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Margaret A. Mahony, M.D.

The Soul Knows:
A Physician's Reflections on Managed Health Care - Margaret A. Mahony, M.D., Inc.


They arrive with uncertainty in their eyes, fatigue, or worse, smoldering irritation. They want to know...What will this experience be like? Will they have time to make sure their questions are answered? How long will they have to wait before being seen? Will they be seen by the doctor or the assistant?

Will their questions be answered to their satisfaction? They are in pain and need help . Will they be listened to? Many have already had one or more undesirable experiences with other professionals. They have learned to become wary. Some demonstrate outright suspicion.

They come seeking comfort, solace and relief from pain, fear and anxiety. When they find comfort, they almost weep with joy - it seems such a rare occurrence. Gratitude wells up from the bottoms of their hearts. Why did it take so long to find someone who seems to care, who listens?

These are refugees from managed care, and they are seeking safe harbor. Their numbers are increasing exponentially, and the safe harbors are becoming inundated, as word of mouth spreads the news.

"I have found a nice doctor," or, "This is a nice office. Try them."

But the masses of refugees overwhelm the safe harbors, and they eventually close their doors. Not unlike a country that decides, due to limited resources, that it cannot feed the entire world.

Do these refugees want something unreasonable or expensive? No, what they desire is something pitifully simple. They are seeking a physician who will sit down and listen to them. A physician who will give them time and attention. A physician who understands the essence of the healing arts and has learned to practice it well.

Why do there seem to be so few of them left? Perhaps the physicians have forgotten something that is terribly important.

Soul to Soul

If physicians came to regard all patients as possessing body and soul, an extra dimension would be added to the physician-patient relationship. The focus would shift during the interaction from the mind to the soul - the physician's soul being attentive to the messages relayed by the patient's soul. I believe that the soul is the source of energy and power for the mind and body and wants acknowledgment One could imagine the following consequences of such a change in perception.

The color of the skin of the body would be insignificant, except for those areas confined to diagnosis and recognition of skin disorders. Likewise, the language generated by the mind and spoken by the body, as well as particular customs characteristic and defining of cultures, would be recognized as interesting manifestations of the human experience. While they would be appreciated for their esthetic value, they would pale in comparison to the presence of the soul.

Thus would the interaction between the physician's soul and the patient's soul become the dominant part of the interview. When necessary, the physician will feel the need to reach out and touch the soul. The physician will want to connect with it and offer consolation regarding its fears for the body - fears of illness, fears regarding upcoming surgery, fears regarding treatment.

One could imagine this extra dimension as useful while making hospital rounds, as well. One can walk about the hospital and hear the groans of pain, anguish and isolation emanating on the medical and surgical floors. One can hear the agonizing scream of fear and pain, followed by the cry of joy emanating from all the souls on the labor and delivery unit. One can hear the quiet sighs and glimpse the most tentative movement of the limbs from the newly born souls in the neonatal intensive care unit. One can be made aware of the intermittently conscious souls in the intensive care unit. And one can glimpse terror in the eyes of the souls in the emergency room.

It is a powerful and sobering dimension, this soul dimension, and it is crying out to be acknowledged.

Safe Houses

A small group of physicians has begun meeting. They are trying to find their way amongst the muck and debris that litters this country. They are busy trying to establish a way of practicing medicine that is consistent with their inner beliefs and values. Their ethics and morals. In essence, in a manner that is consistent with their souls. They are looking for a way to practice medicine that gives honor to their calling and not discomfort, or worse, shame.

They have decided to establish a network outside of any PPO listing, HMO book or any other official arbitrary division of physicians. These doctors have decided to give old-fashioned, high-quality, strictly fee-for-service medicine a try - something that seemed all but lost, ironically rising up from the debris of managed care.

These physicians will establish offices that honor the physician-patient relationship. The physicians in this loosely affiliated and fledgling network have this as their top priority. They will treat their patients with honesty, integrity and compassion. They will listen to the patients and attend to their needs to the best of their abilities.

In return, the physicians ask only that the patients release them from third-party interference. It appears that it is not just the HMOs that are proving oppressive and tiresome - the PPOs are learning from their HMO colleagues. It is almost as if the doctors will put up with just about anything in order to collect a paycheck.

These newly released physicians cannot stomach being paid minions any longer. They will go out on their own and practice medicine the way they know it should be done: one-to-one. One patient at a time, and plenty of time allotted to this sacred dialogue. When patients arrive at these offices, they will feel the difference immediately. They will have to adjust to owning something that they thought they had lost: power.

You see, by making the relationship financially simple, things change. When the patient pays the physician directly, it behooves the physician to be absolutely certain that the patients' needs are clearly being met. Otherwise, the patients will not return. And they will not refer their friends or neighbors.

Imagine the changing dynamic. Instead of being paid by an interfering and unwelcome third party, the patient pays the physician. These physicians then have to act only one way: that is, to do all in their power to honor their professional commitments.

Patients treated in this manner and with this degree of respect will remain loyal - a loyalty based on deep mutual regard. Both patient and physician will benefit. To practice this way is very freeing. The possibilities are exciting to contemplate.

For instance, the physicians will network with each other. If a particular patient needs the professional services of another physician, this will be accomplished with a quick phone call - the faxing of the medical record and a timely appointment guaranteed. Patients will be sent reverently and securely from office to office. The patient will know implicitly that the integrity and the intentions are true.

At these preliminary meetings, the discussions are filled with energy, commitment and passion. It is almost as though these physicians are grasping at something apparently long lost, but now beginning to return sharply into focus. This is the right step; it seems so natural. So logical. So pure. This idea to establish an office practice where patients can feel secure, comforted, honored and respected. The physician's soul will sing in these offices, and the melody will reverberate across this land.

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