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  I gathered up the outdated pictures of my family, handwritten notes from my children when they were much younger, pictures of patients, notes from patients, and the knick knacks that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.

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