Zen and the Art of Health Maintenance

In one of my favorite books, Zen and the Art of Motorcycle Maintenance, Robert Pirsig wrote:

“Quality is a characteristic of thought and statement that is recognized by a nonthinking process.  Because definitions are a product of rigid, formal thinking, quality cannot be defined.”

If you are a patient or doctor then close your eyes and think of a quality doctor visit.  What would be in it?  What would be included? What would you talk about?  How in depth would it be?  Would there be personal discussions?  Would there be eye contact?  Would there be human contact?

Now, do you think that Medicare, the insurance companies, the P4P gurus, and the administrators envision the same thing you do as they create more “quality indicators” to judge whether your doctor gives quality care?  I bet not.

That my friends is the difference between AUTHENTIC MEDICINE and INDUSTRIALIZED MEDICINE.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  8 comments for “Zen and the Art of Health Maintenance

  1. Harold Isenberg
    February 18, 2012 at 2:01 am

    How true and how sad. In one way I am glad that I am nearing the end of my career in medicine. However, I would have preferred to practice another 10 years.

  2. Rich Dudrak
    February 15, 2012 at 12:34 pm

    A really scary Valentine’s present for those rated based on patient satisfaction. Sounds like we need a new paradigm.

    http://www.healthcanal.com/public-health-safety/26557-Patient-satisfaction-linked-higher-health-care-expenses-and-mortality.html

    • Doug Farrago
      February 15, 2012 at 2:44 pm

      Thanks so much for this. I will need to do a separate blog just on this.

      • Rich Dudrak
        February 15, 2012 at 2:58 pm

        Thought you might say that!

  3. John Difini, MD
    February 15, 2012 at 12:24 pm

    Good commentary. Way to strip it down to the bare essentials, Doug.

  4. February 15, 2012 at 8:42 am

    You are so correct to appreciate that distinction.

    But instead of “authentic” vs “industrial”, how about MEDICAL CARE vs HEALTH CARE?

    Doctors, PAs, RNPs, RNs: we do (did) medical care. We interact with another human being one-on-one. It’s driven by a personal relationship and a personal ethic in the context of “scientific knowledge.” We are less process-oriented than person-oriented, at least at “our best” and when “they love us.” And we love ourselves. Of course there’s profit, but it’s more so we can live to doctor another day. But we doc’s, at least until recently, revered the Marcus Welby and Ben Casey and Hawkeye Pierce – the doc who knew the uniqueness of each person, including himself, rather than the sameness of disease categories. Individual trumps group. Listen to us talk in the lounge: “Let me tell you about MY PATIENT (singular) who….” It’s an individualized mathematics.

    Hospital administrators, insurers, regulators, even the RAC, all do ‘health care.’ You are right: their perspective is “industrial,” but that points to the requirement of a process-controlled mentality. Nothing wrong with that if you know what you’re talking about. You have to talk about “Family Practitioners in general who…” or “the treatment of strokes” (rather than the treatment of an individual human patient
    who SUFFERED [key word; a ‘process’ can not ‘suffer’] a stroke). The calculations are not individual but rather Bayesian, that is, the statistics of groups of events. And that’s fine for modeling groups. But not for treating individuals. In health care, groups – which means necessarily ‘process’ – trump the individual.

    Let me add that your hospital CEO and such see themselves, rightly, as the doctor for doctors. These health care providers make it possible for us medical care providers to function. We owe them the same compliance that we expect from our patients, without whom we’d all be trying to be plumbers. (Who else handles as much shit as we do, but makes more money?)

    There was, is, and always will be a dynamic tension between health care and medical care because we live in a world of limited resources, not only dollars, but time. Everybody is mortal, even neurologists, damn it. Neurophysiologically, we flee from risk and we maximize our pleasure. That’s fine. Let’s just admit it. It’s kind of the way we all thought in college (and medical school!): sometimes the process of sex trumped the individuality of love. OK. We’re going to have the same drivers, whether we practice medical care or health care.

    But we need to admit the differences between medical care and health care, and recognize that there will be conflicts between them because PEOPLE practice each. And PEOPLE get personally invested – which is certainly part of our glory. Within each type of ‘care’, you can resolve conflicts using knowledge: “the literature tells us which is the best antibiotic for THIS person with THIS problem at THIS time,” or “OUR actuarial model has a better confidence interval that yours because our granularity is finer.”

    But between these two types of care, you can resolve conflicts between their practitioners only by collaboration, transformation, alignment and engagement.

    And if you both decide that the marriage just ain’t worth it, then BOTH sides are consigned to lonely evenings thinking about what might have been.

  5. Chuck Merson
    February 15, 2012 at 8:35 am

    Principles of Zen and the art of Jewish Motorcycle maintenance

    1. Let your mind be as a floating cloud. Let your stillness be as
    the wooded glen. And sit up straight. You’ll never meet the
    Buddha with such round shoulders.

    2. There is no escaping karma. In a previous life, you never
    called, you never wrote, you never visited. And whose fault was
    that?

    3. Wherever you go, there you are. Your luggage is another
    story.

    4. To practice Zen and the art of Jewish motorcycle
    maintenance, do the following: get rid of the motorcycle. What
    were you thinking?

    5. Be aware of your body. Be aware of your perceptions. Keep
    in mind that not every physical sensation is a symptom of a
    terminal illness.

    6. If there is no self, whose arthritis is this?

    7. Breathe in. Breathe out. Breathe in. Breathe out. Forget this and attaining
    enlightenment will be the least of your problems.

    8. The Tao has no expectations. The Tao demands nothing of
    others. The Tao does not speak. The Tao does not blame. The
    Tao does not take sides. The Tao is not Jewish.

    9. Drink tea and nourish life. With the first sip, joy. With the
    second, satisfaction. With the third, Danish.

    10. The Buddha taught that one should practice loving kindness
    to all sentient beings. Still, would it kill you to find a nice
    sentient being who happens to be Jewish?

    11. Be patient and achieve all things. Be impatient and achieve
    all things faster.

    12. To find the Buddha, look within. Deep inside you are ten thousand flowers.
    Each
    flower blossoms ten thousand times.
    Each blossom has ten thousand petals. You might want to see a
    specialist.

    13. Be here now. Be someplace else later. Is that so
    complicated?

    14. Zen is not easy. It takes effort to attain nothingness. And
    then what do you have? Bupkes

    • Doug Farrago
      February 15, 2012 at 8:37 am

      Funny stuff. But if there is any chance you “borrowed” this from somewhere please send the link so I can credit that person.

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