Demystifying Medicine One Month at a Time

Tag: social medicine

RIP: Richard Fine (1940-2015)

I didn’t know him, but was inspired by the life story of Richard Fine, which I came across while reading his obituary in the San Francisco Chronicle.

Dr. Fine grew up in Cincinnati, and was educated at Cornell — first the college in upstate New York, then the medical school in New York City. He moved to California in 1966 for medical training, and never left.

920x920Like Zelig or Forrest Gump, he was seemingly ubiquitous at major historical events around that time: He volunteered to provide medical care at Altamont, where the Hell’s Angels, working as security for the Rolling Stones, killed a concert goer. He served as a physician to members of the Black Panthers, who were unable to get medical care in more traditional venues. He also ran a clinic for American Indians during the siege of Alcatraz from 1969-1971.

In addition to his medical leadership, he was widely known for his casual dress (bowling or mechanic’s shirts) and riding a motorcycle as his main form of conveyance.

He challenged the leadership of San Francisco General Hospital to provide care for the poor and uninsured, something we take for granted today but wasn’t at all a given when he was starting out. He was instrumental in helping start both a clinic and a residency program to train young doctors in the principles of social medicine — looking beyond the direct biological causes of illness to social causes, institutional discrimination, and beyond.

As you might imagine, he championed the cause of AIDS victims during the early part of the epidemic when other facilities would find excuses not to care for those infected with HIV. He also was known for improving the care of those jailed in San Francisco, making the case that incarcerated individuals still need care. When Type I diabetics were denied insulin and wound up hospitalized or dead, it made more sense for city supervisors to allow Dr. Fine and his trainees to develop better and more humane care plans for those in jail.

I was touched to read that Dr. Fine’s proteges at UCSF and San Francisco General Hospital were able to name their clinic in his honor. They announced that to him at the debut showing of a documentary film made about him last summer, so he was able to learn of the honor before his death due to cancer.

Social Docs

What is “social medicine”?

For some, it becomes a discussion of doctors and other health professionals who have jumped into the social media fray. Whether it’s blogging, Twitter, Facebook or the like.

Which raises a question:

Does it matter to you if your doctor has a social media “presence?” Do you care if your doctor has a Twitter feed or blog?

The blogosphere is full of doctors and patients who care deeply about social media. It’s generational. Twenty-somethings simply expect to be able to find information–both about medical topics and about their doctors on the web. But it’s not just the young ones. The fear is that not establishing a presence will cause “brick and mortar” doctors to lose business if they aren’t social media-savvy.

What do you think? Do you email your doctor? Is your doctor willing to email you?

Research shows that less than 10% of doctors communicate with patients via e-mail. Reasons for this include

  • another source of traffic to tend to
  • no compensation for the time and energy
  • perceived lack of security regarding personal health information.

Patients that do have email communication with their doctors are enthusiastic about it. It saves time. It saves visits. Therefore it saves money. Satisfaction is high.

With the adoption of electronic health records (EHRs), practices often buy systems that include patient portals. These are clunky but secure channels that allow patients to see some of their health records and get some questions electronically answered. Too often the portals simply are tools to generate more visits to the office.

Entrepreneurs are furiously trying to develop applications to address the present need for patents to better communicate with their doctors.

One such company is Twistle (disclaimer: I am one of their physician advisors), a Seattle-based startup that is beta-testing a delightful, secure communication tool for doctors to talk to each other, our staffs, and our patients.

Whether Twistle is successful largely depends on its ability to meet the expectations of the marketplace and garner market share and attention for its application. Whether you’re a doctor or a patient, I encourage you to try it and see what you think. Your feedback is welcome.

“Social medicine” also brings to mind the social purpose, or social utility of the profession. This week thought leaders are coming from around the nation to Tulsa, Oklahoma, to discuss the question, “What is the social mission of medical education in the 21st century?”

It’s all part of an effort known as Beyond Flexner 2012, a Kellogg foundation-funded study that looks at innovative ways of educating doctors to care not just for patients but also for entire communities.

Look for a Twitter feed about the conference under the hashtag #Flexner2012. You’ll also see news posted right here at GlassHospital.

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