Destination Unknown

I cleaned out my office yesterday.  I gathered up the outdated pictures of my family, handwritten notes from my children when they were much younger, pictures of patients, notes from patients, and the knick knacks that accumulate over 18 years of being in one place.  Most of them were dusty or worn with the tarnish of time; things that sit in the office unnoticed until a moment like this.
I also went through the files of old information – information I seldom if ever used – detailing the financial struggles it took to build a successful practice.  Here\’s what we collected in 1998.  Here are the notes from an office administration meeting in 2002.  Here are handwritten flow diagrams I made to figure out a way to improve workflow.  Here\’s a list of patients from 2000 who were eligible flu shots with a sticky note affixed to the folder saying: \”give to Angie.\”  I\’m not sure I ever gave it to her.

The majority of paper, however, was spent on spreadsheets.  There are spreadsheets of productivity, of income, of expenses, projected income, effects of adding new partners, of quality measures and of the ever ominous accounts receivable.  These are numbers my distractible brain always had difficulty wrapping around, yet they stand as a testament to the myriad of details that work in the background of life.  They mean even less to me now than they once did, like the dates on gravestones for people long forgotten, yet their existence reminds me that these days were not the dusty pictures sitting on the shelves of my memory; they were days of many small details and struggles.  Life looks like a movie from the outside, but its reality is found in the spreadsheets it leaves behind.

As I walked from the office with my boxes I didn\’t feel much regret.  I really don\’t think that I could have survived the body blows our health care \”system\” dishes out on a daily basis.  I am not sad to leave those spreadsheets or administrative meetings behind.  I am not sad to leave the daily calls regarding refills of controlled drugs.  I am not sad to leave the paperwork from companies duping Medicare patients into ordering \”free\” goods they don\’t even need.  I am not sad to leave the feeling at the end of most days that I was running on emotional fumes.  I am sad that I couldn\’t make things work with my partners, but am equally grateful that the situation ended with courtesy and respect coming from both sides.  It could not have worked out better.

The hard part was stepping into my reality this morning: I don\’t know where I am headed.  When I next go to the office to work, where will I be?  Who will be there with me?  What will I be doing?  I have a slurry of ideas that must now crystalize, transforming from hypotheticals to spreadsheets.  I have to find a location for my office, decide on an EMR, hire staff, recruit patients, equip the office, decide what I am going to charge, and produce a product worthy of those charges.  It\’s like I have a plot of land and some ideas in my head, but have to now build the house I will live in.   I am setting out on a journey with an unknown destination, which is the scariest thing.

7 thoughts on “Destination Unknown”

  1. Our thoughts and prayers are with you as make all these decisions, We have faith in you that everything will be much better for you and your patients. Just hang in there everything will work out.

  2. Your ex-partners are in for a worse time than you will ever have. New doors open when you close the door behind you. My advice is forget the past, you now are blessed with season….nature’s way of cleaning out the old, refreshing, and growing new things…

  3. I shared is post with my artist son since I’m hoping you will be my doctor. I got an interesting response that I thought you might appreciate.He said “I think he has more than a bit of the poet/artist in him…from this small sample.”

  4. You are very skilled at working me on this one. That was really a home run if you are trying to get in my good graces! I mean that sincerely. Thank you.

  5. I will agree with you once I am up and running. Before then there is the old proverbs about people holding birds and bushes. I definitely am not longing to go to work tomorrow.

  6. Why do you need an office and staff? Would you be able to accomplish what you have in mind for patient care by phone consults and house calls? I ask because we have a vet with no office. He has a cell phone and a van set up with everything he needs, and is able to charge less than the vets who have an office with all the accompanying overhead costs. It seems like a physician no longer jumping through insurance hoops might be able to do the same thing.

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