Musings of a Distractible Mind
Thoughts of an odd, but not harmful primary care physician.
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
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.
The real question I am asking here is not if this care is good or bad (the answer to that is, yes, it is good and bad), but whether it is patient-centered.
This should be a silly question, like asking if car-repair is car-centered. But it is clear that much of the high cost of care in our country is due to the huge number of unnecessary procedures, medications, hospitalizations, and services given to/done on people. Unnecessary care is, almost always, not patient-centered.
The vast majority of people truly want a doctor they respect and actually like. This may come as a shock to many of my jaded colleagues who routinely face the ire of people stuck in waiting room purgatory, ignored or disbelieved by doctors, and treated as objects instead of people. They think that people are angry because they don't like doctors. They view the people on their schedule as, at best, the hungry masses they must placate and, at worst, as their adversaries they must conquer. Then they wonder why their patients are so unhappy?
The past three years has taught me otherwise. People want to like their doctors. We just haven't given them any reason to do so.
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.
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.
OK. Unexpected.
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:
- 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.
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 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.
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
Llamaricks
Be Amusing, Not Averse
Llamaricks
Be Amusing, Not Averse
Llamaricks: My Poetry (I use that word lightly) blog.
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.
Dr Rob Lamberts, LLC
My New Direct Care Practice: Focused on Patients, Not Payers.
Dr Rob Lamberts, LLC
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:
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!
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.
About Me
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:
- I say I am 5'10', but that's probably not true any more.
- I blogged for a long time at Musings of a Distractible Mind
- 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
- Then I took some time out to clear my head and reset my priorities
- I'm not sure I cleared my head, but my priorities are a bit better than they were
- Clear heads are probably over-rated
- 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.
- I once had a penguin named "Bucky"
- 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.
- I am frustrated by our system and how it hurts my patients.
- I own a couple of mock-turtlenecks, but not because I admire Steve Jobs or want to be like him.
- Steve Jobs never owned a penguin named "Bucky"
- I am married and have four kids.
- My age is in the same zip code as that number which is half way to 100.
- I have a beard and it is turning gray. I will probably shave it off if people mistake me for Santa.
- Santa never had a penguin named "Bucky"
- 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.
- I sometimes correct the typos, but most of the time I see them a few months after I wrote a post.
- I was on "This American Life" for a five minute segment. I got to talk to Ira Glass for an hour, though.
- Ira Glass doesn't have a penguin named "Bucky."
- I am trapped in a house that would make a good special for HGTV: Money Vacuums: Houses that Suck
- I did a podcast for Quick and Dirty Tips for a while.
- I never gave dirty tips, and being quick has always been difficult for me.
- 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
When I am scared
In Disguise
My Feet
My Dog, Holly.
My Cat (who we call "kitty" or "lard butt")
My Guitar (Breedlove Northwest Classic)
My Crack Dealer
Some home brew beer I made
A picture my daughter drew of our cat
The Picture Gallery of Awesomeness
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.
