I could say the cliche\’ things about it seeming like yesterday, yet like it has been forever since I worked anywhere else. I guess I just did…so there’s that. But more to the point is the reality that I actually survived. Many expressed confidence in me when I started doing this, while many others expressed supreme skepticism over whether or not this type of practice could actually work. To both of those groups of people I say: keep waiting to make your final judgment. The practice, while profitable and now growing steadily, is still not near to the point I need it to be. It’s heading in that direction, but there are no guarantees; I still could mess this thing up.
It\’s been two years since I first started my new practice. I have successfully avoided driving my business into the ground because I am a dumb-ass doctor. Don\’t get me wrong: I am not a dumb-ass when it comes to being a doctor. I am pretty comfortable on that, but the future will hold many opportunities to change that verdict. No, I am talking about being a dumb-ass running the business because I am a doctor.
Yeah, I am still here. Sorry I left you with Bob the Llamaturkey as my last post to see. That is very thoughtless of me.
Many who have been reading my blog adventure as I build my new practice have noted a bit of a down mood in my writing. Yes, that has been there (not Bob the Llamaturkey, other stuff). The past two years have been quite a but more than I expected. They have definitely been more rewarding and fulfilling than I could have hoped, but they have also been far more anxiety provoking and exhausting than my worries could have conjured. The medical side of things has been wonderful, but the burden of starting a business from scratch is heavy.
Hence the absence of recent blog posts.
Why do patients feel like they are treated like cows, not humans? Why does our system produce more sick people getting more procedures? Why are things so different for the patients in my new practice? It all comes down to one thing: the basic financial transaction of the healthcare system. From it flow all of the bad things doctors and patients experience. From my rejection of it flow all of the wonderful changes to the care I can now give. There is no meaningful reform that can happen without changing this basic transaction.
A local business that does MRI scans is doing a promotion on their Facebook page, asking people to nominate their doctor as the \”Best Doctor\” (in celebration of \”Doctors\’ Day\”, which is Sunday). So yesterday I put this up on my Facebook page: Hephzibah, by the way, is a working-class part of greater Augusta, where …
A year ago today I was excited, nervous, and totally clueless about the road that lay ahead. A year later I am still excited, less nervous, and OK with my cluelessness about the future. My job is to work on the stuff I\’ve got in front of me now, leaving the future to open up as I make this new land a home for me and my patients.
At the beginning of 2013 I stared into the great unknown of this new practice. I had no idea which plans would succeed and which were foolish dreams. The road was much more difficult than I expected, but also much more satisfying. I spent much of my time learning what doesn\’t work, but in the end learned that most good ideas grow out of the remains of a hundred bad ones that didn\’t survive.
To what end?
Those three words have become something of a mantra, a mission, a philosophy of care.
- To what end do I prescribe a medication?
- To what end do I make a diagnosis?
- To what end do I order tests?
- To what end am I documenting?
- To what end is there a patient record?
- To what end do I send a person to a specialist?
- To what end do patients need to come to see me in the office?
- To what end do my patients have me as a doctor?