eternal. His Place is eternal. His Word is eternal. His people are eternal. Center your life around God, His Place, His Word, and His people, and reach out to those eternal souls who desperately long for His person and His place. Then no matter what you do for a living, your days here will make a profound difference for eternity—and you will be fulfilling the biblical admonition to fix your eyes on what is unseen.     This book includes 60 daily devotionals on a variety of topics related to living each day purposefully with an eternal perspective. (My thanks to Stephanie Anderson for compiling things I’ve written and quotations I’ve collected.) I hope they will encourage you to live with eternity in mind as you follow Jesus with all your heart.   —Randy Alcorn

patient-centric is a system that discounts the power or importance of a physician’s, or a nurse’s, professional impact on patient healing. The healing relationship is multi-faceted, and as Dr. John Burroughs describes it, the relationship combines three critical components: A patient who wants to be healed, practitioners who desire to provide healing services and a healthy organization to create the optimal environment for healing. But a patient-centric hospital can neither be a care-provider’s democracy nor a loose confederation of aligned interests. Medicine now is far too complex for cottage industry methods. In fact, the ideal healing environment is one of harmonious synergy in which the hospital is the focal point of coordination and responsibility for standards, continuity and competence—as well as the means of forming and supporting the care team. The patient’s best interests, however, must be the primary and overriding center of everything the team does.

That BIDMC did not bother to apply to the American Nurses Credentialing Center for recognition as a magnet hospital—one of Beth Israel’s distinguishing features—demonstrates just how susceptible to disruption these arrangements are. Such fluctuations and changes could have ramifications not just for individual nurses’ satisfaction and burnout rate but also for the quality of care patients receive.

FastMed sends employees to study customer service at a Ritz Carlton training center. Receptionists and others learn to look the patient in the eye and say their name three times while calling up their records and arranging their care. The service resembles the Genius Bar at the Apple Store, which is precisely the point: Health care should figure out how to provide service and convenience like the rest of the economy.

Frances cared about people. Her personality was such that she was deeply interested in making sure the people around her were happy and knew someone cared about them. She was humble and selfless, and she rarely spoke about herself, preferring to stay in the background and let the other have center stage. She had a good memory. Frances would patiently listen, and was carefully observant and noticed if someone was feeling out of sorts

Gradually, the Lord has changed my perspective by challenging me to see my patients and their families as he does—as people lost and without hope, broken and in need of a Savior.

We must fully understand sin in order to develop the appropriate urgency to pull our patients from its jaws of death.

We actually have the tools and ability to meet our patients’ needs, not because of what we can do or who we are, but because of HIM who is in us!

Daniel Patrick Moynihan, who had served on President Kennedy’s mental health task force as a young assistant secretary of labor, had also received a pen at the signing of the bill, which he’d helped draft. Years later, as a senator from New York, he looked back at that moment with deep regret. In a letter to the Times, written in a city “filled with homeless, deranged people,” he wondered what would have happened if someone had told President Kennedy, “Before you sign the bill you should know that we are not going to build anything like the number of community centers we will need. One in five in New York City. The hospitals will empty out, but there will be no place for the patients to be cared for in their communities.” If the president had known, Moynihan wrote, “would he not have put down his pen?

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And right there, in the birthing center of Saint Luke’s Hospital, I have a medium-sized epiphany that has nothing to do with labor and delivery. She didn’t believe me when I called her. My clinician has failed me, and it hurt. Finally I realize, like never before, that I absolutely need to listen to my patients better, to be more open to believing their side of the story, trust that they need my care, and not always assume that I know more than they do. Just because I’m in a position of power does not mean I have to wield it, creating an impenetrable fortress.

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We get paid much more to keep someone on dialysis than to keep them off of it. If we don’t achieve dialysis metrics—like avoiding dialysis catheters or providing a certain dose of dialysis—known to best result in long-term benefits, we are financially penalized. But create a fistula in a little old lady that usually requires interventions to make it work and keep it working and make her stay on the dialysis machine as long as it takes for the numbers to look right, then essentially get a bonus. If we see an in-center hemodialysis patient four times in a month, we stand to make 50 percent more money than if we only saw her once. And the nephrologist really only has to see the patient once each month—if a physician assistant sees the patient the other times, we still get paid. We would have to document a comprehensive medical history and examination over the better part of an hour with a patient returning to clinic twice to see the same money—and good luck trying to justify why that was clinically necessary to do. The second, third, and fourth in-center hemodialysis patient visits can be more like drive-bys—a simple documentation that we (or the physician assistant) “saw” the patient, with no notation of time required. Private insurance companies and the Medicare ESRD program pay top dollar for dialysis care, not clinic visits. It’s profitable to build another dialysis center, but we haven’t figured out how to build comprehensive outpatient palliative care services.

that care should be safe, effective, patient-centered, timely, efficient, and equitable. The aims resonated with all and were quickly embraced. They became the centerpiece of the recommendations in the final report, Crossing the Quality Chasm

After multiple suicide attempts Maria was placed in one of our residential treatment centers. Initially she was mute and withdrawn and became violent when people got too close to her. After other approaches failed to work, she was placed in an equine therapy program where she groomed her horse daily and learned simple dressage. Two years later I spoke with Maria at her high school graduation. She had been accepted by a four-year college. When I asked her what had helped her most, she answered, “The horse I took care of.” She told me that she first started to feel safe with her horse; he was there every day, patiently waiting for her, seemingly glad upon her approach. She started to feel a visceral connection with another creature and began to talk to him like a friend. Gradually she started talking with the other kids in the program and, eventually, with her counselor.

You can gaze over the fence and covet another person’s life or tell yourself that God has blessed you in ways you never could have earned. Do you ever battle with envy? Have you ever wondered why someone else’s life seems easier than yours? Have you ever struggled to celebrate the blessings of someone else who had what you thought you needed? Have you ever wished you could just switch lives with someone? Perhaps there are ways in which envy haunts us all, so it’s worth examining the heart of envy. What things prepare the heart for envy? Envy is forgetful. In concentrating on what we don’t have that we think we should have, we fail to keep in mind the huge catalog of blessings that are ours simply because God has chosen to place his bountiful love on us. This forgetfulness causes us to do more comparing and complaining than praising and resting. Envy misunderstands blessing. So often envy is fueled by misunderstanding what God’s care looks like. It is not always the care of provision, relief, or release. Sometimes God’s blessing comes in the form of trials that are his means of giving us things we could get no other way. Envy is selfish. Envy tends to put us in the center of our own worlds. It tends to make everything about our comfort and ease, our wants, needs, and feelings, and not about the plan and the glory of the God we serve. Envy is self-righteous. Envy has an “I deserve _____ more than they do” posture to it. It forgets that we all deserve immediate and eternal punishment, and that any good thing we have is an undeserved gift of God’s amazing grace. Envy is shortsighted. Envy has a right here, right now aspect to it that overlooks the fact that this moment is not all there is. Envy cannot see that this moment isn’t meant to be a destination, but a preparation for a final destination that will be beautiful beyond our wildest imagination. Envy questions God’s wisdom. When you and I envy, we tend to buy into the thought that we are smarter than God. In envy, we tend to think we know more and better, and if our hands were on the joystick, we would be handling things a different way. Envy is impatient. Envy doesn’t like to wait. Envy complains quickly and tires easily. Envy doesn’t just cry for blessings; it cries for blessings now. What is devastating about envy is that it questions God’s goodness, and when you do that, you quit running to him for help. So cry out for rescue—that God would give you a thankful, humble, and patient heart. His transforming grace is your only defense against envy. For further study and encouragement: Psalm 34

MONKEY MIND MONK MIND Overwhelmed by multiple branches Focused on the root of the issue Coasts in the passenger seat Lives intentionally and consciously Complains, compares, criticizes Compassionate, caring, collaborative Overthinks and procrastinates Analyzes and articulates Distracted by small things Disciplined Short-term gratification Long-term gain Demanding and entitled Enthusiastic, determined, patient Changes on a whim Commits to a mission, vision, or goal Amplifies negatives and fears Works on breaking down negatives and fears Self-centered and obsessed Self-care for service Multitasking Single-tasking Controlled by anger, worry, and fear Controls and engages energy wisely Does whatever feels good Seeks self-control and mastery Looks for pleasure Looks for meaning Looks for temporary fixes Looks for genuine solutions

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But the idea that features of our personality may contribute to the onset of pathology is anathema to many. In her still-influential 1978 essay “Illness as Metaphor,” the late filmmaker, activist, and brilliant woman of letters Susan Sontag—then a forty-five-year-old cancer survivor—flatly and forcefully rejected the possibility that ill health might signify anything beyond bodily calamity. “Theories that diseases are caused by mental states . . . are always an index of how much is not understood about the physical terrain of a disease,” she wrote.[1] To assert that emotions contribute to disease was, for her, to promote “punitive or sentimental fantasies,” to traffic in “lurid metaphors” and their “trappings.” She found this view especially distasteful because she perceived it as a way of blaming the patient. “I decided that I was not going to be culpabilized.”[2] Sontag’s acerbic rejection of the mind-body connection resonated not only in intellectual circles but also in some of the most hallowed centers of medical thinking. A few years later, the New England Journal of Medicine’s future first woman editor, Dr. Marcia Angell, cited it approvingly, deriding as “folklore” the idea that “mental state is a factor in the causing and curing of specific diseases,” a “myth” for which the evidence is at best “anecdotal.” Like Sontag, Dr. Angell espied in this line of thinking an insidious patient-blaming tendency: “At a time when patients are already burdened by disease, they should not be further burdened by having to accept responsibility for the outcome.”[3] I agree wholeheartedly that no one, ever, ought to be made to feel guilty for whatever transpires with or within their body, whether that guilt arises from the self or is imposed from without. As I stated earlier, blame is inappropriate, unmerited, and cruel; it is also unscientific. But we have to take care not to fall into an easy fallacy. Asserting that features of the personality contribute to the onset of illness, and more generally perceiving connections between traits, emotions, developmental histories, and disease is not to lay blame. It is to understand the bigger picture for the purposes of prevention and healing—and ultimately for the sake of self-acceptance and self-forgiveness. My intent in reframing Sontag’s perspective, then, is to offer a more helpful view. I empathize with her apprehension about being blamed for becoming ill, even as I see her refutation of the mind-body confluence as misguided and scientifically untenable. A clear and honest look at the biographical factors that can disrupt our biological well-being helps us respond intelligently and effectively to illness—or preferably, to mitigate the risks in the first place. This is as true for individuals as for society.

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The approach of mortality isn’t essentially a medical challenge. It’s a highly personal one, centering on individual choice and priorities. The important lesson of Being Mortal is that patient well-being, not mere survival, is the proper object of care, and that “well-being is about the reasons one wishes to be alive.

Patient-centered care” can be summed up as the way I want my parents to be treated in a hospital. Period.

Patient-centered care” can be summed up as the way I want my parents to be treated in a hospital.

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Experiencing Christ’s Love For I am persuaded that neither death nor life, nor angels nor principalities nor powers, nor things present nor things to come, nor height nor depth, nor any other created thing, shall be able to separate us from the love of God which is in Christ Jesus our Lord. Romans 8:38-39 NKJV How much does Christ love us? More than we, as mere mortals, can comprehend. His love is perfect and steadfast. Even though we are fallible and wayward, the Good Shepherd cares for us still. Even though we have fallen far short of the Father’s commandments, Christ loves us with a power and depth that are beyond our understanding. The sacrifice that Jesus made upon the cross was made for each of us, and His love endures to the edge of eternity and beyond. Christ is the ultimate Savior of mankind and the personal Savior of those who believe in Him. As His servants, we should place Him at the very center of our lives. And, every day that God gives us breath, we should share Christ’s love and His message with a world that needs both. Christ’s love changes everything. When you accept His gift of grace, you are transformed, not only for today, but also for all eternity. If you haven’t already done so, accept Jesus Christ as your Savior. He’s waiting patiently for you to invite Him into your heart. Please don’t make Him wait a single minute longer. It is when we come to the Lord in our nothingness, our powerlessness and our helplessness that He then enables us to love in a way which, without Him, would be absolutely impossible. Elisabeth Elliot The love of Christ is a fierce thing. It can take the picture you have of yourself and burn it in the fire of His loving eyes, replacing it with a true masterpiece. Sheila Walsh Live your lives in love, the same sort of love which Christ gives us, and which He perfectly expressed when He gave Himself as a sacrifice to God. Corrie ten Boom Blessed assurance, Jesus is mine! O what a foretaste of glory divine! Fanny Crosby Christ is with us, and the warmth is contagious. Joni Eareckson Tada To a world that was spiritually dry and populated with parched lives scorched by sin, Jesus was the Living Water who would quench the thirsty soul, saving it from “bondage” and filling it with satisfaction and joy and

Dr. Knox Todd began documenting how patients’ race affects the treatment of pain when he was a doctor in the UCLA Emergency Center in the 1990s.46 He and colleagues examined the way doctors treated 139 white and Latino patients coming to the emergency room over a two-year period with a single injury—fractures of a long bone in either the arm or leg. Because this type of fracture is extremely painful, there is no medical reason to distinguish between the two groups of patients. Yet the researchers discovered that Latinos were twice as likely as whites to receive no pain medication while in the emergency room.47 Although it’s possible that the Latino patients complained less of pain, the doctors should have been aware of the high degree of pain they suffered, given the nature of their injuries. When Todd moved to Emory University School of Medicine, he led an Atlanta-based study that confirmed his finding in Los Angeles. This time his research team analyzed medical charts of 217 patients who were treated for long-bone fractures at an inner-city emergency room that served both black and white patients. In a 2000 article in Annals of Emergency Medicine, Todd reported that 43 percent of blacks, but only 26 percent of whites, received no pain medication. In this study, Todd took the additional step of documenting whether or not the patients expressed pain to their doctors. By carefully looking at notations in the medical files, he found that black patients were about as likely as whites to complain of pain. Black patients thus received pain medication half as often as whites because doctors did not order it for them, not because blacks do not feel pain or do not want pain relief.

My multifaceted canary in the coal mine signaling the impulse to control is my belly tightening, my posture changing slightly to lean forward, tension increasing in my upper arms. It feels as though I am preparing to thrust myself into the middle of the problem with everything I know. It comes from a good-hearted place of wanting to relieve suffering and also diminishes interpersonal safety as my system enters mild to medium sympathetic arousal. If we take a step back, we might become curious about how the neuroception of danger arose in the first place, because that is what initiates this chain of events. If we were to explore this, many answers might come: We have been trained to intervene; we don't have any experience that tells us our patient's systems are trustworthy guides to healing; the upset in our patient is severe enough that we fear for her safety; if we can't heal this person, there's something wrong with us; strong emotions are uncomfortable for us and we need to regulate them before they overwhelm us. The list is endless, individual and likely changes with each new circumstance. It is always a most valuable inquiry, especially if we can begin it with compassionate curiousity, which makes it less likely that we will feel shamed by the answer that presents itself. When we remember that neuroception is an automatic adaptive process, it may take character condemnation out of the equation when we invite awareness of what frightens us. If our fear feels heard and acknowledged, there is some likelihood that our bodies will be able to find their way back toward receptivity. As we feel our own openness returning, we can be certain that this embodied change is also influencing our patient and the quality of the connection.

For all of us, there are also likely times when therapy simply doesn't seem to move forward as we imagined it would. At this crossroads, we often question ourselves or blame our patients. Between what our culture requires and what we have experienced in childhood, we might go either direction. We have a particular challenge to feeling competent right now. Our left-centric society has done its best to codify the healing process, leaving us with a set of procedures and expected outcomes that don't welcome the individuality of our people of the fluidity of each person's unpredictable and unique process of recovery. This is doubly difficult, because when we follow the course culture provides, safety is already undermined to a greater or lesser extent. I believe it wounds us when we feel we aren't helping a person because we set out with such good hearts to relieve suffering. A well-practiced practitioner might try to guard our hearts by blaming our people's resistance. When a wounded part of us is afraid we are inadequate, this often generates a critical protective voice to try to urge us toward a better performance. In both instances, our ability to be present for our people gets lost in the need to protect. How can we hold these experiences kindly, recognizing that they are part of the human experience? Right now, we might be able to open the arms of inclusion to these parts of us.

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By April 23, 2014, thirty-four cases and six deaths from Ebola in Liberia were recorded. By mid-June, 16 more people died. At the time it was thought to be malaria but when seven more people died the following month tests showed that was the Ebola virus. The primary reason for the spreading of the Ebola virus was the direct contact from one person to the next and the ingesting of bush meat. Soon doctors and nurses also became infected. On July 2, 2014, the head surgeon of Redemption Hospital was treated at the JFK Medical Center in Monrovia, where he died from the disease. His death was followed by four nurses at Phebe Hospital in Bong County. At about the same time two U.S. health care workers, Dr. Kent Brantly and a nurse were also infected with the disease. However, they were medically evacuated from Liberia to the United States for treatment where they made a full recovery. Another doctor from Uganda was not so lucky and died from the disease. Arik Air suspended all flights between Nigeria and Liberia and checkpoints were set up at all the ports and border crossings. In August of 2014, the impoverished slum area of West Point was cordoned off. Riots ensued as protesters turned violent. The looting of a clinic of its supplies, including blood-stained bed sheets and mattresses caused the military to shoot into the crowds. Still more patients became infected, causing a shortage of staff and logistics. By September there had been a total of 3,458 cases of which there were 1,830 deaths according to the World Health Organization. Hospitals and clinics could no longer handle this crisis and patients who were treated outside died before they could get help. There were cases where the bodies were just dumped into the Mesurado River. The Ivory Coast out of compassion, opened carefully restricted humanitarian routes and resumed the previously suspended flights to Liberia. Ellen Johnson Sirleaf the president of Libera sent a letter to President Barack Obama concerning the outbreak of Ebola that was on the verge of overrunning her country. The message was desperate, “I am being honest with you when I say that at this rate, we will never break the transmission chain and the virus will overwhelm us.” Having been a former finance minister and World Bank official, Johnson Sirleaf was not one for histrionics however she recognized the pandemic as extremely dangerous. The United States responded to her request and American troops came in and opened a new 60-bed clinic in the Sierra Leone town of Kenema, but by then the outbreak was described as being out of control. Still not understanding the dangerous contagious aspects of this epidemic at least eight Liberian soldiers died after contracting the disease from a single female camp follower. In spite of being a relatively poor country, Cuba is one of the most committed in deploying doctors to crisis zones. It sent more than 460 Cuban doctors and nurses to West Africa. In October Germany sent medical supplies and later that month a hundred additional U.S. troops arrived in Liberia, bringing the total to 565 to assist in the fight against the deadly disease. To understand the severity of the disease, a supply order was placed on October 15th for a 6 month supply of 80,000 body bags and 1 million protective suits. At that time it was reported that 223 health care workers had been infected with Ebola, and 103 of them had died in Liberia. Fear of the disease also slowed down the functioning of the Liberian government. President Sirleaf, had in an emergency announcement informed absent government ministers and civil service leaders to return to their duties. She fired 10 government officials, including deputy ministers in the central government who failed to return to work.

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Chapatis will soon become EXTINCT A renowned cardiologist explains how eliminating wheat can IMPROVE your health. Cardiologist William Davis, MD, started his career repairing damaged hearts through angioplasty and bypass surgeries. “That’s what I was trained to do, and at first, that’s what I wanted to do,” he explains. But when his own mother died of a heart attack in 1995, despite receiving the best cardiac care, he was forced to face nagging concerns about his profession. "I’d fix a patient’s heart, only to see him come back with the same problems. It was just a band-aid, with no effort to identify the cause of the disease.” So he moved his practice toward highly uncharted medical territory prevention and spent the next 15 years examining the causes of heart disease in his patients. The resulting discoveries are revealed in "Wheat Belly", his New York Times best-selling book, which attributes many of our physical problems, including heart disease, diabetes and obesity, to our consumption of wheat. Eliminating wheat can “transform our lives.” What is a “Wheat Belly”? Wheat raises your blood sugar dramatically. In fact, two slices of wheat bread raise your blood sugar more than a Snickers bar. "When my patients give up wheat, weight loss was substantial, especially from the abdomen. People can lose several inches in the first month." You make connections between wheat and a host of other health problems. Eighty percent of my patients had diabetes or pre-diabetes. I knew that wheat spiked blood sugar more than almost anything else, so I said, “Let’s remove wheat from your diet and see what happens to your blood sugar.” They’d come back 3 to 6 months later, and their blood sugar would be dramatically reduced. But they also had all these other reactions: “I removed wheat and I lost 38 pounds.” Or, “my asthma got so much better, I threw away two of my inhalers.” Or “the migraine headaches I’ve had every day for 20 years stopped within three days.” “My acid reflux is now gone.” “My IBS is better, my ulcerative colitis, my rheumatoid arthritis, my mood, my sleep . . .” and so on, and so on". When you look at the makeup of wheat, Amylopectin A, a chemical unique to wheat, is an incredible trigger of small LDL particles in the blood – the number one cause of heart disease. When wheat is removed from the diet, these small LDL levels plummet by 80 and 90 percent. Wheat contains high levels of Gliadin, a protein that actually stimulates appetite. Eating wheat increases the average person’s calorie intake by 400 calories a day. Gliadin also has opiate-like properties which makes it "addictive". Food scientists have known this for almost 20 years. Is eating a wheat-free diet the same as a gluten-free diet? Gluten is just one component of wheat. If we took the gluten out of it, wheat will still be bad since it will still have the Gliadin and the Amylopectin A, as well as several other undesirable components. Gluten-free products are made with 4 basic ingredients: corn starch, rice starch, tapioca starch or potato starch. And those 4 dried, powdered starches are some of the foods that raise blood sugar even higher. I encourage people to return to REAL food: Fruits Vegetables and nuts and seeds, Unpasteurized cheese , Eggs and meats Wheat really changed in the 70s and 80s due to a series of techniques used to increase yield, including hybridization. It was bred to be shorter and sturdier and also to have more Gliadin, (a potent appetite stimulant) The wheat we eat today is not the wheat that was eaten 100 years ago. If you stop eating breads/pasta/chapatis every day, and start eating chicken, eggs, salads and vegetables you still lose weight as these products don’t raise blood sugar as high as wheat, and it also doesn’t have the Amylopectin A or the Gliadin that stimulates appetite. You won’t have the same increase in calorie intake that wheat causes.

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In 2009, Dr. Lakhmir Chawla, an intensive care doctor then working at George Washington University Medical Center, and his colleagues examined brain waves in seven critically ill patients who had died; Chawla noted a mysterious and unexpected surge in electrical activity after death. He initially dismissed his own findings, as he couldn’t make sense of them. Surely, “the brain cannot be activated after death,” he had thought. “That goes against everything we have ever presumed about death.” But after he studied the brain waves on the EEG machines in more detail, he surmised that it wasn’t simply a seizure or a “last-gasp attempt” of the brain to save itself. The reason for the sudden change in his thinking? Gamma waves. As he looked at the EEG results, he realized the electrical signal was of a very high frequency. “To see gamma wave activity, which is associated with consciousness, was massively unexpected,” Chawla later explained.

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