Rob Lamberts is an internal medicine-pediatrics physician who blogs at Musings of a Distractible Mind.

This is what a successful direct primary care practice looks like

Physician
August 10, 2015

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 …

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This is what a successful direct primary care practice looks like

A patient fails a drug test, but stays in this doctor’s practice. Here’s why.

Physician
July 23, 2015

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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 …

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A patient fails a drug test, but stays in this doctor’s practice. Here’s why.

A quiet day in the doctor’s office: And that’s the way it’s supposed to be

Physician
July 10, 2015

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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 …

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A quiet day in the doctor’s office: And that’s the way it’s supposed to be

Welcome to the meaningful use series! Who’s going to win, and why?

Tech
July 5, 2015

“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 …

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Welcome to the meaningful use series! Who’s going to win, and why?

If my patients know I am human, they don’t ask for me to be superhuman

Physician
June 9, 2015

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“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 …

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If my patients know I am human, they don’t ask for me to be superhuman

What does real meaningful use of an electronic record look like? Not like this.

Tech
April 17, 2015

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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.

  • Within a year of implementation, our practice became one of the top installations for our vendor.
  • Within two years, …

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What does real meaningful use of an electronic record look like? Not like this.

Waiting for problems to become emergencies is terribly expensive 

Physician
March 12, 2015

“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 …

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Waiting for problems to become emergencies is terribly expensive 

Building a better EMR. Read how one doctor is doing it.

Tech
November 11, 2014

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 …

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Building a better EMR. Read how one doctor is doing it.

Transition of care: A letter to ACO General Hospital

Tech
November 2, 2014

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 …

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Transition of care: A letter to ACO General Hospital

Flipping the basic transaction of health care

Physician
September 30, 2014

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 …

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Flipping the basic transaction of health care

Set free: Thank you for the freedom to care for this sick patient

Physician
September 3, 2014

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 …

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Set free: Thank you for the freedom to care for this sick patient

My new practice saves lives

Physician
August 26, 2014

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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My new practice saves lives

When diagnosing patients, Occam’s razor sometimes fails

Physician
August 17, 2014

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 …

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When diagnosing patients, Occam’s razor sometimes fails

At the hospital, I’m Dr. Nobody

Physician
August 12, 2014

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. …

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At the hospital, I’m Dr. Nobody

Doctors are helpers, not healers

Physician
July 28, 2014

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 …

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Doctors are helpers, not healers

Technology should enhance connections and improve relationships

Tech
June 20, 2014

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:

Technology should enhance connections and improve relationships

The fatal error in health care

Policy
April 15, 2014

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 …

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The fatal error in health care

Doctor and patient: Insecurity meets insecurity

Physician
April 4, 2014

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 …

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Doctor and patient: Insecurity meets insecurity

Growing a new kind of practice: Success is based on executing ideas

Physician
March 13, 2014

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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Growing a new kind of practice: Success is based on executing ideas

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