Richard W. Biek, MD, MPH, Chief Consultant, Biek Public Health Consulting, LLC, (Bio below) is a past Board Member and a member for over 40 years. He shares the following wisdom See http://aaphp.org/PositiveHealth for a basic brief summary of questions.
Do less harm is an excellent goal. The Hippocratic Oath includes abstain from doing harm ... and primum non nocere, i.e., first, do no harm, was introduced in America and UK medicine by Worthington Hooker in his 1847 book Physician and Patient -- attributing to teaching by Auguste François Chomel (1788–1858), successor of Läennec and preceptor of Pierre Louis.
The simplest way to determine if I do harm or good (as a physician) is to ask the world's greatest experts on life and health -- my patients themselves -- in less than a minute -- at the beginning and end of a visit, (most important) in 10 days, and if able, 6 months later -- to tell me how happy, healthy, and satisfied with life they are now, using the simplest 5- point scale: 1 = very unhappy, 2 = somewhat unhappy, 3 = not sure or no answer, 4 = somewhat happy, 5 = very happy. Score healthy and satisfied the same, but record only the total, ranging from 3 to 15. Those at or near 3 may need immediate professional help to avert serious danger. At or near 15 may indicate excellent wellness. If the score rises, we may be on a good path. If it falls, we may be doing harm. Real life choices and results lead us step by step to make the best use of what we've got.
I've found positive health promotion gets the best reported wellness scores for nonurgent care -- simply ask patients in a few minutes to write down (for confidential personal use -- I do not look at the list) all the good that spontaneously and readily comes to mind that they ever experienced or observed. If pausing more than a couple minutes, I ask them to select the best one so far and consider inwardly how to take the greatest possible advantage of it for the greatest possible good right now, and keep adding to the list, to use first when in difficulty.No need to seek other help if what's needed's already listed
Then I ask them to focus on their #1 concern, or if #1 does not come to mind, choose any concern, relax, close eyes, imagine a neon sign of word or two about that concern, continue to focus only on that sign, expect to receive spontaneous suggestions of the next step to take for that concern, say key words aloud, so I can list them, and they won't have to try to remember them.
When suggestions stop coming, ask to point to the best one listed. No matter how long the list, they do so instantly. Asked why that one, they give no rationale except it's obvious. I ask if it seems worth doing considering other priorities. They say it is. I ask if they know exactly what to do. They say yes. I ask to let me know how well it works, and get up to leave.
They ask if I have any advice before I go. I say all advice is detrimental. Good advice creates dependency -- next time in trouble, they ask for more advice. I'd live their life for them. If advice fails, they'd be angry at me, especially if it took much time, effort, and money. All advice stinks the same, takes responsibility from patient, and places it on doctor. They'll learn more from real life what works and what doesn't, by taking one best step after another.
When it works, enjoy. When it doesn't, it's almost always better, because at the first sense of failure, the step that should have been taken comes to mind, and when taken, usually seems far too good to be true.
My patients say that's what's hardest to face -- it shakes them up -- takes extra effort and time to accept great goodness and truth. But they can hardly wait to find and take the most promising next step to discover, develop and apply their vast hidden potential to do good.
Roughly, of those (not urgently) ill or injured, 85% who get health care, 90% who don't, and 95% who learn how and take very good care of themselves will get better. All health, social, and other services that raise average reported total wellness scores should be expanded within reason. All that don't change average scores should be improved until they do, or direct their time, effort, and spending to more beneficial services. All with lower average scores should be stopped immediately, regardless of profit, popularity, political advantage, and even compassionate intention. Why keep doing harm when clearly documented by the world's greatest experts?
At any moment, we have only 3 choices: do good, do harm, or waste time. Choose to do good, and virtually everything seems to work together for success, if not on the first step, on the second and even better one. Good intentions, even when compassionate, are not enough. Good outcomes should to be confirmed. So learning in real life one little best step after another, we can handle lesser shocks, integrate them, wise up, and keep doing ever better.
The best part about each using one's own unique, possibly infinite, possibly eternal potential is that no one else can do what only each of us can do when we find and use our own potential. If we don't, it remains unused. And if we do use it, we do not encroach on anyone else. And it could well be the greatest possible good that we each can do now and maybe forever. The greatest possible harm we can do may be to squelch anyone's discovery, development, and making the most promising use of his/her hidden potential.
Dr. Biek's Biography -
1951 Commissioned as Missionary by United Church Board for World Ministries
1953 BA cum laude U of Dubuque with Majors in English & Chemistry
1957 MD U of Illinois - Chicago, School of Medicine
1958 Rotating General Internship, Wisconsin General Hospital, UW, Madison
1958-1969 Medical Superintendent, Evangelical Presbyterian Church Hospital, Worawora, Ghana
1969-1972 Public Health residency, Wisconsin Division of Health (Madison)
1969 MPH U of Minnesota
1969 Board Certified in Public Health and Preventive Medicine
1969-1996 Public health administration in State of Wisconsin Division of Health & City of Milwaukee, WI, in City of Chicago (Chief Medical Officer) & Cook County, IL, and City of St. Louis, MO
1972 Fellow, American College of Preventive Medicine
1988-1992 Lieutenant Colonel, Senior Medical Officer, 33rd Infantry Brigade, Illinois Army National Guard
1988 Army Medical Readiness Training Exercise (MEDRETE) in Bolivia
1991 Army MEDRETE in Guatemala
1991 Army Achievement Medal
Memberships: AMA, Chicago Medical Society, AAPHP, Assoc. of Military Surgeons of the United States, Reserve Officers Association
Dr. Biek can be reached at 817 E Moorhead Cir Apt A, Boulder, CO 80305-6122, Tel 720-763-9387, Cell 608-695-1931, Fax 303-494-2140. To read more continue on:
Richard Biek went into medicine to do the greatest possible good.
1958-1969 Served in Evangelical Presbyterian Church Hospital, Worawora, Buem-Krachi District, Volta Region, Ghana, often as the only surgeon for 22,000 population, saved many lives with urgent care, but total deaths did not decrease the first 3 years.
1961 Studied epidemiology and public health administration.
1962 Applied this knowledge in Ghana and brought #1 cause of death in EPC Hospital -- post-measles diarrhea in children age 2&3 -- down from 264 to 24 a year, before vaccine was available, by getting Queen Mother to ask women to feed 2&3 year olds an egg every Sunday.
1969 Returned to Wisconsin, formed a committee to promote measles vaccine as soon as it was available, and we were the first of 50 states to eliminate indigenous measles.
1979 Teaching sophomores in Medical College of Wisconsin -- who got very angry when hearing more deaths caused than lives saved by medicine and surgery. Was stunned, and asked Professor Sidney Shindell, Head of Dept. of Prev. Med. if medical and surgical diagnosis and treatment ever improved the health of any population on Earth. He said no. Seeing a doctor, 85% get better. Not seeing a doctor, 90% get better. Whenever doctors go on strike, deaths drop and stay down till strike ends. Civilian deaths in Europe in WW II were down 20% when virtually all doctors were drafted. When they returned at war's end, deaths increased 25%, back to where they were before the war. I asked him how he could teach students to practice medicine if they kill more than they save. He said he teaches them to deal with the concerns of patients as best they can.
1980 Decided to do exact opposite of what other doctors do. Instead of patients coming to see me, I went to see them. I'd tell them each is the world's greatest expert on one's own life and health -- know at least a million times more than any other expert could ever know about one's own well-being.
All were followed for at least 6 months, and reported rising wellness scores. When asked if they consulted anyone else, they all say no, they do this all by themselves. Those with no self confidence, some virtually living in the gutter, suddenly gain it, and make surprising use of it.
1983 Always billing insurance companies, never getting paid, got a check and letter from Wisconsin Blue Cross/Blue Shield saying they don't pay for what I do, but those who call me their doctor used to cost $thousands every year, now cost nothing! So the check was to thank me. I offered to visit insured with large bills, but they were not interested. In fact, only one person was interested in doing what I do in all the years 1980 to present. I still make home visits with the same excellent outcomes.