#MDigitalLife is a WCG program designed to learn from and to showcase physicians who are blazing new trails in the digital world – changing the way that medicine is practiced and better health is realized. You can find previous posts here.
When you see the word “revolution,” what do you think of? Washington crossing the Delaware? The liberation of Tahrir square? Whatever visual is called to mind, it probably wasn’t of white-coated physicians waving pitchforks or employing guillotines. But it was the images of Tahrir square that pushed a family doctor in southern California to pick up a rallying cry on behalf of another group of downtrodden people – the family physician.
Now let’s try another visualization:
They’re heroes, right? They save lives! They can come to the rescue when things look bleakest – and literally change the world for patients and their families. Now one last visual exercise:
Is she a lifesaver? Will she be the one who steps in moments from disaster and steers your acute episode back into normalcy? I’m guessing that your vision probably had more to do with runny noses, tongue depressors and antibiotics. Are your visions accurate? Maybe. Are they fair? Definitely not. And the reason why is going to become abundantly clear over the next few years.
An accidental evolution
Our medical system, by and large, was created in a time where acute episodes were our biggest concern … An outbreak of cholera here, a farm accident there … The doctor’s main job was to fix me up if he could – and if not? Too bad for me. But now, our standard of living is so high, and our medicine and technology so good, that it’s not the acute care episodes that are our biggest problem. It’s the “lifestyle diseases” – the chronic illnesses like type 2 diabetes, heart disease and COPD, that consume the lion’s share of our health care dollars.
Jay Lee, a family physician in Long Beach, believes that those factors, along with our changing notions of reimbursement under the Affordable Care Act, are going to shine a spotlight once again on the value of the family doctor – and he’s part of a revolution designed to bring visibility to that cause.
Jay has worked at community health centers throughout his career, and along the way picked up a masters degree in public health from Harvard. And it was Jay who, prompted by the Arab Spring, started using the hashtag #FMRevolution to pick up on a theme started by a group of residents a few years ago. Those residents, according to Jay, were “fed up with being told that they were either too smart or dumb to be going into family medicine.” They wanted to bring a visible “attitude of legitimacy” to family medicine that’s slowly been eroded in the era of the specialist. They printed up some t-shirts with clever messages like, “Use your whole brain – become a family physician” or “The President has a family doctor – why don’t you?” and wore them to a 2009 meeting of the California chapter of the American Association of Family Physicians (AAFP).
What was old is new again
These enterprising residents also reprinted an article written by Dr. G. Gayle Stephens – 30 years ago – describing family medicine as a form of counter-culture. Family doctors were trying to establish the legitimacy of the specialty back then … a fight that is heating up again today. And social media could prove to be the biggest difference-maker in terms of the movements ability to truly take off. It’s already getting mainstream notice: At last year’s meeting of the American Association of Family Physicians, the board all got started on twitter, and the president (Glen Stream) mentioned #FMRevolution in his keynote address.
I asked Jay what he hoped for from the movement.
“I want every family doctor to wake up every day and say, ‘I’m going to make the world a better place today.’ I love the personal philosophy of astrophysicist Neil deGrasse Tyson: ‘Before the day ends I will have learned something new about the world and done at least one thing that reduces suffering in the world.’ I find that kind of approach really inspiring – and I hope that other family doctors will too.”
Nothing inspires people like winning
There have been times when the #FMRevolution looked a lot more like a real battle than a philosophy. Jay related a story to me about the CEO of hospital system who decided to cut its family medicine residency because it was “too expensive.” An immediate dialog started on twitter and other social channels. Soon, the name of the CEO and the phone number for the hospital had been published and calls started to pour in – from inside and outside the medical community. The general sentiment was that “This is bad for our community. We can’t let it happen” Ultimately, the CEO was called in to justify himself to the County Supervisors – and within six weeks they had reversed his decision. The incident called attention to the power of social media to move mountains, even in a staid field like medicine, and it gave confidence to the fledgling movement. “But,” Jay cautions, “it can’t always be about fighting fires. We’ve also got to plant forests – we’ve got to create a system for family medicine to thrive.”
I am Spartacus
When I asked Jay if he was the leader of #FMRevolution, he hesitated for a moment. “It’s not like that. As far as I know, I was the person who started the hashtag. But I don’t consider myself to be the leader. I may be A leader. But this isn’t an organization in the traditional sense – its guerrilla warfare. None of us has the authority or expertise to address every issue in every place in the country – because healthcare is intensely local. But people, in their communities are inspired and encouraged to get engaged. I hope that FMRevolution will provide things like affinity, a sense of esprit de corps,and broad strokes direction … but each member defines what it means for her and her community.”
Jay believes that the current system has fostered an attitude among physicians that their proper place is in the exam room, practicing medicine on their own. Anything else is perceived as politics – and that’s a dirty word. But he feels that that attitude has been a failure – and caused a vacuum of leadership among clinicians that’s contributed to the sorry state of today’s health system.
“If we don’t take responsibility as individuals in the markets where we work, health reform is bound to fail.”
Meeting a band of guerrillas
One of the most satisfying aspects of the #FMRevolution journey for Jay is that he’s run into some kindred spirits who’ve had a tremendous impact on each other. He referenced three others with whom he’s been most involved in “plotting things.” His fellow co-conspirators:
Ben Miller, a clinical psychologist and professor of family medicine at the University of Colorado School of Medicine; and
Mark Ryan, a family physician from Virginia who writes the “Life in Underserved Medicine” blog
It’s a full agenda for Jay. He spoke at a meeting of the Society of Teachers of Family Medicine in November – a conference that was focused on all aspects of Practice Improvement. His topics included negotiation and conflict resolution (is there any irony in the concept of Revolutionary as Peacemaker?) and – not surprisingly – the role of social media in improving medical practice. He has a paper on the subject that’s currently in peer review. And there’s no doubt that there will be much more to come.
Some people find it intimidating to be asked for a “summary statement.” Not Jay.
“We’re just now getting to critical mass … but I keep thinking about how to create – or at least enable – change. I’m reminded of Newton’s second law: Force = Mass * Acceleration. In social media, the inherent amplification replaces acceleration. And we’ve got mass! There are 105,000 members of the AAFP. If they were all on twitter, tweeting once per day … tell me we couldn’t make a difference!”
Keep up with Jay:
And with the #FMRevolution: @FMedRevolution