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Why Haven’t You Called Me About My Labs Yet?

The pipes in Rome were slowly killing the people.  No one knew lead in the pipes was actually poisonous.

Today, it’s quite easy to scoff at their ignorance.  Yet, each of us have our own lead pipes, those modern “marvels” that future generations will shake their heads at.  We have at our fingertips inventions and practices later proven to be catastrophic to our health and well-being.

It’s one thing to learn about these blind spots after the fact.  What if you knew in REAL-TIME what was happening?

What if you had secret knowledge about your OWN lead pipes . . . ?

What if you were among a small group who knew which of our modern inventions and practices were slowly killing our health and vitality . . . would you still turn a blind eye?

Or, would you make the simple change that set you free?

After reading the following two articles, I now understand why I must spend 17-18 hours a day working to keep up.

I thought that maybe it was just me.  However, this study published in the Annals of Internal Medicine found that during a typical office day, just a quarter (27 percent) of a physician’s day is spent having direct face time with patients – while nearly half (49.2 percent) of a physician’s day is spent on EHRs and other administrative work. This roughly translates into two hours of additional time spent on EHRs and desk work for every hour physicians spend face-to-face with patients.

Over the years, we’ve hired more staff and I now have six and a half staff members to every provider. It’s taken part of the burden of time off of our shoulders, yet, in an era of rising inflation, hiring more staff isn’t affordable.  It’s not a sustainable model financially.

This second study found that with an average primary care practice responsible for roughly 2,300 patients, doctors would need to spend 21.7 hours of patient interaction per day to provide “all the recommended acute, chronic and preventive care” for a panel of this size.  The average internist has 3000-4000 patients in their panels.  There literally are not enough hours in the day to take care of all the office tasks required for a panel size of 2000 patients or more.

It has become physically impossible to do what is now required on treating acute, chronic and preventative care for the patients that we see day to day in the primary care setting. The inability to fully meet patient needs due to factors outside of their control results in frustrated patients and very frustrated physicians who lose sight of why they decided to practice medicine in the first place. This can leave physicians feeling depressed, cynical and suicidal, pushing them to contemplate early retirement, search for other practice options, quit medicine altogether – or worse, take their own life.

This has created the general feeling and perception in the mind of patients across the country that physicians just don’t care, they don’t have time for me and “they just want my copay.”

It isn’t that we don’t care.  If I didn’t care, I would have quit practicing medicine 15 years ago.  I love the practice of medicine.  It is the immense burden of documentation, the paper work, the seven page FMLA forms, and the thousands of ancillary treatment plan reviews & signatures, the providing proof of performance to Medicare and payors required every day that makes it so very hard to complete lab reviews, refills and callbacks in a timely manner.

I haven’t taken a real vacation in 15 years.  Who has time?!

Today, mounting evidence shows that the day-in-day-out pressures experienced by primary care physicians – caused by long hours, excessive fatigue and the sheer emotional toll of the work – can lead to burnout, depression and suicide. Sadly, the medical profession has among the highest risk of death by suicide compared to other occupations in countries around the globe. Recent studies reveal the concerning rate at which primary care doctors feel as though their personal lives are negatively affected by work, feel stressed at work and wish that they had more time to do more for their own health. When it comes to patient care, physician burnout is associated with higher rates of self-reported medical error, substandard patient care, longer recovery time and lower patient satisfaction. Layer on top of the burnout syndrome what some are describing as “moral injury,” the distress weighing on physicians because the business of medicine has overtaken the doctor-patient relationship. And for some, it seems that practicing medicine is literally killing physicians.

To regain control over their practice and personal lives, some primary care physicians are leaving the profession and others are taking steps to deal with work-related emotional exhaustion and chronic over-stress. Over the years, I’ve inherited a number of patients who’s doctors have left practice or moved to concierge models.

I’ve offered concierge services to my patients for years, but few patients have shown much interest up to this point.

Does one just leave medicine altogether?

Maybe.

References:

  1. Sinsky C., Colligan L., Li L., Prgomet M., Reynolds S., Goeders L., et al., “Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties,” December 2016, (Accessed online June 21, 2022)
  2. Altschuler, Justin et al., “Estimating a Reasonable Patient Panel Size for Primary Care Physicians with Team-Based Task Delegation,” 2012, (Accessed online June 21, 2022)

Door-to-Door Vaccine Status Visits Unconstitutional and Unethical

The Biden Administration announced plans this week to send agents “door-to-door” in order to “get remaining Americans vaccinated, by ensuring they have the information they need on how both safe and accessible the vaccine is.”

A leaked script from the Lake County Health Department in Illinois tells the door-to-door Community Health Ambassadors to keep track of the addresses and responses from residents in a “Door Knocking Spreadsheet.”

I find the following four observations essential for you and I to understand:

  1. The U.S. Constitution provides no authority for the federal government to be involved in medicine, for example, by recommending, promoting, or mandating treatments.
  2. If the Ambassador knows a person’s vaccination status, the government has already been collecting personal health data and sharing it with agents having nothing to do with the person’s care, a violation of the Fourth Amendment. The Health Insurance Portability and Accountability Act (HIPAA) will not protect you—it allows very broad disclosure to government officials.
  3. States have the lawful authority to regulate the practice of medicine, but the Ambassadors are evidently not under any constraints regarding training, credentialing, documentation, or scope of practice, although they are collecting data and giving medical advice without supervision. Even medical assistants and medical scribes need to meet certain qualifications.
  4. Ambassadors are promoting an experimental product, with no information on risks. COVID-19 vaccines were authorized via the EUA (Emergency Use Authorization), not FDA approved.  Even if a product is FDA-approved, advertisers and medical professionals must divulge risks, such as heart inflammation, paralysis from Guillain-Barré or other causes, miscarriage, or death. Contrast the Ambassador’s script with the disclosures on a television ad for a drug, say one to treat your dog’s heartworm.

It is my opinion and the opinion of other organizations like the AAPS that this door-to-door solicitation violates the ethical principles of protecting confidentiality and informed consent. Health professionals need a patient’s implied consent even to be seen; they may not simply show up uninvited at a stranger’s home.

Experience Has A Price

A giant ship’s engine broke down and no one could repair it.  So, the owner hired a mechanical engineer with over 40 years of experience.
The engineer inspected the engine very carefully, from top to bottom. After seeing everything, the engineer unloaded his bag and pulled out a small hammer.
He gently knocked on an area of the engine with the hammer.  Soon, the engine came to life again. The engine was fixed!
Seven days later the engineer submitted his bill to the owner: the total cost of repairing the giant ship was $20,000.
“What?!” said the owner. “You did almost nothing. Give me a detailed itemized bill.”
The engineer responded:
1. Tap with a hammer: $2
2. Knowing where to knock and how much to knock: $19,998
The importance of appreciating one’s expertise and experience cannot be stressed enough. . . Because, that experience is the result of years of struggles, hours of trial and error, experiments, thousands of hours of reading, sleepless nights, pain and even tears.
If I do a job in 5-10 minutes it’s because I spent 20 years learning how to do that in 5-10 minutes. You owe me for the years, not the minutes.

Dietary Counseling Tantrums

I am a Family Practice Physician.  I spent eleven years of my life training to become a physician certified in Family Medicine.  But, I found this wasn’t enough.  I struggled to treat the “diseases of civilization” that arise from society, our Western diet and lifestyle.

I, also, specialize in dietary weight/obesity management and low-carbohydrate/ketogenic diets.  I actually spent an additional three years obtaining specialized training and board certification in this field.   When you add all the training and my years of experience in practice together, I’ve spent over 25 years perfecting this art of medicine.

Because of this training, I have been very blessed that people from all over the world travel to Surprise, Arizona, to see me for weight management, dietary advise, and counseling on the diseases of civilization.  I’ve been amazed that simple changes in diet halt and reverse obesity, arthritis, diabetes, cholesterol, high blood pressure, etc.  The list goes on and on …

But I find a disturbing mindset pervasive through the community and the nation:

CarbCounseling

After listening to an number of people get angry over this issue in the last few weeks, I began wondering to myself…

“Who ties your shoelaces for you?”