medicine

Relieving Tension in the Home

There was a lot of tension in my home when I was growing up.  When we were at odds with each other we were taught a very simple coping strategy; avoid it!  Of course that didn’t solve anything or make it go away; the tension just built up over time, eventually exploding like an erupting volcano.

It’s important that our homes be a place where everyone can release their tension in appropriate ways and find a respite and relief.  If not, your teens will find ways to self-medicate the tension away through drugs, alcohol, promiscuity or self-harm. The pressures of their world are far greater than when we were kids, so let me share with you some practical ideas for relieving tension in your home.

<b>Hold the drama</b>

I got a question recently from the distraught mother of a sixteen year old.  She asked, “How do I get my daughter to stop being a drama queen and upsetting the entire family?  I feel that I have to protect my younger children from her blowups.”  I told her that drama occurs because drama works—teens do it because it produces a result they desire.  It is an easy way to gain center stage.

Drama is usually crisis-driven; something has happened that they’re responding to by creating drama. And if it works for them one time, they’ll do it again, and again. Of course while that helps them release their own tension, it tends to add tension for everyone else in the family. So I told this mother to say something like this, “If you can’t control the drama; if you insist on being the center of attention by acting out, there will be consequences. Drama is not an appropriate way to deal with whatever is bugging you.”  Putting an end to the drama in your home will help relieve a lot of tension for everyone, and especially you.

<b>Learn to laugh</b>

When was the last time your family laughed together about something?  Proverbs 17:22 says “A cheerful heart is good medicine.”  Laughter short-circuits tension.  So, watch a comedy together; find good clean comedians you can all enjoy.  Invite friends over who have a good sense of humor. Have a joke night at the dinner table where you assign everyone to bring at least two new jokes and engage in laughter together.  Post humorous cartoons on the refrigerator.  Text jokes to each other.  The point is this, it takes some work, but if your home is tense, you need to bring in some humor to offset it.

Your children watch to see how you respond when things go wrong, and they tend to pattern their behavior after yours. So, laugh at yourself.  When something goes wrong—when you break a glass—don’t get angry, make fun of your clumsiness.  When your teen makes a mistake, don’t get angry, make light of it — “Wow, you really blew it this time! I guess we have a lot of yard work to do together.”  Making anger part …

health, medicine

The Retainer Model or Single payer-What willsave primary care?

http://www.medscape.com/viewarticle/571133

Point/Counterpoint

The Retainer Model or Single Payer — What Will Save Primary Care?

Robert M. Centor, MD; Charles P. Vega, MD

Point: The Retainer Model May Stimulate a Rebirth of Outpatient Internal Medicine

Robert Centor, MD

Outpatient internal medicine has joined the endangered species list, or at least so many commentators have opined.

Fewer internal medicine residents are opting for outpatient jobs. Many outpatient internists are leaving practice, either for fellowships or for hospitalist jobs.

As I consider the medical student’s choice of internal medicine for his or her career, I note that the fascination with internal medicine usually results from the complexity of the field. Internists champion the care of complex patients. We love diagnostic and management puzzles. In the 1970s and 1980s, many internists embraced a definition of primary care that the Institute of Medicine (IOM) codified:

"A set of attributes, as in the 1978 IOM definition — care that is accessible, comprehensive, coordinated, continuous, and accountable — or as defined by Starfield (1992) — care that is characterized by first contact, accessibility, longitudinality and comprehensiveness."[1]

Training programs produced internists who could care for complex disease and also handle a wide variety of clinical issues, including episodic care and preventive medicine. Over the following 30 years, our society apparently has redefined primary care to a definition that degrades the original concept. The American Heritage Dictionary in 2006 provides this definition for primary care: "The medical care a patient receives upon first contact with the healthcare system, before referral elsewhere within the system."

I believe that most insurers and other physicians no longer consider comprehensiveness when they think of primary care.

I would argue that internists do not want and are not trained to do this limited conceptualization of primary care as defined by the American Heritage Dictionary; rather, we are trained to add primary care services to our comprehensive care. Such distinctions underlie the angst of many practicing internists. We have trained a generation of internists to provide comprehensive care, including episodic and preventive care, and yet insurers and especially health maintenance organizations complain that internists are not good at providing quick, efficient primary care. Family physicians are in a similar situation. We have a problem of semantics and thus our discussions about primary care remain confused.

Our reimbursement system also does not pay internists sufficiently to provide high-quality comprehensive care, although our patients are too complex and require more time than what insurers believe constitutes a standard office visit.

Specifically, patients need various levels of intensity. A 30-year-old mother with a sore throat has different physician needs than a 55-year-old man with chronic obstructive pulmonary disease, heart failure, and type II diabetes mellitus.

Clearly, the latter patient will need longer and more frequent visits. Moreover, our current system does not reimburse out-of-office continuity. We have no reimbursement for telephone calls or emails, although patients often have questions

for their physicians. They would like to call their physician for advice, or to …