I think that I’m now practicing the best medicine of my career. What’s the explanation for this? Am I smarter now? Have I simply aged well like fine wine? Am I delusional? Have I lowered my professional standards?
Consider this traditional Jewish fable, which will help me to explain my newfound enhanced professional performance.
A man complains to his rabbi that he is overwhelmed in his
small apartment filled with children, his wife and his in-laws. The walls are closing in on him and he is desperate
for relief.
The rabbi counsels the man to bring a goat into the
apartment. The man is perplexed and
believes this will only worsen his dilemma. The rabbi persists and the man
complies
Months later, the man returns and wails that the situation
is worse than ever. The goat has made the situation intolerable. The rabbi directs
him to remove the goat as soon as he returns home.
Days later the man return and thanks the rabbi for his sage
advice. The apartment now felt huge and
comfortable.
During my decades of private practice, I performed all the
typical functions of practicing physicians.
I had a full office practice. My
partner and I served 2 area hospitals where we rounded each day. I was on call nearly every other night and
every other weekend and holidays.
I was routinely called at home in the evenings and in the middle of the
nights. Calls from the emergency room
at all hours were routine. And, we were
running the practice with all of challenges of personnel, payroll, rising
expenses, billing and reimbursement issues and running our endoscopy unit. This was my professional reality. So, when I was seeing patients in the office
back then, as much as I thought I was focused, I realize now that my mind was
cluttered with distractions that I could not entirely suppress. If, for instance, I entered an exam room to
discuss a patient’s constipation, after just being called by an ICU nurse
informing me of a critical development, can I really put the latter out of
mind?
I left private practice nearly 7 years ago and am now
happily employed by a gargantuan medical institution based in Cleveland. My job now is exclusively out-patient
gastroenterology. I have no hospital,
evening, holiday or weekend responsibilities. And, I am no longer running a business.
When I enter an exam room now to engage with a patient, I have never
been so focused. My mind is free of
static and distractions which has enhanced my concentration and
listening skills.
It is as if during my private practice days, several
goats were wandering throughout our office.
Now, as an employee with a much narrower job description, there is nary
a goat in sight! Like the man in the
Jewish parable, I have been liberated.
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Michael, I completely get what you're saying. I've spent my entire career split between two large health systems, one when I was in private practice and the other where I worked as a physician executive, AKA CMO. When I started in practice (1984), we had GI doctors falling all over themselves in the hospital, trying to get additional patients. Fast forward a few decades and we couldn't pay enough on call pay to get anyone to take ED call. Everyone was doing fine with their outpatient endo centers. They didn't need the 3 AM call about the variceal bleeder (undocumented and uninsured, of course).
ReplyDeleteHonestly, I've seen the same with other specialties-neurology, dermatology, endocrinology, etc. Outpatient reimbursement, often related to scarcity of specialists, has caused a major shift from inpatient to outpatient reimbursement.
You are talking about the world of specialists, who via procedures generate big $ for the systems who employ them, and who are therefore left alone to do their thing. This is not the reality for primary care docs who to the system are widget makers who must be pushed constantly to work harder and faster (with more and more goats in the room). So enjoy your new liberated lives.
DeleteAnd by the way, what exactly is your point about undocumented and uninsured?