Two of the foundational pillars necessary for any long-term relationship are respect and trust.
By Ronnie B. Martin, DO, FACOFP dist.; past president, ACOFP; past president, ACOFP Education & Research Foundation; founding director, IPCEA
To establish these pillars, each participant must be perceived as ethical, honest and—in the scope of the practice of medicine—professional. To be in a business, personal or professional relationship for any length of time demands these principles to be established and dependable. These factors lie at the cornerstones of the partnership developed over the past two decades between the osteopathic physician founders of the International Primary Care Educational Alliance (IPCEA) and the physician leadership of the primary care initiatives of Chengdu and Shenzhen, China.
In 2005, Royce Keilers, DO, FACOFP; William Burke, DO, FACOFP; and I proposed a program designed to develop and deliver a program to retrain specialists as primary care physicians in the Sichuan Province. At the time, there was roughly one primary care physician for every 80,000 patients, and the government put an emphasis on improving this number to reduce hospital spending, improve access and outcomes, and truly build a primary care system. We wanted to support their physicians in learning other ways to care for their patients, not replace their current methods. Knowing that osteopathic principles aligned with their preferred approach to holistic medicine, we believed it was a perfect fit—and that the ACOFP Education and Research Foundation was the perfect sponsor for the program.
As osteopathic family physicians, we know that all great systems are founded on primary care, and we wanted to share this experience with others, so that they may be able to incorporate these practices. Because we approached this program with grace—not insinuating that their current practices were “wrong”—we were met with respect and gratitude, both by patients and fellow physicians. We used similar educational methods to teaching residents in the United States, emphasizing that what we do as physicians is important—but we are not.
We already lived by the mindset “treat the patient, not the disease,” but seeing how we have been able to influence others to handle patient care demands and seeing the difference we could make was inspiring. It renewed our belief that if we could make a difference in such a variant country and system, there remains hope that we can continue to influence the system and make a difference in our own country with our own patients.
With time came more than appreciation from our Chinese counterparts; we developed real, lasting relationships and friendships. It is because of this friendship that I believe Dr. Keilers is still alive.
On one of our trips, Dr. Keilers suffered a non-hemorrhagic stroke while Dr. Burke and I were present. We knew the signs and swiftly took action, stabilizing him and arranging to get him transferred to a hospital and into critical care. The physicians involved in his treatment refused to give up, even driving in the most highly respected interventional radiologist from nearby Guangzhou. After many hours, they were able to remove the obstruction, but I firmly believe that if we had been elsewhere, the outcome may not have been the same. Without that foundation of trust and respect that we had worked so hard to establish, I think they would have given up. Their commitment to treating him was unwavering, and the care he received was outstanding.
The relationships and memories expand past the physicians and healthcare community; we touched the lives of patients, and they touched ours. In 2008, an earthquake struck Sichuan. The IPCEA team was already there, and we volunteered to help. The community was genuinely grateful for our support—we were helping because we could, not because we expected anything in return. The earthquake was a devastating tragedy, but I could feel their gratitude as we assisted them.
The impact the program has had is obvious. There is now one primary care physician for every 40,000–50,000 patients—and that number will continue to improve. They have embraced and advanced osteopathic family medicine and its principles as a model for their country’s primary care system. But even more importantly, IPCEA has impacted us. We already lived by the mindset “treat the patient, not the disease,” but seeing how we have been able to influence others to handle patient care demands and seeing the difference we could make was inspiring. It renewed our belief that if we could make a difference in such a variant country and system, there remains hope that we can continue to influence the system and make a difference in our own country with our own patients.
The article above authored by Dr. Ronnie Martin, was originally published on the ACOFP blog at the link below and is re-published here with permission:
Making a Difference: How Trust and Respect Forged Lasting Relationships and Improved Patient Care