Thoughts of an odd, but not harmful primary care physician.
Thoughts of an odd, but not harmful primary care physician.
My blog has been a destination of the most discerning healthcare reader since 2006. Come see my elegant assortment of topics, such as:
One of the big unfortunate things about the medical system is that it turns listening into a rarity. "You are the only doctor who has ever listened to me," I often get told. Really? That's like being told that I am the only chef who has ever cooked food for someone. Isn't listening the essence of care? How could so many people go through our system feeling like they never get listened to? Yet they do. It is incredibly sad. It causes a huge amount of pain. It probably kills a fair number of people.
But if we are rewarding doctors for spending less time with people, what do we expect? If we are making computer time more profitable than patient time, ICD more important than bowel sounds, Medicare compliance more important than the emotional state of the person in the room with you, then it's hard to blame clinicians for ignoring patients. They are just doing what they are told.
But in our practice we live on this little island of sanity in a world where that is scarce. We work in an place where "you're welcome" is said far more than "I'm sorry." Patient wait times only go up when people have the nerve to show up early -- otherwise, we still have an average of around 30 seconds. I still spend an hour with new patients, for them to get to know me and me to get to know them; and they still generally walk away with an amazed expression on their face, having never experienced a good experience at a doctor's office. We still have a steady stream of new patients without doing much at all in the way of marketing. So all's well in Robsville.
This insecurity is the biggest challenge in my practice: getting people to change their behavior. Somehow I have to somehow get people to pay attention to their health when they'd rather ignore it, to be taking medications when they'd rather not, to be exercising when they don't want to, to lose weight when they love cheeseburgers, and to be checking their blood sugars when they'd rather not know how high they are. After trying lots of things over the past 20+ years, the one thing I find almost never works is what is usually done: lecturing the patient.
My hope is that somehow we are able to return to care that is patient-centered. People want their narrative to be a good one, and doctors need to be able to enter that narrative and become a positive influence. Our goal needs to push people out of the medical realm and back to living the rest of their narratives with as little contact with the healthcare system as possible. That's what patient-centered care really is.
If you look up the word "compliance" in a thesaurus, the first synonym (at least in my thesaurus) is "obedience to." This implies that non-compliant patients are, at least to some degree, equivalent to disobedient patients. This is borne out by the reaction many patients seem to expect of me when they "confess" they haven't taken prescribed medications: they look guilty — like they are expecting to be scolded.
Sometimes the best way to say something is to surprise people and make them laugh. The best humor laughs more at itself than at others' expense.
Sometimes my thoughts go deep. Dealing with death and suffering can do that to an already introspective person.
Health care is messed up. Here I give both an insider's (before I started my new practice) and outsider's view of what's wrong.
The drug test came back abnormal. There was THC present. I walked back to Mrs. Johnson and raised my eyebrows.
"What's wrong?" she asked, not used to whatever kind of look I was giving her.
"Uh, you forgot to mention to me that you smoke weed."
She blushed and then smirked. "Well, yes, I guess I forgot to put that down on the sheet. I don't do it real often, but sometimes it takes mind off of things. I just get real anxious about my kids, my husband...and my heart problems. I only smoke one or two a night"
She's not your usual picture of a pot-head. She's in her sixties, has coronary heart disease, irritable bowel, hypertension, is on Medicaid, and is the essential caricature of the the poor white folk who live in the deep south. And she smokes weed.
"I want to tell you my story now," a patient recently told me, a woman who suffers from many physical and emotional ailments. She had the diagnosis of PTSD on her problem list, along with hospitalizations for "stress," but I never asked beyond that.
"OK," I answered, not knowing what to expect. "Tell me your story."
She paused for about 30 seconds, but I knew not to interrupt the silence. "I killed my husband," she finally said.
Howard died on Friday.
Howard was the general surgeon I preferred sending my patients to because he took good care of them. He listened to what they said, he joked around with them, and he took them seriously. He also was famous for wearing tie-died scrubs. This type of care is unfortunately difficult to find from consultants.
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.
I think there is something in us that makes us want to make heroes. This is part of the attraction of sport and other entertainment. We want to see people doing things that are amazing, superhuman, and heroic. As a child, I imagined me hitting the home run in the bottom of the 9th inning, or hitting the basket with no time left on the clock. I imagined the adulation and praise of my skill from the adoring masses. I dreamed of being a hero.
As an incurable compulsive introspect, I tend to brood, ponder, contemplate, and (of course) muse on "big ideas," such as:
Lately I've been contemplating the nature of human awareness:
Yeah, that's a lot deeper than about dogs watching Oprah.
Fortunately for this my patient, I was not only able to reunite him with the joys of sitting, but I was able, with a little research, to find him his proctological savior at a low cost. Unfortunately, most patients don't have docs who are economically incentivized to save them money, and most people don't realize all of the games played by pharmaceutical companies and pharmacies to routinely perform wallet biopsies, nor do they know how to find the cheapest prices for their medications.
I don't know what can be done about this kind of thing aside from increasing awareness. I'm not real confident in any government solution. People just need to be smarter shoppers when it comes to their care. It's just a shame that people who are dealing with health problems (even if it is just trouble sitting) have to outsmart the gaming done by those supposedly trying to help them.
People are quick to accept non-answers from specialists, to be misconstrued by ER doctors, and to spend a week in the hospital without knowing what is going on. Other doctors are far too willing to accept fragmented care, not knowing the context of the current hospitalization or outpatient consultation.
For those still unaware (perhaps looking through catalogs for gigantic inflatables for president's day), ICD-10 is the 10th iteration of the coding taxonomy used for diagnosis in our lovely health care system. This system replaces ICD-9, which one would expect from a numerological standpoint (although the folks at Microsoft jumped from Windows 8 to Windows 10, so anything is possible). This change should be cause for great celebration, as ICD-9 was miserably inconsistent and idiosyncratic, having no codes describing weakness of the arms, while having several for being in a horse-drawn vehicle that was struck by a streetcar. Really.
Until our system can figure out a way to handle this kind of thing, we will pay a big price. Waiting for problems to become emergencies is a terribly expensive practice. I'm not sure I know exactly what needs to be done for this, but it's becoming an increasingly common problem. Some say that a single-payor system will be the remedy, but they ignore the fact that a third-party payor system is what got us in this mess in the first place. Things are far too expensive because patients don't have to pay for them. That's why stress tests, which don't actually cost thousands of dollars to do, are so expensive. That's why there is $100 hemorrhoid cream. That's why medications are unreasonably expensive: someone else pays the bill.
Good news: my local hospital has the fanciest, newest, coolest computer system (costing major bucks, of course) and now is routinely sending me "transition of care" documents on my patients.
Bad news: they are horrible.
Seriously, we get several of these documents per day and often can't figure out what the document is about. On the bright side, sometimes after taking 10-20 minutes of looking through the 12-14 page document, we do actually gain some useful information.
"Best" is a relative term. Perhaps it's like being a tall fetus, or like a small quasar. "Best" of Rob's posts. Yep. Either an oxymoron or a low bar to get over.
One of my most popular Series, the physical exam combines real information with total nonsense with an aim to both educate and totally confuse my readers.
Read what I've written about my new practice here. Follow the story from my days of dissatisfaction in my old practice to the whole process of figuring this new thing out.
I was excited. Finally I could get my questions answered by America's doctor darling. Since I know he's a busy guy, I thought I'd need to get his attention. No, I wasn't interested in the miracle antioxidant pill that detoxes my carotid arteries, reprograms my neuronal circuitry, melts away belly fat, and enhances me in the bedroom. I know about that already. I've seen his show.
No, my questions were far more important
Be Amusing, Not Averse
Be Amusing, Not Averse
Is it a rhyme?
Is it a Llama?
It seems this time
you've found the drama.
A play on words.
Some words at play.
The line gets blurred.
The color's gray.
This blog is meant
for your own writing.
So please invent
some words exciting.
They may not rhyme.
They may be terse.
But be sublime
and write in verse!
I'll publish those
who meet the measure.
I'll share the prose
for all to treasure.
I put this bee
into your bonnet.
Please send to me
your rhyme and sonnet.
So how should you
submit in your best?
Email me here;
I'll do the rest.
You likely are asking: What’s up with this site?
What’s up with the author? His mind is not right.
And what is a Llamarick? A word that’s created
From a creature that’s odd, and a verse often hated?
To answer those questions, to give explanation
Makes an assumption that has no foundation.
Assuming a reason behind their creation
Gives credit to neurons far over their station
No, most of this writing comes right off the cuff
Not from the cerebrum or smarty-pants stuff
While some of the prose may get you to thinking
Most will cause people to ponder more drinking
The gist of this poem and following pages
Is not stuff of wisdom or wit of the ages
I may talk of issues that folks are discussing
I may give opinions Tho' likely no cussing
Some prose may be poignant, some points may provoke
And others may raise the thought: "What did he smoke?"
What you are reading's the thoughts from my brain
Distracted, demented, at times even sane
And if you consider this poem as a test
You may have the stomach to read all the rest
So if you find insights or gems in their rough
I hope that you’ll join me as I write more stuff
And if all these verses do nothing for you
Then I hope a llama will poo on your shoe.
My New Direct Care Practice: Focused on Patients, Not Payers.
My New Direct Care Practice: Focused on Patients, Not Payers.
My new practice is an attempt to go back to where health care should be: between doctor* and patient. Instead of me being paid by insurance companies or government bureaucracies, I work for my patients, because you work for the person paying you. Being paid by third parties meant that they were the one I had to make happy, not the patient. This is why customer service is nonexistent in health care.
I think people should expect more from their doctors. People expect to have to wait when they shouldn't. They expect to have to come in to have questions answered, even if they are simple questions. They expect for care to be complicated when it could be simple. They expect the doctor to be the center of the health care universe, when they, the patients, should be in that position.
My practice operates on 4 main principles:
People shouldn't view health care as something they need to use. Ideally, people would stay away from doctors, off of drugs, and out of hospitals. The problem is that the whole system we have is aimed at the opposite. My practice is different, taking the time to do the things necessary to keep people well.
I answer the phone. I communicate electronically with my patients. I take the time to get to know them. This is a whole lot better than ordering a bunch of tests, and it's quite a bit cheaper. Unfortunately, communication is penalized by the U.S. system. Fortunately for me, my patients are amazed at the difference they see from a doctor who actually listens.
Health care has been turned into a transaction: find problems, treat them with procedures, and get paid for the number of procedures done (the bigger the better). This has yielded the expected outcome: more care than is needed; lots more. Unfortunately, the focus on treating problems gets in the way with the highest goal of medicine: preventing disease in the first place. My focus is far more on risk reduction and quality of life than on finding disease and doing a treatment (often for diseases that aren't high risk and treatments that are).
If my bank told me that the only way I could get my bank records was to pay for them, I'd fire them and get another bank. This is what doctors tell patients all the time. Why? Because records are not for care, they are for showing the problems and procedures necessary to get paid. I think records should be entirely focused on patient care, not on billing. I think patients are best served to have access to all of their records, especially in this age of mobile computing.M
If you want to see more about my practice, go to my practice website: doctorlamberts.org.
*Obviously, this includes nurses, PA's, NP's, social workers, dietitians, physical therapists, and all of the other members of the health care team. I write the orders as a physician, but care is best done with a good team.
Thanks for stopping by and checking out my website.
I am a doctor
I am an expert on Electronic Medical Records (EMR)
I am a writer
I am making a gigantic change
In September of this year (2012) I stopped working at my old practice so I could build a new solo practice, Dr. Rob Lamberts, LLC. This practice will use the Direct Care model. Go here if you want more information about my practice.
So there it is - if you want to know EVEN MORE about me, keep reading. I tell you about myself in other, less conventional ways....
OK, you got here to my website. If it was on purpose, then you might just want to know a little about me. If it was not on purpose, you might want some good reasons to high-tail it out of here as quick as possible. If you are an insomniac, you might want something to help you sleep better. This post should do the job for all of you. Here's who I am:
A doctor, a doctor, that’s just what I am!I eat yummy toast spread with butter and jam. I work down in Georgia, that hot southern state. And sometimes I finish the food on my plate.
I take care of kiddos and folks that are older. I’ll drink milk that’s warm, but prefer it much colder. I’m a fortunate husband and father of four. If milk is real cold I will often get more.
I alternate verses with food on occasion Mexican’s great and I really like Asian I don’t know quite why I am writing this way But now I am hungry and want a fillet.
So you get the gist of writer you're reading And also have insight to just what I'm eating I am who I am, a distractible fellow Now if you excuse me it's time for some Jello.
There is no collection of pictures so influential and significant as this one. It redefines the whole idea of pictures and then redefines the idea of redefinition. It astounds and amazes, it draws tears and laughter. My only fear is the deluge of traffic I will see from this magnificent collection. I apologize in advance to SquareSpace for this cataclysm.