Wednesday, August 14, 2013
Hi. It’s me again. No, I’ve beed doing fine; my writing slow-down is not due to calamity, catastrophe, apostrophe, or even syndactyly. I’ve been working hard, working like a dog.
That’s a strange expression, “working like a dog” in that my experience with dogs is with our pooch, Holly. This is Holly’s idea of a productive day:
Our cat, of course, makes Holly look industrious. Zander (AKA Lard-Butt) considers a day productive when he’s either conned us into feeding him twice in the morning or if he’s found a new unique place to sleep.
There is a reason why I’ve never heard the expression: “working like a cat.”
So, what’s been so all-consuming that I can’t sit down and write? My computer system. I know it may sound nerdy and lame, but I’ve been putting every ounce of my creative energy into building a system. It’s driven by two main things: trying to give the best care I can, and doing so while avoiding personal bankruptcy. Fear of the latter is strong motivation. So I’ve been pouring myself into this task like nothing I’ve done before. My goal is to build a system that will:
1. Organize information. My care will only be as good as the information I have. It should be presented in a way that gives me just the right amount of information, with the ability to get more when I need it.
2. Cope with the flood of incoming information. Take the piles of communications coming in and route it to the proper storage place, use the information to make decisions, communicate it with the patients, and decide on follow-up. This is an enormously difficult task.
3. Integrate with every communication tool possible. Most doctors don’t do this because they rely on office visits for income, and that hinders the care they give. Communication is care, and I want to have good communication that is enlightened by good information.
4. Create a shared medical record with my patients. I am convinced that my patients will get the best care if they have access to their information. But this needs to be done in a way that is both simple and secure. I want “one stop shopping” for people to communicate or look at their records.
5. Keep my books. I don’t want to go bankrupt and don’t want to go to jail for keeping disorganized books. It’s possible to get freed from the fear of Medicare audits, but not from IRS audits.
6. Organize the future. There are far too many missed opportunities for care. Integrated task-management (shared between patient and their care team) is my goal.
7. Grow with me. If I accomplish 1-6, my practice will grow. I don’t want that growth to outpace my system.
So far I’ve been focusing on 1, 2, and 5, with eyes on the rest. I’ve made great progress, but there’s much more needing to be done. My ultimate goal of this is to build working prototypes of both this practice model and the software that will enable it to be more than just a side-show, an alternative for doctors who want to escape. I believe that this is truly better care. It is focused on what the patient wants: to be healthy and to spend as little time thinking about their health care as possible. It’s working so far, but it can be much more than it is now.
Once I prove concept of this practice model through the software, I hope I will have lots of folks wanting to use it and transform it into something bigger and better. I don’t intend, however, on selling the software; I plan to make it open-source, developing it through contributions and donated talents of others. It’s the practice model that has the potential to transform health care, not the software. The software is the infrastructure, like roads or utilities, on which a new model of care can be built. I will do just fine financially if the practice model works; I don’t need to make money off of software.
So I am working with people to help make this a reality. This software won’t work for most doctors, as it doesn’t focus on the center of their financial universe: the doctor’s office. Care has been held hostage to the office visit. Communication tools allow care to happen outside the office, and that’s bad business in the typical office. I need software that will do things that would harm most practices: keep my office empty, keep my patients healthy, handle little problems that would lead to bigger ones, and give patients the tools to take care of themselves. This is why most EMR software could never work with this type of practice: it supports the doctor-centered, office-based care system that I abandoned when I started this practice. I am looking for people who understand this fact, who get the fact that this is not about software; it’s about care.
I am sorry for the silence. I am especially sorry to my patients who probably wondered what’s going on. I plan on reaching out to each of you, optimizing your care and making sure the records I build will be worthy of being shared with you. I also plan on making the patient experience as simple as possible. There should be only one place to go (on the web or in an app) to contact me, fill out forms, look at your medications, and see your records. It’s got to be simple, and it’s got to work for everyone, not just the computer savvy.
Finally, I am working on ways to partner with businesses to give care for their employees. The interest in this is huge, and there may be insurers out there willing to give cheaper high-deductible plans to people who have a doctor that is hell-bent on keeping them from ever paying out their whole deductible if possible. I want all of my patients to be healthy: something the system I left would never allow.
There’s a word for my pursuit of this lofty goal.
After taking a year-long hiatus from blogging, Rob Lamberts, MD, ACP Member, returned with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind), where this post originally appeared.
Contact ACP Internist
Send comments to ACP Internist staff at email@example.com.
- Bacterial outbreak linked to cheese
- The in(patients) and out(patients) of antimicrobia...
- QD: News Every Day--Diabetes' price tag is expensi...
- Fructose and the follies of history
- A handwashing nudge
- QD: News Every Day--Stimulant use prevalent during...
- Living longer but sicker: health care in the U.S.
- Weight loss doesn't decrease strokes and heart att...
- QD: News Every Day--6 in 10 antibiotic prescriptio...
- The limits to de-identification of clinical data
Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.
And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.
Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.
Controversies in Hospital
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).
db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.
Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.
Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.
David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.
Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.
Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).
David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.
Reflections of a Grady
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.
The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.
Technology in (Medical)
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.
Peter A. Lipson,
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.
Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.
World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.
Other blogs of note:
American Journal of
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.
The Public Library of Science's open access materials include a blog.
One of the most popular anonymous blogs written by an emergency room physician.