Editor's Note: Mark Birmingham, DPM, a podiatric surgeon, as well as a member of the Physicians Practice Physician Advisory Board, offers his review of the recent PBS documentary "Rx: The Quiet Revolution."
Before I started medical school, I had an old, primary-care physician tell me, "You can train a monkey to practice medicine, but it’s the person that makes the doctor." In "Rx: The Quiet Revolution," a documentary that brings the focus back to the doctor-patient relationship, I believe that old doc’s opinion is supported quite well.
David Grubin, the program’s filmmaker, set out to share an ideal that may be lost to this generation’s healthcare providers, but was a way of life for his father, a general practitioner in the 1950s. Disheartened, his father retired from medicine saying about his patients, "They’re paying more, but not getting their money’s worth." Some 60 years later, the filmmaker travels from Maine to Mississippi, then from San Francisco to Alaska, chronicling teams of healthcare providers changing how they deliver medicine. Much more, they are changing how healthcare is received by the patient.
A good portion of the film is focused on populations of patients living in a rural setting, where quality healthcare is less than accessible. From tablets that upload daily blood glucose readings into an immense database in Jackson, Miss., to dispensing medicine via a vending machine that is hundreds of miles away in Anchorage, Alaska,, technology is aiding physicians to deliver much needed care.
Fancy technology is great. Alas, it is only technology and needs a human to actually fulfill the intended end result.
The end result may be, in its simplest form, just educating the patient. In frustration, and yet lauding the change in her new healthcare setting, a Mississippi patient laments the old way of how she received patient education as being, "just as dumb as you was when you went in." A general practitioner in Maine looks at it from a slightly different angle saying about his patients being empowered to change their own health status: "Those that are capable, don’t need me."
Very innovative and new ideas are shared in this documentary; ideas that aren’t the mainstream medicine most of us practice today. The goal of all of these ideas is to make patients an integral part of their own recovery/maintenance/prevention. A goal of not only looking for "compliance" in the looking-down-over-the-eyeglasses way, but more of the remember-our-plan way. The idea is not really that new, just more of a revival of an old way of thinking; one that worked well for America for a period of time.
This is a documentary that physicians should watch. If you’re like me, you work in a metro or suburban landscape, where it can, at times, feel very much like a machine: queuing patients to come in, then sending them right back out. This film says it doesn’t have to be that way. That's a refreshing thought.
I get to share the "monkey practicing medicine" quip with students, residents, as well as patients on a pretty frequent basis. It usually gets a laugh or a smile and brings the presumed chasm between the doctor and his patient a little closer. I think the old doc that told me that line was partially right in his statement that, "The person makes the doctor." I believe it left out one critical part: the patient. This film triumphs in bringing the patient back to center stage.