Once a week, Beyond Boulders runs a five-question interview with either a current Schweitzer Fellow or a Schweitzer Fellow for Life (ie, a Fellow whose initial year with ASF has been completed, but whose commitment to lifelong service continues).
Today, we talk with 1998-99 Chicago Area Schweitzer Fellow for Life — and 3rd Annual FFL Conference attendee — David Fisher, MD, MPH. Now a practicing family physician with specialty certification in geriatric medicine and hospice/palliative medicine, Fisher continues to work with underserved communities in the US and abroad. He graduated from Rush Medical College in Chicago and completed his Family Medicine residency and Geriatrics fellowship at Wake Forest University in North Carolina. His Master’s in Public Health degree is from the University of Illinois at Chicago. Fisher currently hosts “House Calls,” a weekly radio show aimed at empowering patients to take control of their health care experience.
Why did you develop your particular project?
I assisted the Christian Community Health Center, a not-for-profit health center on Chicago’s South Side, in the development of a tracking tool for patients with diabetes. Chronic disease management was just coming into vogue at the time, and the doctors I worked with were dealing with the exploding epidemic of diabetes, particularly among the African-American population. The tool helped them get a handle on the clinical management of their patients in the midst of a busy office practice.
It also helped the patients take control over their illness. Diabetes can be a devastating diagnosis, but when I explained to the patients that careful management would help them avoid the frightening long-term complications, they were motivated to participate in their own health care.
What was the lasting impact of your project on the community it served?
The Christian Community Health Center continues to serve the community in its same location on South Halsted Street, and still uses a tracking tool for improving the health of patients with diabetes. Similar tracking tools for other chronic diseases were developed, using my tool as a model, and these tools helped ease the transition to an electronic medical record at the health center.
What do you think is the most pressing health-related issue of our time, and how do you think it should be addressed?
I am concerned about what I perceive as the erosion of the patient-physician relationship. Many people attribute the excellence of America’s health care to technologic advances, but I believe what sets American medicine apart is the presence of a trusting relationship between patient and doctor. Our emphasis on patient autonomy, informed consent, and privacy has helped preserve this relationship, but both market and political forces have driven wedges between patients and doctors over the past several decades. I believe this loss of trust has contributed to many of the problems with our health care system.
I believe doctors need to re-establish effective and trustworthy communication with our patients. I believe we need to become experts in talking with the people we treat. Honest and persuasive discussions can have a powerful impact on the direction of our patients’ health, whether it is a heartfelt pep talk on exercising or quitting smoking, a convincing explanation of why a vaccine is beneficial, or an empathetic conversation about goals of care with a family facing a terminal illness. Protocols, pathways, and models of care can have a positive impact on the public’s health, but they still depend on that which is at the heart of medicine: two people, the patient and the clinician, making choices about the best approach to health.
Practically speaking, I hope doctors train themselves in conversing with patients, whether by enrolling in seminars or simply reading some good books or patient-physician communication. I also hope more doctors become familiar with the new forms of communication in our culture, via social media. This is why I have, with some trepidation, entered the world of blogging and “tweeting.” I’ve also started my own radio show here in Chicago and that has been a lot of fun.
What was the most surprising element of your experience as a Schweitzer Fellow?
I was amazed by the embrace I received from the community I worked with. I expected to be viewed with some level of suspicion, as the young and naive medical student entering the “real world” of community health in a medically underserved area. The staff and patients at the health center made me feel right at home, and though I did not feel my contribution had much importance, I was treated with great respect and appreciation. I continue to practice in the same neighborhood, making rounds as a geriatrician in nursing homes that surround the health center where I carried out my fellowship project. It still feels like home.
What does Albert Schweitzer’s legacy mean to you, and how have you carried it with you since your initial year as a Fellow drew to a close?
Albert Schweitzer’s example inspires me in several ways.
He understood that “my life is my argument.” The most effective means for change is to model the change I hope to see take place.
He describes the “affirmation of the will-to-live” as the driving force behind his service to others. This echoes and expounds upon Jesus’ command to “love your neighbor as yourself.” When we ponder our own instinct toward self-preservation, and then translate that to others, as though we should apply that same instinct to their well-being as we do to our own, it gives us a grid in which to move that can only result in active love for our fellow humans.
He traveled to places of suffering. He reminds me that those are the places of value. My work in underserved areas of Chicago, my medical relief trip to Haiti in 2009, and my upcoming trip to Angola, Africa in 2010, are in part inspired by the work of Albert Schweitzer.