To be a doctor, you must get up really early. Yes, because you need to make rounds at the hospital before the patients are awake. That way they will not be able to ask you any questions, which will take up too much time and make you late for the office. Of course you must also get to the hospital before the nursing shift changes. Otherwise the new shift of nurses will be waking the patients for vital signs. Then both the patients and the nurses taking care of them for the day will be waiting for your.
Once you arrive at your office, it is important to stay one step ahead of the patients by ordering as many expensive and sophisticated tests as possible. This will not only impress your patients but if you can own or lease the machines that preform these tests, it will increase your revenue.
Also, be sure you employ plenty of physician extenders, nurse practitioners, physicians assistants, technicians, and the like. Those who can preform services that have CPT codes are the best. You can bill for these services as a source of additional income. These extenders are especially helpful when they can work in your office while you are not there. This being the case, you will generate revenue while you are away from the practice, thus helping the practice pay of itself while your office space would otherwise be idle.
Finally, get an electronic medical record with voice recognition software included. This way when you have spent 5 minutes with your new patient, you can say something like, "insert my usual review of systems" and a five page printout will result, making it possible for you to bill for a comprehensive evaluation where limited would be the case if you were taking the time to write out what you could remember discussing with the patient.
It is no secret that I played this game poorly. As frustrating as it may sometimes be, I enjoy tackling the patients questions, listening to their answers to mine, and trying to ferret out a diagnosis from the signs and symptoms as I pondered which tests might be useful and which were a waste of time (and money.) I also loved knowing the names of their kids, where they were going on vacation, and what books they would read when they got there.
After a year, it is now apparent to me why it takes me more than an 80 hour week to do what many of my colleagues consider a part time job. I hope I can always practice some type of medicine simply because I enjoy it.
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Musings of a physician in private practice for 24 years, now teaching in a residency program and working as an ob-gyn hospitalist in a large metropolitan hospital.
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The Local MD
Having now been a physician in private practice for twenty-one years, twenty-six days and about an hour and twenty minutes, it occurs to me that I have become what in medical school was often a derogatory term, the local MD.The presentation on rounds often went something like: "This 45 year old Caucasian male was seen last week by his LMD, and diagnosed with a viral upper respiratory infection..." At that point everyone knew that the LMD had missed the diagnosis. Otherwise the poor patient would not have ended up in a tertiary medical center with three consulting specialist, a fellow, a resident and four medical students at his bedside.What we, the medical students, the resident, the fellow and even the attending hospital physicians did not realize is that we would never know John Smith as well as the LMD. We would never speak to his wife using her first name. We would never be able to recall the names of all his children and know where they were in the world. We would never remember his favorite hobby let alone joke with him about it. Nor would we shed a heart felt tear when we gave him the diagnosis of the aggressive small cell carcinoma of the lung that had landed him in our midst and would kill him in less than three months despite our aggressive treatment that was the best medical science has to offer.At that point in my life I was very proud to be even the lowest ranking person on the team that was on the cutting edge of the diagnosis and the treatment of the gravest of conditions that plagued mankind. I felt so very lucky that I was being initiated in to this sacred fraternity. That I would soon be able to write "MD" after my name. I am still proud of my vocation yet I believe there is a wisdom that has only come with those twenty-years of practice.Today I realize what people want most of their physician is that he or she is someone who cares.Yes, we all want "everything medical science has to offer." Yet, what most of patients need is someone who will listen with their heart as well as with their head. Physician eyes are important, not only for seeing signs of disease in the body but for making contact with the patient's eyes where we are often allowed to see into their soul. All of the technology in the world will not replace a warm clasp of the hand or sitting at the bedside to share a few moments of the day along with the test results.So, I have created this blog. In large part it is a place for me to put my feelings. My hope is that at least some of these posts will resonate with others out there. Not just physicians, but others in caregiving vocations and even those for whom we care. If we are not here for each other then why are we here?
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