Family Medicine Revolution: The Fire Within (in 3 Chapters)

Escape Fire

If you like movies that tell a good story and you give a damn about the future of the U.S. health care system, I recommend carving out 90 minutes from the tyranny of urgency otherwise known as your life to watch “Escape Fire”. You have the option of watching it at your local movie theater or you could do what I did which was to rent it online and watch it whilst en route to this week’s hot, wonkfest otherwise known as the AAFP Congress of Delegates in Philadelphia, PA.

The movie derives its title from the story of Wagner Dodge, a mid-20th century fire fighter, and his crew who found themselves in the path of a rapidly moving wildfire. Realizing that outrunning the wildfire was not humanly possible, this fire fighter reasoned that if he lit a fire around him thereby consuming the fuel around him in advance of the wildfire’s arrival, he might just survive. He tried to convince his crew to light such an escape fire but to no avail, as they would not listen to his logical argument. No one except the fire fighter who lit an escape fire lived another day. The answer was right under his feet.

The solutions to transforming our broken, fragmented U.S. health care system, likewise, are right under our collective feet. With health care costs rising unsustainably, threatening our nation’s economic growth, we must light the health care system’s escape fire. The movie’s first half focuses on how our health care system is, in fact, a sick care system at best and intertwines compelling patient stories with testimonials from voices such as Dr. Donald Berwick (former CMS Director), Sharon Brownlee (health care journalist), and General David Fridovich (Deputy Commander of the U.S. Special Forces). As geeked as I was to hear what Dr. Berwick had to say, I was more pleased to see how open the military health care system was in sharing their struggles, particularly on how soldiers were systematically being over-prescribed pain medications while in the field and upon their return home.

The second half of the movie focuses on potential solutions or escape fires. As a #FMRevolution-ary, I was naturally eager to hear what would be proposed. The movie focuses on three solutions: primary care, enhanced focus on wellness and health, and shifting the perverse economic incentives to deliver volume over value.

Our health care system does not value primary care. Imagine if every patient had a doctor to whom they could entrust not only the management of their medical conditions but more importantly, their health and wellness. The movie nearly implies that if this goal were achieved, patients would have a real opportunity to focus beyond treating their illness. The narrative of a family physician in the Pacific Northwest who changes jobs from a volume-based community health center to one that allows her to more value-based care is used to make this implication. The threat of returning to a volume-based system looms ominously when her new clinic is faced with pending cuts to Medicare and Medicaid.

The movie then meets with Safeway and Dean Ornish. Safeway has a robust employee health program that has single-handedly reduced obesity rates, increased smoking cessation rates among tobacco users, and improved employee morale whilst keeping their health care costs flat. There were remarkable individual testimonials of Safeway employees who fully participated losing significant weight and transformed the quality of their lives.

Dean Ornish, an UCSF preventive cardiologist, is a pioneer in demonstrating that healthy food choices and regular physical activity have a significant impact on health outcomes at lower cost. He and his colleagues have been able to show this for a number of chronic conditions (coronary artery disease), low-grade (prostate) cancers, and even have the power to increase telomere length in our genes. After lobbying Congress for nearly 20 years, he was successful in allowing Medicare payments for preventive health programs such as his.

The movie concludes with the salient argument that because of the vast amounts of lobbying money and power, changing the vector of the health care system will seem virtually impossible. Just as the 19th century fire fighter faced a seemingly impossible situation with the rapidly approaching wildfire, however, we have the ability and the obligation to light escape fires to transform health care to become more centered on patients, primary care and wellness.

Indeed, this is the reason why Family Medicine Revolution lives on. Wherever you are and whoever you are, you have the ability and the obligation to light an escape fire in your local health care market. Trust your intuition and save yourself so that we can save the system together. Let us continue to call for change and keep our leaders accountable. Even better, let us become the leaders of health care transformation. If you’re not at the table, you’re on the menu. Likewise, if you’re not the driver, prepare to get run over.

Viva la #FMRevolution! #PatientsFirst

In the second blog post for The Fire Within, I will make the argument that #FMRevolution is catching fire and will continue to burn brightly.

Author: Jay Lee, MD, MPH

Jay W. Lee, MD, MPH, FAAFP, is Associate Medical Director of Practice Transformation at MemorialCare Medical Group and Assistant Program Director/Director of Health Policy at the Long Beach Memorial Family Medicine Residency Program. He is also Speaker on the California Academy of Family Physicians' Board of Directors.

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