Norman Sharrer Symposium

2014 Norman Sharrer Symposium

Each year, the Norman Sharrer Symposium is aimed at practicing physicians, and nurses, but this year's topic is of interest to the community at large:

Slow Medicine and the Efficiency of Inefficiency

  Join us for an evening with Dr. Victoria Sweet, author of the prize-winning book God's Hotel; a Doctor, a Hospital, and a Pilgrimage to the Heart of Medicine.


Time: 6 p.m.
Date: Thursday, Oct. 16 
Place: Visalia Fox Theatre, 308 W. Main St.
Cost: Free

For more information on this event, click HERE.

You Asked - We Answered

We offered Norman Sharrer Symposium attendees the change to ask a panel of speakers a question.  Please take a look at the questions asked and the answers to them.

The following questions were answered by Bill Winn, following the 33rd annual Norman Sharrer Symposium.

Question: Since our medical system is very money-driven (more tests = more income) how do we do slow medicine in this system? (But let’s do it!)
Answer: Ordering “more tests” probably does not increase physician income but does increase the money spent on “health care.” If we voted to limit the spending on healthcare fewer tests would be ordered. There would then be smaller laboratories and less available MRIs and CT scans. Would the public accept this? It is “hell to pay” if an important diagnosis is missed. This is mostly mission impossible at this time as we all seem to want everything when we are sick.

Question: How do you prevent veterans from being targeted with SSRI drugs that leave them damaged with taroive-dyskenesia and permanent nerve damage/memory loss?
Answer: SSRI drugs such as Prozac do not cause tardive dyskinesia. Certain other drugs – older anti psychotics do however. Anti-psychotics are used to stop hallucinations and control self-destructive behavior.

Question: Spill the beans! How do you make the electronic medical records process more efficient? I want my time back.
Answer: Dr. Sweet is more optimistic than I am (tongue in cheek). How about an executive order that all computer software has to talk to each other? As a physician I do spend more time on the computer documenting storytelling, etc. then I spend with my patients. I have to do this to be paid and to maintain my hospital privileges. I am most efficient at the Samaritan Clinic where I am still free to hand write.

Question: I noticed the data on your opening slide, in particular the year. It read 1014 rather than 2014; is there deeper meaning to this or is this simply an oversight?
Answer: I missed that date. Part of the talk did go back 1,000 years to the time of Hildegard of Bingen - the “physician” for her abbey.

Question: Would changing medical malpractice claims recovery to a system comparable to industrial accident claims now handled as workers comp?
Answer: This cannot happen in the U.S. Doctors or course do worry constantly about being sued and practice “defensive medicine.” In Great Britain (UK) I believe that the party bringing suit must pay to do so. Arbitration proceedings might be another way to go. In our coming election in November, the voters get to decide (Prop 46) whether or not to increase awards to plantiffs which will increase costs more.

Question: Can you explain what a concierge practice would look like? Or, where can we get more information?
Answer: The doctor who practices this way no longer takes your insurance. If you go to the hospital you are cared for by other hospital doctors. The concierge doctor otherwise is constantly available to you by phone, internet, his/her office and may make house calls. You pay flat rate for this $1,500 to $3,000 per year to the doctor. Concierge doctors work in wealthier areas such as the bay area. I don’t know of any in Visalia.

Question: Can you illustrate any instances where fast medicine might be superior?
Answer: It is always superior when you are very sick such as in need of surgery, heart attack, bleeding – anything immediately life threatening.

Question: Couldn’t we separate medical words from billing words?
Answer: This is possible only in fully socialized medicine such as in the U.K. They pretty much are – but in the U.S. system complete separation is not possible. Billing services for offices business services do billing. Business services for hospitals do billing. These services submit code numbers to the payors (insurance companies). Sometimes the payors will review the medical records to be sure they are not being “cheated.” We have to give our insurance companies permission to review our records.

Question: In our area we have a large population with metabolic syndrome. How could your model of medicine help them?
Answer: The obesity epidemic is all over the U.S. “Slow medicine” should provide more time for education re: diet and exercise. This is better than nothing, but by itself cannot correct this problem which ironically affects the poor more than those better off.

Question: Tell us more about a concierge practice for the sick poor.
Answer: Dr. Sweet proposed a test of 20 patients (poor) who would receive concierge care. Their medical outcomes would be compared with others not receiving such care. She is guessing that 40% would be saved so medical etc. might offer this option in “slow medicine clinics.”

Question: Does slow medicine have anything to offer?
Answer: An example here would be to take extra time to refer the patient for liver transplantation when necessary – it takes a great deal of time to do something like this. The slow medicine approach might also help with difficult earlier interventions such as cessation of alcohol use or treatment of hepatitis C.

Question: Is medicine working or systematizing the use of the placebo effect/the mind, body-attitude effect? To really understand it as a component of healing since we are not purely physical, but mentally emotional-relational beings.
Answer: Placebo pills do help relieve symptoms in randomized drug studies. They are now considered unethical for a doctor to prescribe as deceit is involved. Serious illnesses should be treated with drugs known to be effective. Alternative approaches which are also helpful are often complementary.