I should be encouraged. I was asked to talk on public radio last week about my new practice, then I was on a panel of “experts” in Washington DC on Monday. Everywhere I talk about what I am doing I get positive reactions. I get very positive reactions, actually. I was approached by someone wanting to work with me “when I get my practice running” to help roll it out to other physicians.
But these words don’t seem to encourage me at all; in fact, they seem to have the opposite effect. The reason? I am building a practice, not a practice model. I am going to work with people, not ideas. This is reality, not theory. Real patients are going to put their real lives in my care. The closer I get to practicing once again, the more time I must spend out of the world of “good ideas” and in that of hard work.
And what I am doing is a lot harder than I thought. There are so many loose ends that must be addressed before I can even see my first patient, that it feels like I am juggling Jell-o. I have a physical office that is being renovated, an EMR system to learn, patients to sign up, staff to hire, bills to pay, licenses to get, regulations to obey, care plans to make, details, details, details.
Even with all of that work done, I have to hope I haven’t missed anything. I have to hope the people I hire are right for the job. I have to hope I haven’t left out important details, or missed any deadlines. I have to hope I can make disparate computer systems work together to accomplish my goals. I have to hope enough patients sign up to pay the bills. I have to hope I stay healthy, that I have no major family crisis, or that I don’t make bad choices in my personal life.
The attention I’ve gotten through my writing, my radio appearance, and my speaking appearances have actually made this harder. It’s the difference between being an underdog and an overwhelming favorite. It’s the difference between being the #1 choice in the draft and a late-round choice. When expectations are for overwhelming success, even partial success is a disappointment. Peyton Manning and Ryan Leaf both had high expectations, but only Manning could translate that into success. The next few months will determine if I am a Manning or a Leaf.
This reality underlines another thing: the weakness of words. When the medium for my craft is writing or speaking, the measure of my success is my persuasiveness. The NPR segment held me up as a doctor who is dealing with our system in a radical way. The “experts” who were on the show to give their opinions about the Affordable Care Act (“Obamacare”) viewed my practice with skepticism. Some of my family wondered if I was frustrated at my inability to respond to their dismissiveness toward what I am doing. It was actually what I expected. I see it all the time, as my writing is posted on my blog and the others that republish what I say. I get agreement and praise when I state my case well, but get arguments or dismissiveness when I don’t. The weapons in this battle are words, and the one with the best words wins. But I have something that others don’t have: the chance to prove myself right. The best argument against “it won’t work” is not “oh yes it will,” it is “look: it works.” Success silences critics. There aren’t any people who doubt Peyton Manning can be a success in the NFL.
I guess the moral of the story is this: be careful what you say. It’s far easier to say than to do. Being good with words and convincing in arguments can lead to praise and even fame, but it also increases pressure. I can win the war of words, but that victory does nothing to help my patients. All my patients care about is if I can make it work. And that takes for more work than words.
Rob Lamberts is an internal medicine-pediatrics physician who blogs at More Musings (of a Distractible Kind).
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