Rob Lamberts is an internal medicine-pediatrics physician who blogs at Musings of a Distractible Mind.
I recently attended (and spoke at) the Concierge Medicine Assembly in Atlanta. My role was to give the perspective of a “successful” direct primary care (DPC) practice. This being the second such conference in three weeks, I’ve learned that my panel of 600+ patients and survival for two and a half years puts me in the higher ranks of solo DPC practices. The Atlanta conference was actually a combination conference, catering to …
I got a call from a patient who had a family member sick and in the ICU. She wondered if I could come over “to offer support.” Even though the family member wasn’t a patient, I thought it would be good to go.
The ICU brought on flashbacks to my residency years, in which I spent a lot of time in the ICU. …
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 …
It’s been a very slow week in my office. Today we almost pitched a no-hitter, having only one patient come in toward the end of the day. Overall, we’ve been quiet in nearly every way: few phone calls, few patients stopping by, few appointments, few secure messages.
What’s wrong?
That was a trick question. This is exactly what should be happening when things are going …
“Welcome back health care fans! I’m Dr. Rob.”
“And I’m Dr. Rob’s evil twin.”
“Good to see you again, Dr. Evil”
“Nauseated, as always, to see you, Dr. Rob. We’ve got a thrilling lineup in store for you tonight, as the Washington Senators take on the Mighty Docs in the third round of the meaningful use playoffs.”
“Don’t you mean payoffs, evil twin?”
“Hilarious, Dr. Dufus. The meaningful use series did promise big payoffs and better care. But …
“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 …
I drank the Kool-Aid early. We installed our first EHR in 1996 with me doing the lion’s share of pushing and pulling. While I’d ultimately turn my back on this passion, I had a number of notable accomplishments before walking down my road to Damascus.
“I’ve been getting winded lately.”
He’s a middle-aged man with diabetes. This kind of thing is a “red flag” on certain patients. He’s one of those patients.
“When does it happen?” I ask.
“Just when I do things. If I rest for a few minutes, I feel better.”
Now the red flag is waving vigorously. It sounds like it could be exertional angina. In a diabetic, the symptoms of ischemia (the heart not getting …
The documentation I get from everyone is terrible. Seldom does it tell me what I actually want to know, and if there is useful information it is buried in an avalanche of yada yada. The main reason for this is that documentation is driven by our ridiculous payment system, which requires us to follow arcane rules to generate notes that justify the obscure codes we submit for money from the …
Dear ACO General Hospital:
Thanks for contacting me about my most recent blog post. I’m sorry to scare your administration about HIPAA information, but I am equally concerned about that and will always do my best to respect the privacy of my patients. At your request I hid even more of that information.
I know it’s kind of embarrassing to have that kind of thing made public, and I am overall …
My life changed dramatically when I started my new practice. The biggest change personally was a dramatic drop in my income as I built a new business using a model that is fairly new. That’s a tough thing to do with four kids, three of whom were in college last fall. OK, that’s a stupid thing to do, but my stupidity has already been well-established.
Yet even if the income stayed …
I got the following email a few weeks ago (details changed for confidentiality reasons):
Dear Sir,
I read about your unique practice online. I have an 91-year-old ambulatory father who will not go to a doctor. He definitely is not well and this is the only way I can get him the attention he needs. He is adamant about not wanting medical interventions, however he still needs to be seen …
Oh yeah. Hot dang. All right. Groovy.
Boom goes the dynamite.
I had a very great day 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.
The first patient was a guy who is …
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I don’t like to brag, but if there is one area of my skills as a doctor about which I am proud, it would be my skill as a diagnostician. I like to play Sherlock Holmes and figure out what’s going on with people, and I think I’m pretty good at it.
So I lied. I do like to brag … a little.
In most people’s mind’s eye, the role of diagnostician …
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.
I went to visit a patient who was admitted over the weekend to see what was going on. She was a bit upset about the confusion of the hospitalist service and how orders apparently didn’t get written for her care by the admitting physician. …
It’s a seductive idea. We doctors possess knowledge and experience which can not only help people, but can save their lives. We get opportunities to be the right person at the right time to offer the right help that makes all of the difference. It’s one of the greatest things about our profession. It’s also one of its greatest traps.
I’ve heard many doctors refer to themselves as “healers,” as if …
My 87-year-old father broke his hip this past weekend. He was in Michigan for a party for his 101-year-old sister, and fell as he tried to put away her wheelchair. The good news is that he’s otherwise pretty healthy, so he should do fine.
Still, getting old sucks.
During the whole situation around his injury, surgery, and upcoming recovery, one thing became very clear: Technology can really make things much easier:
The janitor approached my office manager with a very worried expression. “Uh, Brenda …” he said, hesitantly.
“Yes?” she replied, wondering what janitorial emergency was looming in her near future.
“Uh …well … I was cleaning Dr. Lamberts’ office yesterday and I noticed on his computer …” He cleared his throat nervously, “Uh … his computer had something on it.”
“Something on his computer? You mean on top of the computer, or on …
She looked at me, eyes pleading, telling me without needing to say a word: I am not lying to you. I am not crazy. I am not making this up.
I sighed. “We’ve done the work-up and know this is not your heart. I don’t think there are a lot more tests that can be run.” I studied her expression, trying to discern what she wanted to hear from me.
I’ve come …
Sorry for the long gap between blog posts. I have been distracted by the volume of work that I have had to do. Is that a good thing? Yes. Is it a bad thing? Certainly.
I recently heard an interview of Mark Cuban, the owner of the Dallas Mavericks basketball team, billionaire entrepreneur, and one of the “sharks” on the show “Shark Tank.” The show involves entrepreneurs the opportunity to pitch …
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