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It was the week before final exams at the end of my first year in medical school when the pain in my back lower left molar finally reached a point where it could no longer be ignored. And I had ignored my teeth for some time.
The language of medicine is highly evolved and complex and allows clear, detailed, specific and unambiguous descriptions. Except when it’s not.
Four years ago this month, my family practice elected to join a local hospital owned and managed outpatient medical group. It has not gone as planned.
They say, life imitates art.
Our group of four family physicians had just recruited a fifth physician to join us. We knew him pretty well, having served as preceptors both for his inpatient medicine experience as well as a six-week rotation seeing our patients in our office. He was born and raised in the local community and already had longer-term relationships with some of our patients than we would ever have. The negotiations were complete, the papers were signed, and the five of us were celebrating over dinner.
Even knowing I would end up running late, I always looked forward to my biweekly visits with Charles in Hospice.
Primary care medicine is intense and chaotic, a constantly mutating kaleidoscope of information, emotions, goals and obstacles. It is designed to confuse and distract, and will find and magnify any tendencies towards ADD in even the most organized clinician. During my 30+ years as a family doc, I’ve come to depend on some core principles and concepts to stay grounded and maintain focus. Below the fold are my Ten Rules.
I’m not sure when the change happened, but it was quite apparent this month.
He was there for a common acute problem when the dilemma caught me off guard. After I had explained the likely cause of his six weeks of sore throat (allergic post nasal drip) and treatment options, I asked if he had any questions and he answered that he would like a prescription for Cialis.
This week I reviewed the most recent minutes of a hospital committee charged with initiating and managing clinical quality initiatives. As usual, the minutes documented a substantial amount of conscientious hard work by a very motivated group. However, one item caught my attention: they were sending a draft of quality goals for 2012 to the four Division Chiefs for approval, with a deadline of 9 days later.