Sorry for not posting for a while.  It’s not that things have been quiet; they definitely haven’t been.

Here’s the update:

• The construction has been delayed, so the office will open on the 28th of this month at the earliest.  Inspectors are a pain in the buttocks.
• This delay has kept me from hiring staff, as I need to have a solid start date for them.
• The extra time has allowed me to do a lot more preparation.
• Despite all of my preparation, I won’t be able to do a lot of figuring things out until I start seeing patients.
• Changing EMR systems really sucks, even for someone who has a very deep understanding of them (perhaps especially for someone with a deep understanding).  I’ll write about that later.

One of the big things I continue to be taught in this process is that the only way to accomplish big things is to do the little things.  This is a hard lesson for an impatient visionary like me to learn.  Good ideas are sexy, and they can get a lot of people patting me on the back and calling me smart, but good ideas aren’t enough to make real changes; they must be brought to life by taking care of as many details as possible.  Vision is still important; it gives me the fuel to get through the long hours dealing with all of the little stuff.  Vision also gives a way of prioritizing which little details get the time and which are left for later.  But vision without detail is just vaporware.

This is a big part of why I’ve gone silent.  I tend to write from passion, and there is little passion generated by a long night figuring out how to put lab results into my EMR system.  Marketing doesn’t get my writing juices flowing.  Writing about paying bills won’t get me many new followers.

The other thing that slows my writing is fear.  It’s a scary thing to not know how long it will take for me to become profitable, let alone make a decent income.  Pats on the back are nice, but they don’t pay bills.  I would like to give words of wisdom about how to build a practice, but I still don’t know if I will succeed in this.  The roadblocks have been numerous and extremely frustrating.  There is no guarantee that this will work (despite all of the people who have faith in me), and the best way to battle the anxiety is not by writing, it is by doing all of the little things needed to get me closer toward my goal.

My blog has recently been nominated for an award recognizing people in medicine who are “activists.” Thanks to whoever nominated me.  In considering this award, I asked myself the obvious question: am I really an “activist?”  Simply writing about something doesn’t make me an activist, I must do things of consequence, things that make a difference.

So what are things of consequence?  I think they are little things, not big.  Combine a worthy cause with hard work, and you have an activist.  So, despite the fact that I am caught up in a bunch of little things that need doing – ugly, boring little things –  those little things are the flesh that turn ideas into innovations, writers into activists.  I suspect all activism is like that: the ideas behind an activist may be glamorous, but the reality is dealing with a deluge of little things.  It’s frustrating, it’s tedious, but it’s reality.  Magic wands don’t exist.  Activism sounds heroic, but it’s probably often pretty dull.

Perhaps we should spend less time listening to the eloquent, and more time looking for the true activists: the people who are making a big difference by doing a bunch of little things that others would avoid.  The success of my new practice will depend on my ability to do just that.

Rob Lamberts is an internal medicine-pediatrics physician who blogs at More Musings (of a Distractible Kind).