The times, they are a-changing. My practice is in the process of becoming a different type of practice, with prevention and personal care at its center. That's what I've always tried to do, but I have found a new practice model in which I can really focus on wellness and preventing the complications of illnesses.

MDVIP, a subsidiary of Procter and Gamble, allows physicians to work with a smaller number of patients, as a combination old-style family doc, health coach, and technical medical expert. I will be able to spend the time with each patient, and his or her individual problems, that is necessary to achieve the best results, both for healthy living and for the treatment of illnesses when they occur.

My practice size will decrease to less than 600 patients, from its current 3500-4000. Each patient will have a yearly physical examination that is extremely comprehensive. These are sometimes referred to as "executive physicals," but a better term would be a comprehensive assessment and annual health plan. We will work together to form goals and benchmarks for the coming year, and I will help each person to reach those goals as time passes.

In addition, since the practice is much smaller, visits will be on-time and as long as is needed. Each patient will have my cell number to reach me on evenings and weekends, with instructions to actually use the number when they need to talk to me. I won't be trading call on weekends anymore, so I will be the one to return the calls. Patients can expect to get in for problem visits the day they call, or the next day. One of my goals is for my patients to have no idea what an urgent care center looks like.

There are many other layers to this type of practice. I am very excited about starting. You can learn more about the practice at www.StevenBurnsMD.com.

The change in practice occurs on December 28, 2010. Call if you want to know more about the MDVIP practice.

Foggy Canyon

From the precipice a fog blanket,
thick and opaque and still and gray,
eclipses the chasm below.

The trail, steep and narrow
limestone path of muley mud,
dives out of sight into the mist,
beckoning.
I follow its blind lead,
blinking in wet air below.
Gray leads into gray,
five, six, eight feet ahead,
canyon grandeur captured in a
small mist box.

Ahead, low mountain sage grows,
its trumpet flower hanging gold in still air.
Hummingbirds hum below the mist
as the sun breaks the canopy wide,
penetrating the canyon.
Morning wakes,
delayed as a lover who stays
for one more caress as he leaves the bed
rejuvenated, vitae interruptus,
resuming life again.

Looking under the cloud, I--
open-mouthed with wonder--
see cliffs and plateaus,
temples and spires,
Kaibab limestone above,
Vishnu schist below,
Rio Colorado below,
sun-broken cloud above,
see them again
as if for the first time.

--by Steven Burns

A New Year, a new half-marathon

It's a nice, rainy morning, and I love it. I'm glad it wasn't raining yesterday. You see, I ran in the P. F. Chang Rock 'n' Roll half-marathon, and rain would have put a huge hitch in my getalong.

I met with 22,000 of my closest friends at ASU, and we took shuttle buses to the state capitol, 15th Avenue and Jefferson in Phoenix. There, a very large number of people milled around and waited in long lines for Port-a-Johns. A pretty good band was playing near the booths that were handing out bagels, bananas, water, and coffee. Then it was time to get ready to run.

I was in the 13th 'corral,' as we were grouped by the times we planned on finishing. My group consisted of maybe 400-500 people, and I suspect the groups farther back were much larger. At 8:30, we started moving forward, and as we reached the starting line, I saw Senator John McCain waving to the crowd from a platform 20 feet above the crowd. His face must have been hurting by then from all the smiling.

Immediately after crossing the starting line, the group spreads out, all the while jockeying for position. You're not really trying to pass other people--just trying to keep to your own pace, and not step on anyone else. It's sort of like driving on the freeway, but without all the anger and fear.

At 7th Avenue, we turned north and then at McDowell we turned east. I think that whatever 'runner's high' I had occurred before the 3 mile mark, which is 12th Street. By the 6 mile mark, I was in the groove, but my legs were beginning to complain that I was using them badly. Unlike last year, the 7 mile marker was not a discouragement. Last year, I realized that I was only half way there, and that was disappointing. This time, my thought was, "I'm half way there and I'm not dead yet."

At 12 miles, a song came on my iPod that was most timely. "Everlasting God," by Lincoln Brewster, came on with "Strength will rise as we wait upon the Lord," and "You lift us up on wings like eagles," and finishing with a child reading Isaiah 40:28-31, which concludes with "...those who wait on the Lord will find new strength. The will fly high on wings like eagles. They will run and not grow weary. They will walk and not faint."

Now THAT's a runner's high.

Crossing the finish line is always a high, and this time, I didn't feel like I had to walk across the line. I stopped as soon as I could, and texted everyone in my family that I was all done. In every way. This year, the organizers had Mylar blankets for the runners, and I was surprised how good it felt to be that warm.

Last night, Denise and Michael and I went to see "The Book of Eli," with Denzel Washington. It's an interesting movie, with some theological overtones. Mostly what Hollywood thinks that Christians believe. Anyhow, I stood up after being seated for quite a while, and I was not sure my legs would hold me up. It's an odd feeling, and I was glad for the handrail in the aisle of the CineCapri.

Today, the thighs are pretty sore. I guess I'll start running again in a week or so, but for now, I'll just bask in the joy of having finished the race, again.

Labor Day Weekend Notes

It's Saturday in Prescott, and we are sitting here, inside, with rain pouring down. With coffee. It's a good day. I hope that your weekend is as good as mine has been so far.

August has come and gone without a health care reform bill. Mostly, that's a good thing. The bills that have been floating through Congress have been monstrosities, keeping all the bad parts of our current system while adding more bad things on top. The demagoguery on both ends of the political spectrum continues to be nauseating, but then that has not changed for at least my lifetime.

My academy, the American Academy of Family Physicians, supports reform that would insure everyone, but I think most of us remain skeptical about the federal bureaucracy doing a better job than private industry has done. An editorial by Hugh Hewitt points out that everyone is being asked to sacrifice for a better health system, except for one group: Trial lawyers. One of the huge drivers of health care cost is the tort system, and if Congress and the President were serious about decreasing costs and using that money to cover everyone else, they would address the problem of the costs of liability suits in our country.

I suspect we'll see that problem addressed by our legislators right after a flock of pigs fly over the White House. In formation. Going south for the winter.

In the past few weeks, the incoming head of the Canadian Medical Association has written in the press that their system is woefully inadequate, and cannot continue on its current course. You can read the article about her statements at:

http://www.google.com/hostednews/canadianpress/article/ALeqM5jbjzPEY0Y3bvRD335rGu_Z3KXoQw

She appears in the article to be calling for a private plan alongside the public health system, which I find very interesting. For many years, it has been illegal in Canada for physicians and patients to go outside their public system, so patients have only the American system to get around the waiting times and inefficiencies of their system.

I can't really defend our current system, but when you read in the press about all the bad problems, remember that you need to know the context of the statistics that are used on both sides. Many of them follow the old saw that there are liars, danged liars, and statisticians....

Have a lovely weekend and a marvelous September.

Five More Shopping Months 'Til Christmas...

The month of July is over, and the various other shoes have not yet dropped. No vote, yet, on health care reform in Washington. The bloviators have started telling us family docs that we're going to make more, and the big bad specialists are going to make less. Translation: We'll make less, and they'll make a lot less.

Our various medical societies are signing onto reform with the illusion that they can help shape the legislation by helping to pass it. If history is a faithful guide, then the politicians will use that support until it is too late to reverse the votes, and will then slice those who help them into tiny bits. We never seem to learn.

I have a reform idea in four parts:

1) Make group insurance illegal. The whole concept of employer-based insurance skews the risk in insurance such that it cannot make sense for the whole populace.

2) Use community pricing. By setting fees and prices for insurance locally, there will be local control and local factors that cannot be managed efficiently from Washington.

3) No refusal for pre-existing conditions. This must be done in order to cover the whole public, but it must be combined with:

4) Mandatory purchase. Everyone must buy insurance, no matter what their situation or reasons for not wanting to do so. This spreads the risk over the whole public, not just those who are healthy enough to buy private insurance.

If my program were adopted, it would require no new government programs, other than using part of the IRS to monitor insurance purchase, and possibly a system to help those who really, really can't afford the insurance. Maybe their 'earned income credit' could go to insurers instead of to the individual, to buy a catastrophic coverage insurance at low cost.

Anyhow, I don't have any illusions that reasonable change will occur. Such is my faith in the United States Congress.

Be well, and stay cool....

Late June Musings

Several topics, medical and not, come to mind on the evening of Fathers' Day. First, it was a marvelous day that ended with all my kids and grandkids at the house for a cookout and croquet. They have all left, now, and my hearing may return to normal someday soon. I feel truly blessed to have all of them living close, and willing to come over to humor their dad and granddad.

Second, I think the adults in Washington are awakening and realizing that you can't just say, "Shazamm!" and fix the American medical system. George Will wrote a good column that points out many people who don't have insurance get it within six months or so, and that many choose not to buy insurance when they have both the right and the income to do so. In fact, millions who qualify for Medicaid (AHCCCS in Arizona) don't even sign up, when it would cost them nothing for the privilege. The cost for the program that has been advanced by our President is so large that terms used for it (astonomical, astonishing, gigantic, mind-blowing) seem small and inadequate. I'm concerned that the damage to our medical system if it is adopted would be permanent, without any hope of regaining what we have now.

Third, just for fun, the books I'm reading or that I've read recently:

The Omnivore's Dilemma, by Michael Pollan. The author follows industrial food production, along with 'organic' foods of various types, ending with an exercise in hunting and gathering. I found it delightful, and for the first time in my life have purchased some foods labeled 'organic,' with some understanding of what that means.

unChristian: What a New Generation Thinks about Christianity...and Why It Matters by David Kinnaman. This is a wake-up call for anyone who is part of the established church in America, no matter which denomination or lack thereof he or she belongs to.

Why Evolution is True by Jerry Coyne. The author is a professor of evolutionary genetics, and his is a description of the facts supporting evolution. Whether one believes that evolution happens or not, this is a must-read for those who want to be well-informed on the topic. I think we need to still the rhetoric on this subject, which unnecessarily pits scientists against theologians, when the two sides can be so easily reconciled.

An Inconvenient Book by Glenn Beck. Light reading that is somewhat politically incorrect and definitely from the right side of the political spectrum.

ReThink Your Life by Stan Toler. This is a "mind diet" that can lead a person to deeper understanding of him/herself in the spiritual realm.

William Shakespeare, a Compact Documentary Life by Samuel Schoenbaum. This was just loaned to me by a friend, who promised that it was the definitive work on whether Shakespeare really wrote the plays and sonnets attributed to him.

This list does not include any popular popcorn novels currently in my possession, and there may be others I've forgotten. I'm also getting ready to start The Tipping Point, Malcolm Gladwell's first book. I've already read Blink and Outsiders by the same author, and I heartily recommend anything he writes, past or future.

Well, now I'm ready to start another week, so off to the races. Be well.

Insurance and Medicine for the Future

So far, we don't have much detail about the plans for changing our medical (health care) system. From the liberal side of political discourse, we keep hearing how horrible everything is, and how difficult it will be to make changes, and all of us will have to give up something to make the system work. From the conservative side, we hear how bad socialized medicine will be, that the government-run medical system will be hopelessly expensive and inefficient and that people will die from the reduction in care.

Here's what I know: so far, when the feds say that are going to do something, the result is quite often the opposite of the published purpose, and that they are pretty bad at creating anything of value in our society. When they talk about tinkering with the medical system, I shudder, because they can do so much harm in such a short time. The medical systems in Europe largely act under a socialistic framework, and they make decisions that we in the U. S. find repugnant. For instance, years ago in Great Britain, if a person was over 65 years of age, they could not have cardiac bypass surgery. They were old, the thinking went, and so should go ahead and die. As I understand it, the policy changed eventually, but that sort of mindset would never have made it to the starting point in policy-making for American insurance systems.

I really expect not much to change, because there are powerful forces aligned against such change. Large employers don't want people to be able to get insurance outside their employ, as that lessens their hold on good workers. The insurance industry doesn't want change, as their profits are likely to drop, or they might cease to exist entirely if the feds take over. The pharmaceutical industry does not want change of any sort, because all the plans discussed so far involve reducing cost of medications, and choices of medicines to take. The government is not likely to allow real change because, like it or not, many of the lawmakers owe too much in favors for the support of insurers and drug companies, so even if our president wants change, there will likely be extreme opposition to that change.

If we could just see some real discussions about this without politicians trying to demagogue the issues for their own personal benefit, then I think we could see real change. But we're kept in the dark with pseudofacts and hyperbole, designed to scare people into accepting laws and policies they would never allow if they knew what was really in them. I just hope that we physicians will be able to continue to keep our offices open and to see patients without the feds or insurers getting in the way too much.