1. Philadelphia: Cradle of Liberty

2. WELCOME THE DRAGON: Opening the Heart of Balint William L. Miller, MD, MA Lehigh Valley Health Network The 17 th International Balint Congress Philadelphia, PA September 8, 2011

3. Ranier Maria Rilke

4. A CASE

5. Who is the doctor? Where is the patient in Balint? Where is the illness located?

7. Change & Transformation Established Traditional Practice Critical Mass of Patients, Clinical Processes, & Staff Practice Redesign Space & Office Design Access Design Technology Design Visit Types Financial Models Identity Shift TeamsProactive, Planned Care Paradigm Shift Patient- Centered Care Accountable Population- Based Care Whole Person Holistic & Comprehensive Care Care Process Design Citizen of Medical Neighborhood Web Portal Shared Record PCMH

8. Who Is the Doctor?

9. Dragon Slayers?

10. Observation I ntervention DOPC STEP-UP IMPACT D irect O bservation of Primary C are (1994-97) S tudy T o E nhance P revention by U nderstanding P ractice (1996-2000) Insights from Multimethod Practice Assessment of Change over Time (2001-2004) P&CD P revention & Competing D emands in P rimary C are (1996-99) ULTRA Using Learning Teams for Reflective Adaptation (2002-07) NDP National Demonstration Project (2006-08) Cross-Disciplinary Literature CQI EPOCH EPIC SCOPE NRN-D

11. Lessons About Docs Surprising emotional reactivity & abrasiveness of docs Monumental power difference between doc and receptionist Surprising lack of self-care skills among docs Surprising lack of communication between docs Most practices want to improve, but few want to change Docs prefer hearing what to do rather than learning

12. A Transformed Physician Team-based Care Collaborative Care Facilitative Leadership Population Management Multiple “Channels” of Care Patient Partnership Transparency of Care Time for a Good Drink!

13. Where Is the Patient in Balint?

14. Patient Experience of Care Got Worse

16. Where Is the Illness Located?

17. Health Care Spending per capita ($US Purchasing Power Parity) 2008 OECD Data United States $7538 Germany $3737 Organization for Economic Cooperation and Development: Health at a Glance 2010 http://www.oecd.org/document/16/0,3343,en_2649_34631_2085200_1_1_1_1,00.html http://www.oecd.org/document/16/0,3343,en_2649_34631_2085200_1_1_1_1,00.html

19. Tomorrow’s Balint?

20. Welcoming the Dragon!

22. A Case Revisited

24. Ranier Maria Rilke