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Thursday, April 19, 2012

The Moral Energy

My flight had been delayed and now I was three hours late for the Arkansas Quality Conference in Hot Springs.

As I prepared to jump into a a handicapped accessible taxi in Little Rock, I asked the cabbie if it was okay to take me when I was not handicapped.  I was the only fare waiting, so he said hop in.

I buckled myself in the back seat and tried to converse over the large open space designed to hold a wheel chair.  My feet dangled like a child from my high seat.  After a few minutes of conversation, yelled across the gulf between us, I asked if I could sit in the front.  I twisted my body over his center console and dropped into the seat as we sped down the highway at sixty miles per hour.

Then I heard the cabbie's story, for we all have stories and some of us paint them on our backs. His daughter died of cancer 20 years before. She was only nine years old.  We exchanged condolences. He had been an enlisted army man for 20 years. When he left the service, he found the only job available was long haul trucking.  On the lonely road he would eat and eat and rarely sleep, then he had a heart attack.  No more trucking for him, or the income he gathered at that job.  He recovered and lost 100 pounds and now wanted to go back to trucking, but he needed copies of his medical record to prove he was fit.

I interrupted then, "You are a vet, and you can get those records via the Blue Button."  He was happy to hear that there was a way to access them.   

As we rode into Hot Springs the very green trees that loomed above us amazed me. I left the cabbie with my well wishes and entered the convention center.

The Hot Springs Convention Center is beautiful.  It is built like a wedge upon a sloping hill.  When you walk from end to the other, you begin at great height but as you walk down a very long hall you arrive at a conference space at ground level.

The space is filled with art.  It is not pretty art.  By that I mean it is beautiful, tragic and profound, but not the safe pretty art work that graces so many public buildings.  When I reached the conference space, Janna Williams and her team greeted me. Then I began to paint. I set up my easel in the vender area and began a painting I called "The Natural State." 

"The Natural State"

In this painting the beautiful green trees loom large before the viewer. A road stretches into the distance to meet a far off horizon.  I painted all of this and then the award banquet began.  I moved my easel down the hall and set up once again in the main Ballroom.

I watched the awards unfold as one facility was awarded for a quality project.  The facility staff had decided to encourage medical students to call patients post-discharge and find out how the patients were coping. This way they could determine if the patients needed additional help. This practice substantially reduced readmission rates. 
So within the painting ,I placed a patient on the road of care looking bewildered and confused.  One student pulls her arm, dragging her forward to her health goal. This student seems as eager as a child. The other student touches her arm as she tries to reach the patient by using a telephone.

the goal of care 

Then I stopped painting for the night and spent a delightful evening in the company of my Aunt Minnie and my sister Esther. They had driven up from Enid, Oklahoma to see my speech and enjoy a day trip in Hot Springs.  My aunt Minnie is a retired ICU nurse and my sister works for the State of Oklahoma in adult protective services, so I knew they would be interested in the medical conference.

Aunt Minnie and her girls I presented on my speech April 18. There were other speakers before me.  Ray Hanley, President and CEO, Arkansas Foundation for Medical Care, J. Gary Wheeler, MD, Professor of Pediatrics, UAMS College of Medicine and Andy Allison, PhD, Director, Division of Medical Services Arkansas DHS gave speeches that soared one around the other and told us many things.

They spoke of “The Moral Energy” that can regulate healthcare and it became the title of this piece.  Once we depended on the doctor’s Hippocratic oath to provide safeguards in medical care.  Now we expect legislation to augment the doctor’s oath and create a moral energy in patient centered healthcare. 

The Moral Energy

So in this painting it is dawn.  As the sun crests the horizon, it forms a light bulb held in a patient’s arms.  Below the patient a mother sits and is listening to her child.  The child is a pediatric patient holding soap in her hand and she is telling everyone to wash his or her hands.  In the water below, money floats for as Andy told us if you want to know what is going on “follow the money.”

Patient Centered Care a Bright Idea

To the left of the patient, a doctor is rowing a boat.  As he presses forward with his oars he is staring at a television.  He wants patients to decide upon their healthcare choices with as much forethought as they choose a television.  He also wants data sets to be open so patients will have the resources to do such research. 

To the doctor’s right a five-year-old child is in a straight jacket.  He has a string of anti-psychotic medication twisted around his body.  He represents an attempt to curtail the over prescribing of anti-psychotics to children in the state of Arkansas. 

To the child’s right a young mother is nursing her baby in a facility that has realized the benefits of providing lactation support far outweigh and the loss of productivity that was once ensured by placing a bottle in every squalling mouth.

Comparison Shopping, child anti psychotics and lactation support

To the right of the patient boat, a care team boat is being rowed into the picture.  The doctor is reaching out to the patient supported by the nurse and even the housekeeper is part of the team. At the oars a patient rows energetically for the patient is part of the care team as well.

The Support Team

The fourth speaker of the day was Len Kirschner, MD, MPH President of AARP in Arizona.  He gave an amazing and often hilarious speech on the history of health policy.  His speech was entitled: Politics and Healthcare: a Look Back and a Look Ahead.”  His speech contained so many quotable moments but among them was this very important point: “In 1966, as a condition for receiving Medicare funds, hospitals desegregated. Health care drives change." (Tweeted by @AFMC)

So within the painting I added Len with a history book in hand reminding us that if we forget our history we are destined to repeat it.

I spoke next and the speech was well received.  Then we raffled off the painting “The Natural State” and an Oklahoma State alumnus won the piece.  I said thank you to all the amazing folks in Arkansas and hugged my family goodbye. 

I hoped in a shuttle to head back to the airport.  The driver was a very nice fellow with four children: two in college, one in high school and one in third grade.  When he realized the event was a medical conference, he asked me what was my take on “Obamacare.” I proceeded to spend the next 40 minutes explaining the Affordable Care Act and its many provisions to help regular folks.  I also threw in a little information about HITECH and Meaningful Use.   When I finished, he said all that sounded really good.  So, why didn’t they explain it that way on television?

I wondered about that too, perhaps they lacked the moral energy…

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