Hi.  This is doctor Rob, and you have reached my blog.  If you are here to read my blog, then continue to do so.  If this is an emergency, please call 911. That is one of my pet-peeves.  Every single doctor's office I call I am told the same thing: "If this is a true emergency, please hang up and dial 911."  I even got that message when I called the ER. When I ...

Read more...

As an incurable compulsive introspect, I tend to brood, ponder, contemplate, and (of course) muse on "big ideas," such as:

  • What makes people choose things which cause themselves harm?
  • Are some people better people than others, or are they just more skilled at hiding their problems?
  • Is pain really a bad thing, or is our aversion to it a sign of human weakness?
  • Does God ever wear a hat?
  • Do dogs watch Oprah?
  • Why did I ...

    Read more...

How's my practice doing? I am now up to nearly 400 patients, and while Jamie and I have talked about hiring a new staff person, we seem to be hitting our stride in this different practice model and have not yet been overwhelmed.  New patients are coming with regularity, some still coming from my old practice and many others through word-of-mouth from satisfied patients.  Yes, people still seem very satisfied with ...

Read more...

My older brother is also a doctor, but not a PCP like me.  He's a specialist: a limnologist.  If you have problems with blue-green algae in your lake, he's the man to see.  Limnology is the study of lakes, and fittingly, Bill works in the "Land of a Thousand Lakes" as a professor in fresh water ecology. I'm not sure he's thinking of switching over to direct-care limnology.  I've been afraid ...

Read more...

Lately I've gotten hooked on watching the reality TV show, the Deadliest Catch.  It's astounding to me what these guys go through to catch crab in the Bering Sea. One of the recurring themes on the show is the new crop of "greenhorns" -- new recruits to the profession of working crab boats -- that try to show they can hack "the world's most dangerous job" each year.  They often come with ...

Read more...

Things are going well with the practice, but I am being wrung a bit dry.  That's the reason for my dip in writing.  I am putting a lot of energy and emotion into the practice, and I don't have a whole lot left at the end of the day.  I have always been one to write out of passion and convictions -- I write because I believe what I am ...

Read more...

To what end? Those three words have become something of a mantra, a mission, a philosophy of care.

  • To what end do I prescribe a medication?
  • To what end do I make a diagnosis?
  • To what end do I order tests?
  • To what end am I documenting?
  • To what end is there a patient record?
  • To what end do I send a person to a specialist?
  • To what end do patients need to come to see me in ...

    Read more...

He seemed a bit grumpy when he came into the office.  I am used to the picture: male in his early to mid-forties, with wife by his side leading him into the office to "finally get taken care of" by the doctor.  Usually the woman has a disgusted expression on her face as he looks like a boy forced to spend his afternoon in a fabric store with his mother. ...

Read more...

365. That’s how many days I’ve been away from our health care system.  A year ago was my last day in my old practice.  Here’s what I wrote in my journal:

This is it. This is the last day of work at Evans Medical Group. It’s more weird than anything. I am sad to leave the comfort of my old job, but happy to be able to spread my wings and be ...

Read more...

“Daddy?” “Yes, Jonathan?” “Sometimes my leg hurts.” “Yes?” “Why does it hurt?” “Uh, that’s a tough question.  Does it hurt a lot?” “No, just every once in a while.” “OK, and where does it hurt.” He gives an expression of disbelief at the stupidity of the question.  ”My leg!” “Where on your leg?” “I don’t know,” patience now growing thin.  ”I just want to know what’s causing it.” “Well, Jonathan, it doesn’t work that way.  My main job is to make ...

Read more...

I have a vague recollection, a memory shrouded in mist, where I pondered what seemed like a radical question: What would a health record look like if my only concern was patient care?  This was a radical question because in my previous life I was an electronic health record aficionado.  I was good at EMR, which meant that I was really good at finding work-arounds:

  • How can I work around the requirements for ...

    Read more...

The question has been raised: Why re-invent the EMR wheel?  What is so different about what I am doing that makes it necessary to go through such a painful venture?  I ask myself this same question, actually. Here’s my answer to that question. What medical records offer: High focus on capturing billing codes so physicians can be paid maximum for the minimum amount of work. What I need: No focus on billing codes, instead a ...

Read more...

A patient calls or emails me with a problem.  I talk with them over the course of a few days, using whatever form of communication works best.  Eventually, they need to come to the office to be seen – either for something needing to be done in-person (examination, procedure, or lab test), or because of the advantages of face-to-face communication.  At the visit, I not only deal with one problem, ...

Read more...

Hi. I’m Rob and I am a recovering doctor.  Yeah, I am recovering ... doing a lot better, actually.  Things are tough, but they are a lot better since I left my destructive relationship with Medicare, Medicaid, and insurance companies.  I’ve had to learn how to manage my own money (now that I can’t count on them to bail me out any more), but things are looking a lot better.  I ...

Read more...

A post I wrote nearly three years ago has recently gone viral, bringing tens of thousands of readers and a huge number of comments.  It’s a letter I wrote to my patients who do something that all but guarantees a bad relationship with many (if not most) physicians: they don’t get better. There are basically two responses I get to this post: either readers are grateful to have a doctor admit ...

Read more...

It feels dangerous to write this, but ... my practice seems to be working. But as afraid as I am to admit it, the thing that was once just a good idea is now actually growing and improving.  We are up to about 300 patients (with a big infusion when a local TV network did a story on my practice) and have enough money to pay bills without a visit from ...

Read more...

Mind-Map This, apparently, is a map of my mind.  It’s a little shocking to find out that my mind looks like a sea creature, a bug, or perhaps a vegetable.  Actually, “Rob’s mind” and “vegetable” are often used in the same sentence. Someone suggested to me that I may benefit from mind mapping.  I don’t know how to describe it, but I think spatially; ...

Read more...

There was a hole in the wall of our bathroom that was a painful reminder of a bad encounter with a plumber.  Yes, that hole has been there about a year, and it has been on my to d0 list for the duration, daring me to show if I inherited any of the fix it genes I got from my father.  Why not hire someone to come fix it?  I ...

Read more...

So how’s my new practice going?  In some ways things are going about as well as they could.  My patients are amazed when I answer their emails or (even more surprisingly) answer the phone. "Hello, this is Dr. Lamberts," I say.  This usually results in a long pause, followed by a confused and timid voice saying something like, “well…uh…I was expecting to get Jamie.” Yet I am often able to deal with ...

Read more...

Dear HIPAA: I’m sure you get a lot of hate mail, especially from folks in my profession, so when you got this letter from me you probably assumed it was more of the same.  Let me reassure you: I am not one of those docs.  I do think patient privacy is important, and actually found you quite useful when facing unwanted probing questions from family members.  I believe the only way ...

Read more...

Most Popular

✓ Join 150,000+ subscribers
✓ Get KevinMD's most popular stories