Organic Medical Homes (that are Gluten-Free)

October 22, 2012 My New Practice

What comes to mind when you hear the term “medical home?”  Perhaps you favor the definition put forth by our government (AHRQ): The medical home model holds promise as a way to improve health care in America by transforming how primary care is organized and delivered. Building on the work of a large and growing [...]

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Lessons from Silence and Running

October 18, 2012 Personal Musings

There is nothing exciting or glamorous about doing what I am doing: building a new practice from scratch.  It’s a slow and often mundane process that takes far longer than it looks like it should.  There are a thousand questions I need to answer: Where will my office be?  What will my logo look like? [...]

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Hideous

October 12, 2012 Pharmaceutical Junk

This, in my opinion, is the crowning glory of my drug company junk collection.  It’s absolutely hideous, so bad in fact that it is wonderful.  Clarinex, as some may not know, is basically “son of Claritin.” Claritin was a non-sedating anti-histamine which made a bus-load of money for the manufacturer.  But then the drug went [...]

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Kodak, Instagram, and Health Care Reform

October 9, 2012 Health Care - How it's Broken

I grew up in Rochester, NY.  Statistically, this means that I probably had a family member who worked at Eastman Kodak, as the company employed over 62,000 people in Rochester at its peak.  I did, in fact, have two: my father and my brother-in-law.  My brother and I both worked there during two fun and [...]

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Destination Unknown

October 1, 2012 My New Practice

I cleaned out my office yesterday.  I gathered up the outdated pictures of my family, handwritten notes from my children when they were much younger, pictures of patients, notes from patients, and the knick knacks that accumulate over 18 years of being in one place.  Most of them were dusty or worn with the tarnish [...]

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Last Day

September 28, 2012 Personal Musings

Last day of work. Lots of important questions run through my mind: what do I wear?  Do I shave?  Do I wear sandals?  Should I have gotten a haircut? In the office, I see consults on my desktop – consults that really mean very little to me now, as the majority of these patients won’t [...]

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Last Week

September 25, 2012 Personal Musings

This is it. Eighteen years of practice is now condensed to my final four days seeing patients in the practice I built.  While I am not bitter about what has happened (in fact, a large part of me is delighted), there is a sense of finality in this as one of my life’s major passings. [...]

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Care on the Continuum

September 19, 2012 Health Care - How it's Broken

My change from a traditional practice to direct-care has caused me to challenge some of the basic assumptions of the care I’ve given up to this point.  Certainly, the nature of my documentation will radically change with my freedom from the tyranny of E/M coding requirements. Perhaps the biggest change in my care comes courtesy of the [...]

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The Dog Pen

September 17, 2012 Pharmaceutical Junk

In looking through my vast collection of pens I came across a surprise: It raised the obvious questions: Why do I have a pen from Blueboy Chihuahuas? Why would I have a pen from a company in Lowell MA? Did a Chihuahua rep come around to my practice trying to get me to encourage my [...]

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Relationship

September 15, 2012 My New Practice

Probably the hardest part of making the change from a traditional to a direct-care practice is the effect it has on relationships.  I am only taking a maximum of 1000 patients (less at the start) and will be no longer accepting insurance.  These changes make it impossible for me to continue in a doctor-patient relationship with [...]

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