A prison story

I haven’t written in a few weeks. Frustration, anxiety, pesky illnesses, and new passions really take a toll on you. I still feel partly censored in what I can divulge here, so let me tell you about the new passion I’m trying to develop. I’m learning to play guitar. And more than learning to play it, I want to know everything about them, about music, and just really feel my blood pulsate differently when I think of it. I have even bought an electric guitar I’m taking apart, modifying, and (hopefully) put back together again. I love the feeling it gives me to be in control of such a versatile instrument. Just thinking about it gives me a buzz…

Another passion of mine is humanity, yet I say that more in the Fyodor Dostoevsky sense of “The more I love humanity in general, the less I love man in particular”. I like watching prison documentaries for the stories about a different version of humanity you may or may not encounter every day. And there is one story that keeps bouncing around in my head which I would like to share because I found it so intriguing.
There’s this prisoner serving a sentence that will mean he spends the rest of his life in prison with no possibility of parole. He starts off by telling the story of how he has been a criminal for a very long time. He was selling drugs, stealing, using drugs, etc. He had been in and out of prison since he was a teenager until eventually he managed to score his final life-long sentence.

Anyhow, while he was in prison, his son got arrested for murder. At one point the son was in the jail next to the prison his father was in. What the prisoner’s son and some other men had done was they killed someone, and for that crime they were up for the death penalty. But the son's lawyers organized for his father to testify at his son’s trial, saying how he gave a bad example to him, and that he wasn't there to teach him right because he was always in and out of prison or high and drunk as the son was growing up. Also, the family was very poor because the father wasn’t able to work because of his criminal lifestyle, drug and alcohol abuse, etc. The co-defendants in the son’s murder trial didn’t have the opportunity to have their sentenced reduced from the death penalty because their fathers weren’t in prison.

 When the son's trial date came up, the lawyers thought they'd do a charitable act by both father and son and organized to pick them up in the same prison van so they could ride together to the courthouse. In the prison van, the guards and lawyers were all feeling very warm and fuzzy that they had granted this father and son to sit together even for a short trip (though no one knows who specifically asked for this). While in the prison van, the son held his father’s hand through the handcuffs behind their backs. He was grateful to his father for helping get him off death row. Afterwards everyone who had helped organized this great gesture between father and son, were feeling really good about themselves.

Then someone asked the father if he was happy to see his son, and was he excited to be able to help him out, etc. The father answered and said he'd never ever felt worse in his life! He said never had he felt more ashamed and like an absolute worthless human being. He had never felt as low as he felt that day. He said he was disgusted at himself; truly hated himself for the experience. He said he would have preferred never to have seen or heard or touched his son again in his life than to see him like that: in the back of a prison van while up for the death penalty for the disgusting crime he had committed. He said never had he felt like the worst father and the worst person in the world than that day. He said to him that it felt like it was his own death sentence that day, knowing he had failed as a human being. That day he truly repented of all his own wrongdoing and he wished he had never been born so at to give life to someone like or worse than him, even if he was his own blood.

He cried at how embarrassed of himself as a human being he was, and the fact that people thought of him as a hero or a good man for having gotten his son off death row. (Yes, the son had his sentence reduced to life without the possibility of parole.)

Wow, this story touched me very much and I can’t even really explain why.

The goals and business of general practice

In the last week I have been involved in the recruitment of a new nurse to the primary care clinic I’ve been working in. (And I should note that the terms general practice, general medicine, and primary care, are been interchangeably here) I suggested that we ask applicants in the job interview what, in their opinion, are three goals of (private) general practice medicine. This is a question that potentially has dozens of answers! To patients, up to 95% of the time it is about helping them deal with immediate, though generally non-urgent, health problems. The rest of the time it is about preventing ill or worse health. To governments, the goals of general practice medicine are to keep people healthy so that they utilize less government-funded health resources. General practice is meant to keep patients out of hospitals. But what are the goals of primary care medicine if you happen to work in a primary care clinic? I think that if you understand the way the business of general practice, the goals of general practice are fairly straightforward - from a business perspective, because this is an industry just like many others.

How does general practice work? Well, patients require a service so they contact the practice’s administration staff to book this service: a medical review with a doctor. Booking appointments is just one of the tasks of the admin staff, and their tasks are fundamental to the proper and smooth running of the practice as a business and also in optimizing the clinical interaction between the patient and the doctor. The doctor takes the patient’s clinical history and requests investigations and treats their condition, etc. To do this more efficiently and effectively, they often enlist the help of the practice nurse. The nurse has a very important part in the running of the practice too. They are there to advocate for the patient, to help carry out a lot of the preventative activities related to medical practice, they administer medications and immunisations, they perform some of the tests the doctor needs to help clarify the patient’s diagnosis, etc. They do all this in the background so the doctor doesn’t need to do it herself – and in this time the doctor may see another patient or take care of another clinical activity. That’s it. At the end, the patient pays one fee to cover the cost of seeing the doctor, the nurse, and having administration staff assist them.

How General Practice Works

Now, how does the money side of general practice work? There is one source of money coming into the practice: patients. That’s right, the only income-generating activity in general practice occurs in the interaction between the doctor and the patient in that room. For example, talking to the receptionist doesn’t attract a fee (as a patient you could theoretically come in and talk to one all day and she can’t bill you for anything as she hasn’t sold you anything).  

Where the money in General Practice comes from.

What then? Well, the money generated by the doctor’s fees is pooled and is meant to cover the cost of paying the practice’s staff, the building rental fees, insurance costs, medical and non-medical equipment costs, etc. And that exactly is why it is important for practice managers, for administration staff, and for nurses to help doctors see more patients and to see them efficiently and effectively.

Where the money in General Practice goes to.

So what are the business goals of general practice? I believe they are so closely related to the duties of general practice that you could be forgiven for mistaking them. The first priority of (any) medical practice are the patients. Keeping them well, that is giving them what they pay us for (assistance with health problems), is and needs to be the first goal. The second goal is to optimize the interaction between the patient and the doctor; the “service” being sold. It is the task of everyone working alongside the doctor to make sure this happens well, smoothly, and in a time-efficient manner. The third priority is to the community in which we work. This makes sense not just in a humanistic ideal but because general practice, as opposed to other medical specialties, often deals with people who are well and healthy – and who want to remain that way! Healthy patients don’t attend cardiologists, for example, to prevent cardiac disease. No, they would go see the cardiologist once cardiac disease is diagnosed or suspected and they need secondary prevention or treatment. But general practice does see well people for this and many other preventative activities.

It makes so much sense from a business point of view to fulfil our duties in general practice, that is to patients, to the staff, and to our community. Patients that are well-cared for and feel/know that they are being prioritised want to continue using that service. If you optimise the doctor-patient interaction (in business terms: time), you make the business more profitable. And if you cater to the local community, that community gets to know and trust your service and seek it out amongst the other dozens of similar practices around. What is there to lose by fulfilling the duties of our jobs in general practice, really?