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Musings of a Distractible Mind


Thoughts of an odd, but not harmful primary care physician.

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Musings of a Distractible Mind


Thoughts of an odd, but not harmful primary care physician.

Musings

My blog has been a destination of the most discerning healthcare reader since 2006.  Come see my elegant assortment of topics, such as:

  • Health Care Policy
  • Llamas
  • Personal insights from a doctor's perspective
  • Bob Saget
  • Patient-centered care
  • Body odor
  • Whether it is "Health Care" or Healthcare

Come visit and see the site that Oprah doesn't dare admit she reads. 

Recent Posts

Musings
Boom Goes the Dynamite

I had a very great yesterday. 

I saw three patients who had recent diagnoses of cancer.  Yeah, those two statements seem to contradict.  They don't.  Each person I saw gave me a clear view of how the practice I've been building over the past 18 months is making a difference.  A big, big difference.

Occam's Razor Burn

As a clinician, I fantasize about being the heroic detective who notices those obscure facts that others would miss, coming up with the life saving  diagnosis when all others had failed.  This, unfortunately, is not how it usually works when dealing with real human patients, and my desire to find a single diagnosis to explain what is going on can actually distract me from finding the answers my patients need.

Dr. Nobody

Today I had a very special experience, one which many of my patients have faced: I was treated like a nobody while at the hospital.  Yay me.

Doctors aren't Healers

I've heard many doctors refer to themselves as "healers," as if we have some special power to bring about healing in our patients.  This idea confers some sort of a higher status and originates, to some, from a "higher calling" to a more noble life.  Again, this is a logical step, in that we have opportunities on a regular basis to help and even save the lives of people.  It's natural to believe that somehow the healing power comes from our touch, or even from our knowledge.

It doesn't.  I am not a healer.  

The Basic Healthcare Transaction

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.

Sample Blog Categories

Humor

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.

Deep Thoughts

Sometimes my thoughts go deep.  Dealing with death and suffering can do that to an already introspective person.

Our Broken System

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.

Musings
Musings
My Turning Point

As an incurable compulsive introspect, I tend to brood, ponder, contemplate, and (of course) muse on "big ideas," such as:

  • What makes people choose things which cause themselves harm?
  • Are some people better people than others, or are they just more skilled at hiding their problems?
  • Is pain really a bad thing, or is our aversion to it a sign of human weakness?
  • Do dogs watch Oprah?
  • Does God ever wear a hat?
  • Why is "big ideas" in quotes?

Tough questions.  

Lately I've been contemplating the nature of human awareness:

  • Is self-awareness (the ability to think of ourselves in the first person) a uniquely human trait, and is lack of self-awareness the essence of mental illness?
  • Is empathy, or other-awareness the highest of human traits?  Is this what the biblical idea of being "made in the image of God" really means?

Yeah, that's a lot deeper than about dogs watching Oprah.

Giving.  Thanks.

I have seen through the lives of my patients a pernicious belief that emotion must by unified.  Either a person is happy or they are sad.  Either life is good or it is bad.  Either I like my full house of people or I don't.  Either I am sad about my loss or I am happy.  This simply is wrong

True Genius

What does it take to succeed?  Acclaim?  Intelligence?  Good luck?

No, it takes something far less exciting than those things... 

Musings
Dr. Nobody

Today I had a very special experience, one which many of my patients have faced: I was treated like a nobody while at the hospital.  Yay me.

Ask Dr. Rob: Medical Wreckords

Dr. Rob:  

Long-time reader, first time writer!  I want to know why it is that my doctor makes me pay to get my own medical records.  It seems like since they are my records, they should be free to me!  Can you explain this to me?

- Lucy in Texas


Thanks, Lucy, for asking such an astute question that is near and dear to my heart.

There is, in fact, a simple answer as to why doctors don't want you to lay hands on their medical records, Lucy.  It's the same reason you don't want your son's underwear after his first semester in college (known to have broken autoclaves):  they stink.

Why do they stink?  It's complicated.  The best way to see this answer is to look into the past.  Way back.

Personal Tech

When I say we need more tech, I am not saying we need more computerization so we can produce a higher volume of medically irrelevant word garbage.  I am not saying we need to gather more points of data that can measure physicians and "reward" them if they input data well enough.  The tech I am referring to is like that I used regarding my father.  I want technology that does two things: connects and organizes.  I want to be able to coordinate care with specialists and to reach out to my patients.  I want my patients to be able to reach me when they need my help.  Technology can do this; it sure did for my dad.

Adventures in Caring and Acting Affordable

Some would think that since I no longer accept money from insurance companies, the Affordable Care Act would have less of an effect on me.  Those folks may be right in how it directly impacts my practice (since I don't know the actual impact on other doctors, it's not easy to compare), but there has been a significant impact.  I've got plenty of ACA stories.

But that's not what I am going to discuss in this post. 

My personal adventures with this law are far more interesting from the other side of the insurance card: the health care consumer (AKA patient).  It has been quite a ride -- one that has not yet reached its destination.

Fatal Error

Changing the focus of care to this is more than just emotional idealism, it is good business.  Care should not be about codes, procedures, medications, tests, or interventions, but instead about helping people live their lives with as few problems as possible.  We need an economy that thrives when the patient costs the system less.

Any attempt to reform without this change will ultimately fail.

(Mis)Adventures in ICD-10

Just a glimpse into the ICD-10 shows how to code the all-too-common problem of when people are injured on railway vehicles (which are not streetcars, mind you).  I think it is fitting, when talking about ICD codes, to start with the area of train-wrecks...

Best Of

"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.

The Physical Exam

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. 

My New Practice

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.

Musings
Musings
Musings
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Llamaricks


Be Amusing, Not Averse

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Llamaricks


Be Amusing, Not Averse

Llamaricks: My Poetry (I use that word lightly) blog.

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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.

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Dr Rob Lamberts, LLC


My New Direct Care Practice: Focused on Patients, Not Payers.

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Dr Rob Lamberts, LLC


My New Direct Care Practice: Focused on Patients, Not Payers.

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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: 

1.  Focus on health instead of sickness.

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. 

My patients spend most of their time on the couch across from me.  Not in the exam or waiting rooms!

My patients spend most of their time on the couch across from me.  Not in the exam or waiting rooms!

2.  Listening is more important than doing things.

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. 

3.  Less medical care is often better than more

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).

4.  Patient records belong to patients

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.

 

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About Me


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About Me


About Me

Thanks for stopping by and checking out my website.  

I am a doctor

  • I am a primary care physician, practicing full-time in Augusta, Georgia.  I started practice here in 1994, and have recently left the practice I helped found to do something else.  More on that later.
  • I am board-certified in both Internal Medicine and Pediatrics.  I got this training at Indiana University Hospitals in Indianapolis, IN.
  • I went to medical School at Jefferson Medical College in Philadelphia, PA.

I am an expert on Electronic Medical Records (EMR)

  • I led our practice in implementation of EMR in 1996.
  • In 2003, our practice won the Davies Award for Primary Care from HIMSS (The Health Information Management Systems Society), which recognized us for our outstanding use of computerized records in a primary care setting.
  • I was very active in our EMR vendor's user group, serving on its board from 1997-2001, and serving as president from 1999-2000.
  • I served in many different ways on multiple committees (private and government) advocating for better use of EMR and wider adoption.
  • I have given presentations advocating for EMR use at many different venues around the country.
  • In 2011 I was a speaker at the CDC public health grand rounds on the subject of EMR, which was broadcast around the world and viewed by more than 20,000.
  • My writing about implementation and use of EMR has appeared in print journals and online.

I am a writer

  • In 2006 I started writing the blog, Musings of a Distractible Mind.  I did this on a whim, having no idea how my writing would be received.  If you want to see my really old writing, visit here.  You be the judge if I've gotten better or worse.
  • My writing, it turned out, was quite well received, being cited and republished my many high-profile websites.
  • In 2009, I was recruited by MacMillan publishing to host the House Call Doctor podcast, which was a weekly podcast giving explanations to things medical.
  • In 2010 I decided that I had too much on my plate, and gave up the podcast as well as taking a break from blogging.
  • In 2012 I started blogging again on my new blog, More Musings (of a Distractible Kind).  I also attempted to have a poetry blog, Llamaricks, which hasn't really gotten much content.  I do hope to write some more of this...unique...poetry in the future, though.
  • It turns out I liked the old name, and so in 2013 changed the blog back to Musings of a Distractible Mind , and now have consolidated it all in one happy place.
  • For more information about where my writing has appeared, go here

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....

Using a List

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:

  1. I say I am 5'10', but that's probably not true any more.
  2. I blogged for a long time at Musings of a Distractible Mind
  3. A lot of people read that blog and it was a lot of fun to write, but then I kind of got muddle-headed and started getting brain cramps
  4. Then I took some time out to clear my head and reset my priorities
  5. I'm not sure I cleared my head, but my priorities are a bit better than they were
  6. Clear heads are probably over-rated
  7. I now blog in two locations: I write a new blog called More Musings (of a Distractible Kind) which is pretty much volume 2 of the old blog, and I write a poetry blog called Llamaricks.
  8. I once had a penguin named "Bucky"
  9. I am one of those strange doctors who actually likes using a computer to do records.  I have been successful enough to win some award thingies and get elected to some other stuff, but I really just care about making things work better.
  10. I am frustrated by our system and how it hurts my patients.
  11. I own a couple of mock-turtlenecks, but not because I admire Steve Jobs or want to be like him.
  12. Steve Jobs never owned a penguin named "Bucky"
  13. I am married and have four kids.
  14. My age is in the same zip code as that number which is half way to 100.
  15. I have a beard and it is turning gray.  I will probably shave it off if people mistake me for Santa.
  16. Santa never had a penguin named "Bucky"
  17. When I write, I don't do it with a lot of planning.  I just sit down and write what comes out of me.  That's why it is so random.
  18. I sometimes correct the typos, but most of the time I see them a few months after I wrote a post.
  19. I was on "This American Life" for a five minute segment.  I got to talk to Ira Glass for an hour, though.
  20. Ira Glass doesn't have a penguin named "Bucky."
  21. I am trapped in a house that would make a good special for HGTV: Money Vacuums: Houses that Suck
  22. I did a podcast for Quick and Dirty Tips for a while.
  23. I never gave dirty tips, and being quick has always been difficult for me.
  24. I was kidding about the penguins.   I know, I know; penguins are nothing to kid about.  My mom told me that all the time.

 

In Verse

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.

In Pictures

What I look like occasionally

What I look like occasionally

When I am scared

When I am scared

In Disguise

In Disguise

My Feet

My Feet

My Dog, Holly.

My Dog, Holly.

My Cat (who we call "kitty" or "lard butt")

My Cat (who we call "kitty" or "lard butt")

My Guitar (Breedlove Northwest Classic)

My Crack Dealer

My Crack Dealer

Some home brew beer I made

Some home brew beer I made

A picture my daughter drew of our cat

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The Picture Gallery of Awesomeness


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The Picture Gallery of Awesomeness


Pictures for the ages

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.