COMMENTARY

Rx: The Quiet Revolution: Heart and Soul Meet Modern Medicine

Seth Bilazarian, MD

Disclosures

March 31, 2015

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Editor's Note: A two-part documentary, Rx: The Quiet Revolution and Rx: Doctors of Tomorrow, will air on some PBS stations on April 2 at 9 PM Eastern. Reflecting on his physician father's practice and the move away from hands-on care in contemporary medicine, the documentary's award-winning director, David Grubin, highlights a range of innovative practice models from Maine to Alaska. Medscape asked some of our experts to preview the film and offer us their reactions and opinions, which are available here.

In this commentary, interventional cardiologist Seth Bilazarian, MD, provides his review.

This is Seth Bilazarian on theheart.org on Medscape, for Practitioner's Corner. I am going to review a PBS healthcare documentary called Rx: The Quiet Revolution. This documentary will air on April 2. Dr Jennifer Mieres, the executive producer, was a former president of the American Society of Nuclear Cardiology, and I was asked to provide some insights for our audience.

My experience with TV documentaries, or documentaries in general about American healthcare, has been extremely negative. They frequently blame doctors for the ills and woes of the system. They don't portray any kind of reality that I see. When I watch these documentaries, often very little is shown that resembles what I experience in terms of a doctor/patient relationship. I frequently would sit and say, "That never happens. I have never seen that." And they often portray doctors as being primarily financially motivated, uncaring, and lacking empathy for their patients.

So I entered this review with some trepidation. Rx: The Quiet Revolution is a 90-minute documentary that covers practices in four parts of the country: a general practitioner who converted his practice to an innovative group practice in a rural area in Maine, a diabetes care practice in the Mississippi Delta, a "nursing home without walls" that delivers healthcare for geriatric individuals living at home to avoid having them go into a nursing home, and a program for the native people of Alaska that is providing holistic care in an innovative way.

When I watched it, I was actually quite delighted that it really does resonate quite a bit with me. I am going to share with you some things that I wrote down as I was watching the show.

Dr David Loxterkamp is a primary care physician in Maine who was profiled in the first segment, and he said some things that really resonated with me. This is a quote: "Failure of the healthcare system still always feels like personal failure. You see all that can be done or hasn't been done, and you feel a personal responsibility for it." I certainly feel that way whenever patients fall short in my practice.

He also said, "The idea of collaborating with the patients sounds very good. What happens when patients can't fulfill their side of the bargain? Sometimes it feels like the patient is failing the partnership, but I may have misunderstood what they wanted from me. I have my agenda, they have their agenda; oftentimes, they don't directly overlap. Their failure to be compliant comes from a lot of different reasons, which are often the same reasons that they are in the fix they are in. They are in the diabetes, smoking, or obesity fix."

Another thing he said is, "We have to set the stage that this is a cooperative venture, and both the patient and doctor need to understand that the patient's decisions are more important than the doctor's decisions."

I thought that this was very insightful and very reasonable, and it portrays the problem that we often have with our patients in a very realistic way. I am delighted that the public will see this side of it. Dr Loxterkamp added that "patients who can make wise lifestyle choices don't need the doctor," and I think that many of us would certainly agree with that.

In the second segment, on diabetes in the Mississippi Delta, a patient is profiled. Her name is Annie Ford, and she lives in Louisville, Mississippi. She has diabetes that is extremely poorly controlled; her glucose levels were generally in the low 300-mg/dL range. This area of Mississippi is what they call the epicenter of diabetes, with 40% of the children being obese.

The healthcare program that is highlighted was developed at the regional and state levels to create several technological and team-based approaches to improve diabetes care, one of which is telemedicine. This patient, Annie Ford, puts her data on an iPad®, and the information is transmitted to a central location. It is monitored every day, and the team calls her back. She has diabetes coaches. She has regular primary care visits locally, as well as remote electronic visits on Skype® with a diabetologist.

The patient says that her experience before this program was that "nobody cared about the patient with diabetes. They just send them to the doctor. They just tell you to take the medication and come back in 3 months and check that, and there is no teaching on what to eat or what not to eat," and, "You need someone who cares."

This program has been very successful, at least as profiled in this documentary. The profiled patient's glycemic control dramatically improved, falling from the upper 200s and low 300s to below 100 mg/dL. One thing that resonated with me as a doctor was when the leader of this program said, "We had to find what works here in Mississippi," and much of that probably comes from working there. They are continually trying to innovate, to find what works in Mississippi but wouldn't necessarily work in my patient population, a first-generation population largely from Latin America. These kinds of solutions have to be found locally.

I would like to make a few concluding comments about this show. I do recommend that you watch it. The old general practitioners did a lot of things right. They spent time with patients. The problem is that medicine today is much more complicated. We need the sophistication of modern medicine combined with the heart-and-soul approach of the country doctor. We need team-based approaches and medical professional providers who are teachers, coaches, advisers, and cheerleaders. We need relationships.

I took heart from the medical care given in this program. I felt that the practitioners were using modern, scientific-based methods, but they were fortifying them with conversation, a partnership, teamwork, and trust.

I don't think we could find anyone who wouldn't agree that medical care currently in the United States is deficient or broken, and that doctors are part of the solution. Doctors are clearly critical; we are necessary, but we're not sufficient. That is how I think about this. Watching this kind of program makes me feel that I am a key part of the team, but I can't do it alone.

Real health and wellness are multidimensional. They require that our patients be healthy emotionally, as well as physically. The circumstances that many of our patients live in aren't supportive; family life, home life, or community life can be very challenging. This makes our ability to manage their congestive heart failure or their coronary disease very challenging as well.

Rx: The Quiet Revolution makes a compelling argument that we can help patients achieve their targets of optimized health if we work with larger teams. I don't think there are many doctors who would object to this. This is something that we would welcome. Most practicing physicians would be elated to see this initiated.

I hope that we will see more of these programs, and the conversation will begin to change from one that blames doctors to one that sees that doctors can do a slice of the care (certainly the medical care), but that health and well-being are largely influenced outside of the office and need to be addressed in larger programs.

I commend this program, Rx: The Quiet Revolution, and offer my compliments to its producers. I'm Seth Bilazarian.

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