Courage to Heal: A short historical novel on the life of Dr. Sidney Garfield

By Robert L. Moore, MD, MPH, MBA, Chief Medical Officer

“Peak performers see the ability to manage change as a necessity in fulfilling their missions”

–Dr. Sidney Garfield, Founder, Permanente Medical Group

Surgeon Sidney Garfield partnered with industrialist Henry Kaiser to create what was to become the largest integrated health care delivery system in the United States, known for its high quality, its labor-management partnership, and its cost effectiveness.

In the early years, the American Medical Association and the California Medical Association sought to destroy the model and to drive Dr. Garfield out of business; Kaiser Permanente only survived due to the influence of Henry Kaiser.

Courage to Heal, written by journalist Paul Bernstein, gives a good sense of the political and personal forces that came together in the 1930s and 1940s to start the Kaiser health system, while providing a glimpse of the state of medical practice at the time.  The book highlights the skill and courage of Dr. Garfield and others who believed that everyone deserved access to preventive and curative care regardless of their ability to pay, a radical idea at the time.

This is an inspiring tribute to the ideals of medicine as a profession and a system of care.

Bringing the Patient Story Back to the Medical Record

By Robert L. Moore, MD, MPH, MBA, Chief Medical Officer

“A story can put your whole brain to work.”

–Leo Widrich, co-founder, Buffer

Linguists have shown that humans that do not store their thoughts or memories in written form have a remarkable ability to remember and relate long stories orally, from generation to generation.  Even with written language and now audio-visual capture of information, stories are easier to remember than a stream of facts, events or even a theoretical framework.  (The early chapters of Sapiens: A Brief History of Humankind offers a good summary.)

There is a neurologic basis for this.  Streams of facts or ideas mainly stimulate the auditory processing portion of the brain, while stories activate the deep brain structures associated with emotions and long-term memory, as well as various portions of the cortex.  A story puts our whole brain to work.

This may explain why studies of Electronic Health Records that segregate clinical tidbits into different discrete parts of the medical record decrease the ability of a subsequent reader to really understand what was going on with a patient.  The patient story is lost, making the medical record a poor communication tool.

A well written opinion article in the September 1, 2020 Annals of Internal Medicine calls on clinicians to “Restore the Story” in clinical notes.  The American College of Physicians created a “Restoring the Story Task Force” to promote this effort.  The article summarizes the attributes of an ideal clinical note:

“The ideal clinical note is more than a verbatim transcript.  It is a coherent representation of relevant data that have been sifted through and examined in the context of the patient’s life and priorities, yielding an assessment of the situation and rationale for recommended next steps.”

In the electronic health record, the two most important places for telling the story are the history of present illness and the assessment.  Utilizing the free text option in these two locations is essential to achieve this.