Sometimes this job sucks

When he came into my ER complaining of chest pressure today I was in the middle of sewing a non-bony amputated piece of a man's finger back on for underlying granulation assistance. I called out orders to the nurses for the chest pain workup and glanced at the tachycardia on his EKG. No STEMI but that BP of 204/120 was concerning. Before I could get to his room a call from the lab alerted me to a sodium of 123. Adding the nurse's story of his coughing and chest pressure, my differential started with lung cancer. That isn't typical for me to do, but I kept it on top upon entering his room. I found a frail, worked-hard-all-his-life-and-it-showed patient laying on the bed in front of me. He had been having a hard time finding a PCP to take his insurance and finally his new one started him on BP meds this past week. Admittedly he hadn't started them because he was worried about the possible side effects of angioedema. "I've worked myself down from smoking 3 packs a day to only 1/2 pack." A nitro patch lowered his pressure but the CXR confirmed my fear. The radiologist wanted another look with a CT and then I had to tell a complete stranger that he has cancer. He didn't want me to call anybody. He didn't want anybody to know. I said, "ask me any question." "You don't have time for my questions," he quipped. "I have all day for you," I replied and waited in silence. 
- No, I don't know how long you have to live.
- Yes, I think that it is in other places (thank you CT).
- Yes, it's possible that "thing" they found on your liver about 8 or 9 mo ago is related.
- Yes, you can go home today instead of the hospital. 
- No, I can't say this is a death sentence. 
He removed his oxygen, pulled at his cords, and followed with, "Just let me go home and die." 
I went to the doctor's room and cried. I'm FM and pick up occasional ER shifts. I've diagnosed my own patients with cancer before but, strangers seem to be harder for me. Perhaps it's because I can't follow up with them; maybe I feel helpless that I can't walk them through their prognosis like I can my own patients. Mostly, I feel just as alone as they do in moments like this. The walls close in, the air feels thicker. There are no answers. But, I have all day for you...

Sometimes this job sucks.

Summer is my favorite kind of disorganization

(Written in June, so you can tell how disorganized I really am!) Recently I was encouraged to start writing again, as if what I have to say could be impactful or thought-provoking. While that's possible - and I hope that I am able to live my life in such a way that promotes this - I write for different reasons beyond the purpose of this particular post. I know in the past I've promised to write more often or at least more regularly; but, since that hasn't happened, I promise not to promise that again.

As I sit here w/ my iPad in my lap writing this, it is 9:57 pm and I am watching my children play video games. Yes, it's past their bedtime and yes, they're playing video games. I can absolutely justify the video games, allowing more hours a day than I recommend to parents, because my boys jump on a trampoline when they play. Let me repeat that...95% of the time that my 5 and 8 year old sons are smashing Avenger Legos on the big screen they are continuously bouncing on a personal jumper or the floor. It's often the most exercise they get all day so they typically get more electronics time than they "should." But, hey, it's not a perfect world; it's MY perfect world. (Don't worry, I make them stop when the jumping begins to subside - or the arguing starts!) And we are making memories. I have a million things to do but they love having me present to show me just how many coins they collect or "bad guys" they stop!

Speaking of a million things to do...don't we all? Our minds are continuously listing out what "needs" to be done: groceries, laundry, dishes, meal-planning, packing for vacation, etc., etc., etc. During the school year I am off on Wednesday mornings as an administration day. I use that time to attend the Hendersonville Morning Rotary meetings (join me!) and then I hole up in my office paying bills, checking labs/imaging, reading physician notes, finishing charts, meeting with staff. In the summer, however, I take the entire day off on Wednesdays - to spend time with my family. After Rotary I come home and find ways to enjoy our time together. This means that everything else I am used to accomplishing on Wednesdays gets pushed aside, for whenever I can fit it in! This leaves me feeling entirely out of sorts; but, we are making memories. They know I'm present with them and we can just BE together.

Then there's vacation - and paying for that. With the school schedule, my life is not much different from many of my patients...I have to work in vacation time while formal learning is put on hold. I also have to figure out how to budget my time off from work. Like many other small business owners, being away from the office equals making less money. Since paying for trips requires money, it's a catch-22 to take off but need to be there at the same time. Even coming back often leads to working more hours to play catch up. This crazy conundrum of increasing the billable hours in order to take time away from work is beyond their knowledge and comprehension; and, for that, I am glad. All they know is that for two independent weeks out of every summer I am not leaving them. I am by their side through every experience and we are making memories. They have no idea what awaits me upon our return and often it is even unclear to me. Summer starts out with plans and intentions and ends in chaos and fun - and lots of memories - my favorite kind of disorganization.

The fussing is starting and I am ready for bed myself. I pray you allow what's left of Summer fill your memories - everything else will get done, eventually.

Forecast for failure

Have you missed me? Regardless, I've missed me. Somewhere in this life I've become "too busy" to do anything. When people ask how I'm doing, "busy" is a word I use often. I AM busy. We all are. But, I love to write; so, I'm going to make an effort to be more vocal (can you imagine?) and speak up more. There are so many incredible changes happening in my world every day and I am excited to share them with you. Truthfully, my mind races with everything that needs to be done and all of the optimism upcoming. I enjoy talking with my patients, but I want you to have the access you need even more to the thought process that goes through my head. It's going to be a journey, particularly as we round the corner of the changes in the cost of healthcare this fall. 

The major carriers: BCBS, Cigna, and United Healthcare, are expected to raise the costs of premiums by 40-60%. BCBS of TN is claiming a $500 million loss over the past 3 years. Just this week the TN state insurance commissioner forecasted the upcoming demise of Obamacare plans that will be available to people. What does this mean for you? Well, if you're like me, it means you'll be scrambling for a new plan that is more affordable in a couple of months

Hopefully, you've had a chance to read my Facebook page on some of the upcoming changes we're planning for January 2017. While the details have yet to be revealed, this information is coming soon and I think you'll be pleased with what you see. The solo family practice doctor is unfortunately becoming a thing of the past, but the quickly emerging sustainability of Direct Primary Care is saving the day for many. 

 

Antibiotics...

This is the season of "sinus infections" as patients like to call them. Regardless of the actual problem, a majority of people think they have a sinus infection and need an antibiotic. Often people come to my office expecting an antibiotic. Some leave educated about why I don't want to give one and why they don't need one and are glad. Others leave angry because, despite my medical training and knowing when to avoid antibiotics, this is what they think they need. I will even have some who go straight to one of the many hundred walk-in clinics who will "just give me what I want." It's one of the most frustrating things for me to treat because people don't like or won't accept the real treatment. 

If you have chosen to trust me as your physician, I promise to make decisions that I think are the safest choice for your health. 

When it comes to an upper respiratory infection, yes, I know you feel bad. I'm on day 6 of my own, but improving daily.

I know you "don't have time" to be sick. Who does?

I know you're travelling to see family. Great! Have fun!

I know you'd love to be able to "stop it before it gets worse." Well, trust me, if I could do that, I'd be a kabajillionnaire. 

I wish I could stop a cold, but I can't. So, because I absolutely want you to feel attended to, I want to take a second to educate you. Most of the illnesses we experience are viruses that cause a plethora of symptoms, including, but not limited to watery, itchy eyes, dry mouth, sore throat, runny/congested nose, pressure in the face and forehead, cough, wheeze, fever, laryngitis, discolored mucus. A virus like this has no cure. There is no treatment for a common cold virus and there are more than 200 different types of viruses that can be implicated to cause these symptoms. I'm famous for saying, "there are two things that can cure you, God and time, and I am neither one of those." That's the truth. A virus will go away, usually, with rest and taking care of yourself. The cough and cold industry is a billion dollar one because of these symptoms and because there's nothing else you can do. Well, almost nothing. I do have an ability to give a really good cough medication by prescription if needed! How do you know it's a virus? A good clue is this: if your spouse or kid or friend or co-worker had it first, and now you have it, it's a virus. That's how they spread. They go from one person to the next...and you can't stop it. Read again, I, your physician, can not stop it. Neither can any other healthcare provider. 

I can't really tell you when giving antibiotics became the popular thing to do. I'm not sure when this trend started, but I can tell you honestly that it has become one of the most dangerous medical treatments out there. Antibiotics are used to treat bacteria, not viruses; yet, people still think they need one when they get a cold, regardless of what I tell them. There is a lot of harm to be done in taking medication you don't need. Antibiotics kill the good bacteria in your own body, which can lead to a lot of imbalance in your usually well-regulated gut. They can also cause commonly treated bacteria to mutate and form a resistance to being killed. There are already major players in this game, as many of you have likely heard of MRSA. There are others that are even stronger than MRSA and some that have no treatment because of the overuse of antibiotics in our world. It is estimated that more than 700,000 people die annually in the world due to antibiotic-resistant bacteria. If we continue to use a medication when we don't need it, then we will not have the medication when we do. 

The CDC recently had a great article that I put on my FB page about how to know if you need one or not. I like it because it's simple and I wish more people would really accept it. Truthfully, think back to being a kid...did your parents really take you to the doctor for a cold, or did you just miss a day or two of school and get through it? But even though most people like everything to happen in the snap of a finger, it's going to take at the very least 7-10 days before you start to feel ok again. Be patient, drink plenty of water, invest in some good medication...and suck it up, buttercup. If, however, it's been more than two weeks or you have trouble breathing or you run a continuous fever...that's a different story. There are exceptions to every rule...

Ultimately, let's just all try to use our common sense and give God the time to help your body heal itself. 

Never good enough

When I decided to start my own practice, I knew there would be challenges. I have found that one of the hardest things to get right in medicine is learning how to smile even when you don't want to. I'm sitting here trying to think of a profession where complaints are more commonplace than not. I think restaurants probably get less complaints than a medical office, which can often be difficult on the staff. I really wanted to be customer service oriented in this position, and I still strive to do this with my staff daily, but this is not a place where I believe that "the customer is always right."  I'd just like to take a moment to enlighten you on some of the complaints you have and to address them from a point of view other than your own. 

1) Payment is expected at the time of service. Somewhere along the the way years and years ago, people stopped paying for their office visits and merely expected to be billed. Recently, due to insurance changes and higher deductibles, this expectation requires a change. When it used to be as simple as a co-pay to cover your visit, now there is a co-deductible. This is often a much higher amount than ever before because insurance companies are expecting you to pay more for your health than ever before. This is not our fault yet daily we get push-back from people who are aghast when they are asked to pay prior to being seen...or even after. I've got news for you. It takes money to run a practice and it takes your money. Without my patients I wouldn't have a practice but without my patients paying their bills I wouldn't have the money to run it, either. Think about this...you can't go into Publix and load up your cart and then get to the front and say, "Oh, just bill me later for all of this." Medicine is no different. You are purchasing a service just like you would purchase groceries. Of course, if you are having trouble paying for the service I will always do my best to work out something with you. Just don't get angry when my staff asks for you to pay for your food. 

2) Prescriptions must be sent electronically. Believe it or not, I'm not a big fan of the electronic age of medical records. While it appears to be an easier process, and certainly there are less charts to keep up with, it has a lot of hiccoughs. In 2011 the government started requiring electronic prescribing from physicians and practitioners. The flip side of this is that pharmacies are not required to request prescription refills electronically. In fact, most pharmacies are still on an fax system, which is an entirely different world. MOST of the time before you leave our office your prescriptions have already been sent to your pharmacy. There are occasions where I forget, because, yes I'm human and I completely forgot what I said I would do. This is not the majority, however. We get many, many complaints from you that the pharmacy doesn't have your prescriptions. This turns into a he said, she said argument: we have proof that we sent it, they claim they don't have it, and the you are the one left in the middle. Unfortunately, however, we experience the large part of the blame for this and you end up yelling at my staff. More than once we will call the pharmacy and ask about the mysteriously lost RX and it is, in fact, there but not yet ready for pick up. Three thoughts on how to handle this so you and I both experience less headaches. 1 - Give us the benefit of the doubt. I realize you need your medicine. I realize that you don't have any control over the situation and that we do. Yet, give us a chance to help you figure it out before you just start blaming us for not doing our job. The girls are on your side and they want things to be as smooth as possible for you but it is hard to be nice to somebody who is not being nice to you. 2 - Choose a local pharmacy. I'm not going to tell you which pharmacy to use, and sometimes you don't really have a choice, but I will say this: we never get this phone call from those of you who shop local. When I send my prescriptions to the locally owned pharmacies, the nurses get less patients yelling at them. The prescriptions reach them, the pharmacist has it ready and even knows your name when you go in the door. 3 - Don't run out of your medications. Yes, this requires you to know when you are due for your refills. I can't know when you need them. Soon it will be an office policy to not refill medications outside of an office visit. Chances are, if you are out of your medication then you need a return office visit.

3) We can't always answer the phone. Let me give you a math quiz. I have three full-time and one part-time employee (i.e., not here every day). On Thursday, October 2, the fewest amount of calls that I had into my office at any given time was around 10:30, with 8 in-bound phone calls. (My phone system tracks this and for those of you curious, within the next half hour the number jumped to 30.) At the same time there were a minimum of 5 patients in my office. Now, despite my master's degree in physics, I can't make the number of staff multiply to assist the number of patient needs. While I would love to be able to have somebody who could answer every single phone call that comes in, the fact is that we can't. When a nurse is in a room helping check-in a patient, giving shots, checking labs, etc., she can't answer the phone. When the front desk is on the phone, checking patients in or out, taking payments, sometimes they can't get to the phone. I will go ahead and dis-spell two myths: we don't just sit around waiting for the phone to ring, and, you aren't our only patient. While we want to be able to take care of everybody, our priority goes to the people who have appointments and then to the phones. Please, please, please, don't call in and curse because you have to leave a message, and also don't call in and leave 6 messages in an hour's time. We do our best to call everybody back and, we like it just as little as you do. Right now I don't have a solution but, as Shakespeare said, patience is a virtue; assume it if you don't have it. Give us a break. We really are trying.

 

When I teach medical or nurse practitioner students, I tell them this: "Just remember that no matter what you do, it's always your fault." Patients have an expectation that we are supposed to be perfect and never get anything wrong. I would ask you to look at your own life and realize that our jobs and imperfections are very similar to your own. Together if we work to understand each other better, I have no doubt that things will improve on both sides. 

Update July 25, 2015: I've had a few responses to this and one comment in rebuttal to mine that I would like to publish in share. When I find it, I promise I will. It was from a well-meaning pharmacy student who made some great points. Stay-tuned!

It's just Hair...

If you've been around me for the past three years you have undoubtedly seen many different hairstyles, lengths and even colors. The fun thing about hair is that you can do whatever you want with it from day to day and it completely changes who you are, the way you feel, the style of your outfit, or even the mood of your event. For me, I've always liked my hair long. I wouldn't let my mom brush it without giving her a fit so there was a time when she had it cut like a boy...and I hated it. I kept it long throughout junior and high schools, into college and way beyond. A hair tie acts as a bracelet on most days and truthfully I'm not much of a girly-girl so it isn't unusual to see it pulled back in a ponytail. I like to joke that you're lucky I even brush my hair when I get up so it's interesting that I enjoy my hair long. As much as I do, however, I have given it twice in the past to charity so that others might also enjoy it. I am, as my friend Kristin, would say a "hair farmer."

There are several charities that will take hair donations in order to benefit those who have none for one reason or the other. The two times I have given have been to Locks of Love (www.locksoflove.org), which is arguably the most well-known non-profit of its kind. They serve financially disadvantaged children and adults under 21 years old suffering from any illness that either takes their hair or does not allow them to have hair. Interestingly, most people think of cancer as the reason people would acquire a hair prosthesis from LOL; in fact, the most common medical condition they serve is alopecia areata. Yep, say that five times fast.

Alopecia areata is one type of medical condition under the general name Alopecia, which is an auto-immune disorder that has no known cause or cure. Alopecia literally means loss of hair or baldness. This condition actually affects approximately 2% of the population. To use the word disease, while technically appropriate, implies that this is an illness that carries a negative connotation. I could sit here and spout off lots of facts and information to you, but you'd be bored and better served but doing the research yourself. I've made it easy for you right here and will tell you just to go to the website of the National Alopecia Areata Foundation. Another really cool place to learn is from a new charity that I discovered called Bows & Ballcaps (www.bowsandballcaps.com). B&B was started by an amazing girl named Hannah, who understands first what hand what it is like to live with alopecia. As you will see by reading her website and FB page (Bows & Ballcaps), this was the inspiration for her charity and desire to give to others who deal with hair loss, regardless of the cause.

The first time I saw Hannah was at a Rotary meeting where she attended with her dad. Though I didn't meet her until much later, her infectious smile stayed with me beyond that first day. What I would like to do is bless the efforts she has started for her charity with a fundraiser of my own. There is no doubt I am going to cut my hair and I nearly did it just a few days ago, definitely frustrated with how wild it has become. To use today's terms, it is a "hot mess!" Here's the plan and where you come in. We are going to raise money for Hannah, and how much money we raise will lead to how much hair I cut. The concept is 1 inch for every $100 raised with an goal of $1200 (eek!). 100% of the money raised will go straight to Bows & Ballcaps. I've never cut 12 inches before, but if we raise it, I will cut it! I suppose we need a time limit, but I'm going to give it 30 days, at least. Hopefully we won't need that long but I would like to hold a hair-cutting celebration on March 7 or 8. I'm really excited to share this experience with you, educate you on this common health condition, and, more importantly, promote the philanthropic efforts of Hannah. You can donate by dropping off a check or cash at my office or you can give directly to B&B. And for those of you hoping, if we raise over $1200, I am NOT shaving my head.

"Why in the...does a doctor schedule an appointment for 2:40 and keep my ass in the waiting room for at least 30 minutes?"

A friend of mine (who I really do adore), posted this on his FB page, which made me go off on a rant. I know you are surprised by this. Vickie says I need a soapbox to stand on in front of my podium at work. I really want to share it with you because I feel like sometimes one of these patients comes in my office and just needs to hear this. (None of the names listed below are real and have been changed to protect the innocent and keep the privacy of those who trust me with their health.)

FB Post: Why in the..keeping it clean-sorry...does a doctor schedule an appointment for 2:40 and keep my ass in the waiting room at least 30 minutes?

                Friend response:  If you get a decent answer to this, share with the class please.. I told the doctor one time that my blood pressure was high because I was, um, fricking waiting for a half hour...

                #2 Friend response:  Usually it's because they have added on extra patients at the last minute and it makes everyone suffer. OR because he/she just bought a bigger McMansion...

MY RESPONSE

I am SO glad you asked and also VERY glad you have other people in line who don't know the answer. I am happy to offer you the right one...
While in a perfect world each patient would come in with a simple problem, (i.e., I stubbed my toe, I have poison ivy), they don't. More commonly a day goes like this...
Mrs. Jones is 76 and has smoked nearly her entire life. She made an appointment for a lump that she has noticed come up on her arm. A quick visit...today. I think they might be nothing but since I'm not sure I send her to a surgeon who also thinks they might be nothing but takes one off anyway. Remember Mrs. Jones because she will come up in a moment. 
A few days later I am seeing Mr. Green who is 78 and following up on his thyroid medication. Should be simple enough except that Mr. Green's wife of 56 years has just passed away. She, too, was my patient. He is crying, unable to sleep, full of anxiety and depressed. I, too, start to cry and console and pray for him right there in the room. Only after we have that discussion are we able to move on to his "medical" care. 
One reason we are late: we console.
Right after him I go in to see a chronically uncontrolled diabetic. It would be easy to think that she is simply non-compliant, but the fact is that she cannot afford her medications and so she only takes them every few days. I am aware that there patient assistance programs available online but she does not have Internet access so I take the time to help her fill out the appropriate paperwork for this. 
One reason we are late: we care.
Remember Mrs. Jones? The surgeon is now on the phone and wants to talk to me. Turns out those lumps she had are stage IV lung cancer and he has sent for for a CT scan which he is sending the results of to my office. She is at my front desk asking for these results...she has no idea she has cancer. So, yes, I work her in, "adding on extra patients at the last minute and it makes everyone suffer." Not only do I get the joy of explaining to her that she has cancer that came up as suddenly as a Spring rain, I get to call her husband on the phone and explain it to him while she cries in my office. I call the oncologist to set up her appointment for the very next day. I get to be the one who tells her that she doesn't have very long to live. 
One reason we are late: we take time.
Yes, this was a real day. And, yes, often I am AT LEAST 30 minutes behind, at the very least. That particular day I was 90 minutes behind. But I can guarantee you that not another person that day was upset with me because each of them has learned that I am the type of doctor who would do the exact same thing for each of them. 
So the next time your doctor is 30 minutes late, instead of playing Candy Crush or FB on your phone and constantly looking at your clock, look around the office or the waiting room. Say a silent pray for those there with you because you have no idea why they are there, just like they have no clue about what you suffer. But I do. I carry it home with me every night. I work my nurses too hard for too little pay because I demand that my patients are taken care of. They do more than just bring patients back to rooms. They call in your refills, fill out your paperwork, write notes for school or work, find samples and coupons, play with your kids, look up your immunization records, talk to your spouse on the phone who is worried about your recent visit to the ER. Sometimes they spend more than two hours on the phone with an insurance company for Mrs. Little, trying to figure out why they will no longer cover her medication for her multiple sclerosis that has been the only thing that has allowed her to function for the past 5 years. And sometimes I even have to argue about it with somebody on the other line. 
One reason we are late: we are advocates.
And, sometimes even the doctor has issues like the day I learned (in the middle of my morning) that my mother had breast cancer. I'm sure you were in the waiting room complaining about my being behind while I was in the bathroom crying and trying to freshen up because I still had patients to take care of. 
One reason we are late: we are human.
Yes, in a perfect world, we would never be behind, but we would also ONLY see healthy young people whose biggest complaint is how far behind we are in our schedule. And, while it would nice to think that your $20 copay is paying for my "bigger McMansion," the truth is that I work 60 hours a week running my own clinic (actually IN the clinic) and another 4 hours every night (after my kids go to bed) and another 12-24 hours in an ER 2 hours away on the weekends in order to pay my staff less than what they deserve and try to chunk away at the $270,000 in student loans that I willingly took on so I could hear people complain about themselves (or me and my office) all day long. 
Take time to think about that the next time you're waiting 30 minutes and maybe you'll realize that 30 minutes really isn't as long as you think. 

I could be wrong. What do I know? I'm just a doctor here to piss you off.

Added July 21, 2015: While I wrote this post for my patients, friends and family 2 years ago, it has recently gone "viral" to the point where people from all over are commenting on it. So, yes, there have been nearly 100 comments in the past couple of days. I have read each and every one of them. At least 95% of them have been supportive, suggestive, and have sparked thoughtful regard while the other 5% have been plain mean or derogatory, even cursing at me. I'm glad that this has led people to think, or discuss, this problem more. I know that many physicians are frustrated with the current state of how this works and I would recommend you take the time to discuss it further with your physician if you have your own thoughts or concerns. Doing so, of course, will take more time and may cause the next patient to run a little behind; but, a good physician will certainly want to hear your thoughts, good or bad, and ways to improve your relationship. Thank you for your support, those who have offered it; but I have chosen to not allow the comments to be viewed so that it does not cause argumentative debate or negative banter. I will continue to read each of them, however, and ask that you continue the discussion beyond this.

Saturday, June 25: With over 3.5 million views and 5000 comments, I have to admit that I am humbled by the readers who have responded in multiple ways. I am touched by your stories and comments and have decided to implement some of your positive suggestions. While I have been unable to read all of the comments entirely yet, I will work at them methodically until I have completed the task. So far that have been a few suggestions to which I would like to respond.

1) Schedule less patients: unfortunately this is not an easy answer. I'm not one to say no when somebody needs to be worked in, because, usually, it is a necessary reason. I hope that's forgivable. 

2) Many people have recommended that they wish their doctor's staff could inform them and they wouldn't be so upset. While calling everybody on the schedule is not feasible, and only leads to more complaints about the phones not being answered on the incoming lines, I definitely am going to work with my own staff on being sure they are communicating with the patients who are there. And, before any more of you accuse me of turning away late patients. I rarely do that, simply because I know patients have to take time off to get there. So, I usually work them in, which does put me at risk for making me behind, but I know there are circumstances beyond your control. 

3) One person literally asked me to "schedule time for compassion." Admittedly, I still laugh at this suggestion because it is absolutely ludicrous to think that I could even know how to do that, but then I became sad that this person perhaps doesn't experience it in his own life. As a physician, your personal life is just as important and directly related to your medical life. When my patient came in just this past week with a cough, I could tell he was concerned about much more. So, while he was in the appropriate time slot for a cough, my staff could not have known that he would relate to me that his sister had just passed a few days earlier. You can not schedule time for this, or prepare for this, and I wasn't about to rush him out after this news. 

4) Have a backup plan: I wish I knew what this one meant. It's not like working at a restaurant and you run out of chicken. The assistant manager can just run down to the store and by more. I don't know what it means to have a back-up plan. Of course, the idea to leave open spots in your schedule falls into this category, which we do...but these are often taken by same-day call-ins.

5) One that I am truly going to try is to have a pre-visit form for each patient to fill out that gives expectations about your visit. I'm very excited to implement this concept and am working on something that I can use as of this week. 

I seriously will listen to any reasonable offer of suggestion or advice, but I don't think there is room for cursing at me. I understand this struck some people wrong, though that was not my intention. I will continue to read the comments with a prayerful heart and thoughtful consideration. Thank you again, for your time.

Source: https://www.facebook.com/jasonbright

Being Treated Like a Servant

Some of you know that I have recently become a member of the Hendersonville Rotary Club; an honor that I do not take lightly. At the beginning of every meeting we are encouraged or challenged (or both) with a word by Reverend Keith Gunther. This morning he spoke on servant-hood and one line he said has stuck in my mind all day. "Be willing to serve even if it means being treated like a servant." Does that just stick out and punch you in a face like a brick like it did me? I can honestly say that, while I feel my calling has been to serve, I don't always do it with the heart of a servant in Christ. 

A little over a week left to go at FHC and lately things have been a struggle...something a few of you might especially notice. Without a doubt things have been busy. Many of you are trying to get in to see me before I leave; refill requests are coming in by the bucket-fulls; and labs are not being called back in the most timely manner. For all of your waiting and frustration, I apologize. I am but one person, and, unfortunately for her, I have one nurse right now. We feel your pain and your irritation just the same and we leave the office every night later than everybody else trying to not save everything until tomorrow. Indeed, we do leave the office but I don't leave my work. 

I carry each of you home at night.

I come home to two beautiful baby boys who I have missed terribly during the day. (Did I get that diagnosis right? Did I remember to call in that prescription?) I have missed taking them and picking them up from mother's day out and putting them down for naps. (I really need to write that letter to her specialist. Don't forget to look for his x-ray to come across the fax machine.) I come home to a wonderful husband who listens to me and supports me and gives everything he has to make sure our house is taken care of for our family. (I can not remember if I gave them that handout I meant to give.) I get a few hours of family time that is a mixture of dinner, play-time, bath-time, and a few stroller walks or visits with friends. (Don't forget you have that meeting tomorrow during lunch.) They are in bed at 9 (hopefully!) and then I go to work. Notes, labs, prescriptions; the leasing company, the insurance agents, the supply catalogs...furnishings, paperwork, accounting, web-site development. (Did I sign up for that life support class yet?) If I'm lucky, I'm in bed at midnight to get up at 5:45 so I can try to finish a few more charts, sign off on more paperwork, write a few patient letters. (I need to sit down and review more about his diagnosis so I can be sure we aren't missing anything else.) I leave in the mornings before anybody is up and usually arrive at the office before anyone else; I am still carrying each of you with me. 

Somebody asked me early on if I thought this venture would be a lot more work for me. Obviously going out on my own will be more work because I will be responsible for both the business and the employees along with my patients. But, honestly, it will not be more work in regards to what I do for my patients. I am primarily alone in this already where I am and take care of other people's things in the process. Yes, it is going to be a lot of work but at least I will be working hard for myself and I hope that my team and my patients will recognize this. I'm here to tell you that I don't always serve in a way that is pleasing to God and I was reminded today of that. 

(Mommy, you wanna play Smash Brothers with me.) And, thus another 20 minutes is spent laughing with my son and not taking care of you. 

If you can believe it, there are times when I am not perfect. I do forget to refill prescriptions; I don't always write letters the very day I see you; it is a rare day that I am on time for your appointments. My heart is to be your family physician, not just a doctor who controls your blood pressure and diabetes. I want to sit down with you to help you figure out why we are having trouble controlling them and research ways to get just the right options for you. I want to teach you and involve you so that the decisions made are not simply my telling you what to do but are something you feel is a joint decision based on collaborative efforts. All of this takes time and patience and recognition that I can't get it all done in one day. But, I have to remember that at the heart of it all is my desire to serve; and, no matter how much is on us, no matter how we are treated by you or others, my service should be for Christ and representative of Him. Lately I have not always been that way. I pray that you will forgive me when it is not and that He will remind me how to return to it when I do not have it.

I am not saying all of this for any kind of recognition or affirmation. This is not for pity or pride. I simply have a lot on my heart right now and have been through a few things in the past few days that have been heart-breaking. I want to share with you a little part of me. I am just like you with struggles to juggle life; balance work and home; and serve, even if it means being treated like a servant.

Trust me, it wasn't an easy decision.

Leaving Family Healthcare of Hendersonville was never my original intention when I moved here. Actually starting my own practice was not even on my radar. I was thrilled to fall into a practice with a good reputation and an established set of patients. But, as we all do with most situations in life, I started to realize that I wanted to do things a little differently than they were being done. And as things at FHC were always out of my hands, I decided that I should just try it. 

I know many of you may be disappointed with my decision but I trust that most of you will understand. Those who have had the opportunity to really get to know me will accept this as what is best for me and my family and, I hope, for you. My ultimate desire is to be the physician God desires, to practice medicine to the best of my ability and make decisions that are based on sound medical evidence and spiritual guidance. Jevhovah Rapha is the ultimate healer, the great physician. I chose a name that is not necessarily traditional but one that represents my foundation for the type of physician I wish to be. 

So here we are and I hope you will be as well.