Proceedings of the 25th National Conference Stephens Tribute (Pugno, Mills Questions and Comments)

Last Updated on April 16, 2022 by Lee Burnett, DO, FAAFP

We gratefully acknowledge the sponsorship of the Penn State University Hershey Medical Center Department of Family Medicine for funding the transcription and editing of this section of the Proceedings of the Twenty-Fifth National Conference:

This section follows: Proceedings of the 25th National Conference – G. Gayle Stephens Tribute (Frey, Geyman)

The designated lead questioner for the morning’s Stephen Tribute is Doctor Perry A. Pugno of the American Academy of Family Physicians, Leawood, Kansas. [Doctor Pugne is a Senior Fellow of the National Conferences on Primary Health Care Access]:

Dr Pugno: Thank you for those comments.

I was charged with the responsibility of asking the first question; and it says questions and comments. So I’m going to ask a question and make a comment. My question actually goes to Rick.

Rick, I personally would like to hear a whole lot more about what you found out about Dr. Stephens. And I’d ask if you would permit the Coastal Research Group to put your presentation in its entirety, text and slides, on the website so that we could all benefit from that. So that’s my question.

My comment is, notice the language we’re using, we talk about relationships, personal physicians. We really are the specialty that puts the patient at the center.

And John you were just talking about the need to make the patient the center of our efforts. We deal with them one at a time in a personal relationship, but within the context of the big picture. We’ve been really fortunate as a discipline to have leadership that is truly visionary and – not just visionary – but who give us the blueprint for how to get to that vision.

I’m going to reflect a piece of memory here. Back when dinosaurs walked the Earth and I was a medical student, there was a new faculty member, who I won’t disclose, but his initials were John Geyman, who was assigned to a medical student, me, to counsel my career.

He asked me what I was planning to do with my career. At that point I probably muttered something about anesthesia, pulmonary medicine, something like that. And he looked me right in the eye and said “Perry; you’re going to end up in medical education; family medicine education”. I told him he was crazy. Our visionaries are truly visionaries.

Walter Mills, MD, UC San Francisco/Natividad Medical Center, Salinas, California [Dr Mills is the 2014 Perry A. Pugno National Conference Scholar]: This will be my christening here. Walt Mills, I’m at UCSF Natividad.

John, it’s nice to be with you in person. Rick Flinders has told me about you for a long time and others of you in this family of family physicians.

At this particular inflection point as we think about the Future of Family Medicine 2.0, I was struck by the physician as healer as one of the areas that you quoted.

And I just wonder, Perry, at all, is there a little window in here where we can get a little more radical about talking about whole patient care or whatever our tenets are that we have talked abou todayt. We are the specialty that has dedicated itself to being true healers.

Do you have any thoughts about the opportunities for differentiating ourselves for the people that we serve on this higher level,

John Geyman, MD:  Well, my first comment is that we all have the same good intentions, but we haven’t talked much this morning yet, about the fact that most physicians are employed by hospital systems and some by insurers, and they’re under pressure by the bean counters to see X number of patients per hour..

More and more all the ideals that we represent in this room are impossible, and this is true of all time-intensive specialties like family medicine, like geriatrics, like psychiatry.

In psychiatry now, 90% of practicing psychiatrists spend 12 minutes per patient. They’re doing medicine checks. The person in psychiatry we earlier times has gone away. Moreover, most psychiatrists see the easy stuff and stay away from psychosis and bipolars and this and that.

This is a trend across all of the medical professions. We’ve been tweaking the system trying to change the delivery system in different ways.

One thing we’ve learned is I think, I’ll say on Wednesday, is you can’t reform this delivery system as long as it’s “for-profit” and an open deal, and as long as you don’t change the financing system.

So we’ve got to get a broader gauge as Gayle Stephensl would say. We’ve got to commit ourselves. We’ve got to learn enough about what the options are and then pursue them and lead others.

If you’re talking about radical solutions and you’re talking about radicalism, you’re talking to the right guys up here, ok. The problem is how do you operationalize the radical change? I think that’s the issue.

Sometimes we talk about radical change in abstract ways. When we get down to the nitty gritty of how do we make it happen, then we begin to back away. So I think what we need to do, and what I think Dr. Stephens would say if he were here, is let’s not just think about or conceptualize the radical change; we have to actively look for ways to implement it. We have to operationalize it.

Dr Clasen, Wright State University, Dayton, Ohio (Moderator): Thank you, Doctors Flinders, Frey and Geyman. We’ll move on to our first Thought Provocateur Session of the 26th National Conference.

This section is followed by: Proceedings of the 25th National Conference – Thought Provocateur #1(McCanne) “What to Expect: the PPACA’s Promises Unkept”.