Doctor Rob's Home Page. Distractible Musings, Llamaricks.
http://distractible.org/ - Nov 25, 2013 12:56:44 PM - Dec 5, 2004 9:22:04 AM
Musings of a Distractible MindSCROLL DOWN
Musings of a Distractible Mind
Thoughts of an odd, but not harmful primary care physician.
My blog has been a destination of the most discerning healthcare reader since 2006. Come see my elegant assortment of topics, such as:
- Health Care Policy
- Personal insights from a doctor's perspective
- Bob Saget
- Patient-centered care
- Body odor
- Whether it is "Health Care" or HealthcareMusings
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 the office?
- To what end do my patients have me as a doctor?
Is being in my practice something that saves money? Some anecdotes from the recent past suggest the answer, giving evidence of significant savings, both financial and life quality, that my patients and their payors get. This is an important case to be made to both the patients (who want to know if their $30-60/month is worth it) and payors (who could financially benefit from promoting this practice model). I realize that this does not constitute a proof of concept, but it is not without meaning.
Sample Blog Categories
Sometimes the best way to say something is to surprise people and make them laugh. The best humor laughs more at itself than at others' expense.
Sometimes my thoughts go deep. Dealing with death and suffering can do that to an already introspective person.
Our Broken System
Health care is messed up. Here I give both an insider's (before I started my new practice) and outsider's view of what's wrong.Musings
"Best" is a relative term. Perhaps it's like being a tall fetus, or like a small quasar. "Best" of Rob's posts. Yep. Either an oxymoron or a low bar to get over.
The Physical Exam
One of my most popular Series, the physical exam combines real information with total nonsense with an aim to both educate and totally confuse my readers.
Read what I've written about my new practice here. Follow the story from my days of dissatisfaction in my old practice to the whole process of figuring this new thing out.
Be Amusing, Not AverseSCROLL DOWN
Be Amusing, Not Averse
: My Poetry (I use that word lightly) blog.
Is it a rhyme?
Is it a Llama?
It seems this time
you've found the drama.
A play on words.
Some words at play.
The line gets blurred.
The color's gray.
This blog is meant
for your own writing.
So please invent
some words exciting.
They may not rhyme.
They may be terse.
But be sublime
and write in verse!
I'll publish those
who meet the measure.
I'll share the prose
for all to treasure.
I put this bee
into your bonnet.
Please send to me
your rhyme and sonnet.
So how should you
submit in your best?
Email me here;
I'll do the rest.
You likely are asking: What’s up with this site?
What’s up with the author? His mind is not right.
And what is a Llamarick? A word that’s created
From a creature that’s odd, and a verse often hated?
To answer those questions, to give explanation
Makes an assumption that has no foundation.
Assuming a reason behind their creation
Gives credit to neurons far over their station
No, most of this writing comes right off the cuff
Not from the cerebrum or smarty-pants stuff
While some of the prose may get you to thinking
Most will cause people to ponder more drinking
The gist of this poem and following pages
Is not stuff of wisdom or wit of the ages
I may talk of issues that folks are discussing
I may give opinions Tho' likely no cussing
Some prose may be poignant, some points may provoke
And others may raise the thought: "What did he smoke?"
What you are reading's the thoughts from my brain
Distracted, demented, at times even sane
And if you consider this poem as a test
You may have the stomach to read all the rest
So if you find insights or gems in their rough
I hope that you’ll join me as I write more stuff
And if all these verses do nothing for you
Then I hope a llama will poo on your shoe.
Dr Rob Lamberts, LLC
My New Direct Care Practice: Focused on Patients, Not Payers.SCROLL DOWN
Dr Rob Lamberts, LLC
My New Direct Care Practice: Focused on Patients, Not Payers.
My new practice is an attempt to go back to where health care should be: between doctor* and patient. Instead of me being paid by insurance companies or government bureaucracies, I work for my patients, because you work for the person paying you. Being paid by third parties meant that they were the one I had to make happy, not the patient. This is why customer service is nonexistent in health care.
I think people should expect more from their doctors. People expect to have to wait when they shouldn't. They expect to have to come in to have questions answered, even if they are simple questions. They expect for care to be complicated when it could be simple. They expect the doctor to be the center of the health care universe, when they, the patients, should be in that position.
My practice operates on 4 main principles:
1. Focus on health instead of sickness.
People shouldn't view health care as something they need to use. Ideally, people would stay away from doctors, off of drugs, and out of hospitals. The problem is that the whole system we have is aimed at the opposite. My practice is different, taking the time to do the things necessary to keep people well.
My patients spend most of their time on the couch across from me. Not in the exam or waiting rooms!
2. Listening is more important than doing things.
I answer the phone. I communicate electronically with my patients. I take the time to get to know them. This is a whole lot better than ordering a bunch of tests, and it's quite a bit cheaper. Unfortunately, communication is penalized by the U.S. system. Fortunately for me, my patients are amazed at the difference they see from a doctor who actually listens.
3. Less medical care is often better than more
Health care has been turned into a transaction: find problems, treat them with procedures, and get paid for the number of procedures done (the bigger the better). This has yielded the expected outcome: more care than is needed; lots more. Unfortunately, the focus on treating problems gets in the way with the highest goal of medicine: preventing disease in the first place. My focus is far more on risk reduction and quality of life than on finding disease and doing a treatment (often for diseases that aren't high risk and treatments that are).
4. Patient records belong to patients
If my bank told me that the only way I could get my bank records was to pay for them, I'd fire them and get another bank. This is what doctors tell patients all the time. Why? Because records are not for care, they are for showing the problems and procedures necessary to get paid. I think records should be entirely focused on patient care, not on billing. I think patients are best served to have access to all of their records, especially in this age of mobile computing.M
If you want to see more about my practice, go to my practice website: doctorlamberts.org.
*Obviously, this includes nurses, PA's, NP's, social workers, dietitians, physical therapists, and all of the other members of the health care team. I write the orders as a physician, but care is best done with a good team.
Thanks for stopping by and checking out my website.
I am a doctor
- I am a primary care physician, practicing full-time in Augusta, Georgia. I started practice here in 1994, and have recently left the practice I helped found to do something else. More on that later.
- I am board-certified in both Internal Medicine and Pediatrics. I got this training at Indiana University Hospitals in Indianapolis, IN.
- I went to medical School at Jefferson Medical College in Philadelphia, PA.
I am an expert on Electronic Medical Records (EMR)
- I led our practice in implementation of EMR in 1996.
- In 2003, our practice won the Davies Award for Primary Care from HIMSS (The Health Information Management Systems Society), which recognized us for our outstanding use of computerized records in a primary care setting.
- I was very active in our EMR vendor's user group, serving on its board from 1997-2001, and serving as president from 1999-2000.
- I served in many different ways on multiple committees (private and government) advocating for better use of EMR and wider adoption.
- I have given presentations advocating for EMR use at many different venues around the country.
- In 2011 I was a speaker at the CDC public health grand rounds on the subject of EMR, which was broadcast around the world and viewed by more than 20,000.
- My writing about implementation and use of EMR has appeared in print journals and online.
I am a writer
- In 2006 I started writing the blog, Musings of a Distractible Mind. I did this on a whim, having no idea how my writing would be received. If you want to see my really old writing, visit here. You be the judge if I've gotten better or worse.
- My writing, it turned out, was quite well received, being cited and republished my many high-profile websites.
- In 2009, I was recruited by MacMillan publishing to host the House Call Doctor podcast, which was a weekly podcast giving explanations to things medical.
- In 2010 I decided that I had too much on my plate, and gave up the podcast as well as taking a break from blogging.
- In 2012 I started blogging again on my new blog, More Musings (of a Distractible Kind). I also attempted to have a poetry blog, Llamaricks, which hasn't really gotten much content. I do hope to write some more of this...unique...poetry in the future, though.
- It turns out I liked the old name, and so in 2013 changed the blog back to Musings of a Distractible Mind , and now have consolidated it all in one happy place.
- For more information about where my writing has appeared, go here.
I am making a gigantic change
In September of this year (2012) I stopped working at my old practice so I could build a new solo practice, Dr. Rob Lamberts, LLC. This practice will use the Direct Care model. Go here if you want more information about my practice.
So there it is - if you want to know EVEN MORE about me, keep reading. I tell you about myself in other, less conventional ways....
Using a List
OK, you got here to my website. If it was on purpose, then you might just want to know a little about me. If it was not on purpose, you might want some good reasons to high-tail it out of here as quick as possible. If you are an insomniac, you might want something to help you sleep better. This post should do the job for all of you. Here's who I am:
- I say I am 5'10', but that's probably not true any more.
- I blogged for a long time at Musings of a Distractible Mind
- A lot of people read that blog and it was a lot of fun to write, but then I kind of got muddle-headed and started getting brain cramps
- Then I took some time out to clear my head and reset my priorities
- I'm not sure I cleared my head, but my priorities are a bit better than they were
- Clear heads are probably over-rated
- I now blog in two locations: I write a new blog called More Musings (of a Distractible Kind) which is pretty much volume 2 of the old blog, and I write a poetry blog called Llamaricks.
- I once had a penguin named "Bucky"
- I am one of those strange doctors who actually likes using a computer to do records. I have been successful enough to win some award thingies and get elected to some other stuff, but I really just care about making things work better.
- I am frustrated by our system and how it hurts my patients.
- I own a couple of mock-turtlenecks, but not because I admire Steve Jobs or want to be like him.
- Steve Jobs never owned a penguin named "Bucky"
- I am married and have four kids.
- My age is in the same zip code as that number which is half way to 100.
- I have a beard and it is turning gray. I will probably shave it off if people mistake me for Santa.
- Santa never had a penguin named "Bucky"
- When I write, I don't do it with a lot of planning. I just sit down and write what comes out of me. That's why it is so random.
- I sometimes correct the typos, but most of the time I see them a few months after I wrote a post.
- I was on "This American Life" for a five minute segment. I got to talk to Ira Glass for an hour, though.
- Ira Glass doesn't have a penguin named "Bucky."
- I am trapped in a house that would make a good special for HGTV: Money Vacuums: Houses that Suck
- I did a podcast for Quick and Dirty Tips for a while.
- I never gave dirty tips, and being quick has always been difficult for me.
- I was kidding about the penguins. I know, I know; penguins are nothing to kid about. My mom told me that all the time.
A doctor, a doctor, that’s just what I am!I eat yummy toast spread with butter and jam. I work down in Georgia, that hot southern state. And sometimes I finish the food on my plate.
I take care of kiddos and folks that are older. I’ll drink milk that’s warm, but prefer it much colder. I’m a fortunate husband and father of four. If milk is real cold I will often get more.
I alternate verses with food on occasion Mexican’s great and I really like Asian I don’t know quite why I am writing this way But now I am hungry and want a fillet.
So you get the gist of writer you're reading And also have insight to just what I'm eating I am who I am, a distractible fellow Now if you excuse me it's time for some Jello.
What I look like occasionally
When I am scared
My Dog, Holly.
My Cat (who we call "kitty" or "lard butt")
My Guitar (Breedlove Northwest Classic)
My Crack Dealer
Some home brew beer I made
A picture my daughter drew of our cat
The Picture Gallery of Awesomeness
The Picture Gallery of Awesomeness
Pictures for the ages
There is no collection of pictures so influential and significant as this one. It redefines the whole idea of pictures and then redefines the idea of redefinition. It astounds and amazes, it draws tears and laughter. My only fear is the deluge of traffic I will see from this magnificent collection. I apologize in advance to SquareSpace for this cataclysm.
Things have been crazy. It’s much, much more difficult to build a new practice than I expected. I opened up sign-up for my patients, getting less of a response than expected. This, along with some questions from prospective patients has made it clear that there is still confusion on the part of potential patients. So here is a Q and A I sent as a newsletter (and will use when marketing the practice).
About My New PracticeQ. When will it open?A. My office will open in January, 2013, but the exact date is still not set. I had initially hoped to be already seeing patients, but things always are harder than they seem.Q. How much will it cost?A. I will charge only a monthly payment which depends on the age of the patient:
- $40/month for children under 3
- $30/month for people ages 3 to 29
- $40/month for people ages 30-49
- $50/month for people ages 50-64
- $60/month for people 65 and up.
- There is a $50 charge for the first month for people under 40, $100 for those 40 and up.
- There is a $150/month family maximum ($200 maximum for 1st month).Q. Are there other charges?A. As of now, there are none. All office visits and any procedures done in the office are covered by the monthly fee.Q. How can I afford to do this?A. I have greatly decreased my overhead by not accepting insurance and keeping my charges simple. My goal is to have 1000 patients paying the monthly fee, which will limit the number of staff I need to hire.Q. What will patients get for the monthly fee?A. In addition to office visits, patients will get:
- Direct access to me via phone
- Access to me through secure messaging
- A personal health record, a health summary customized for each patient giving detailed information to help with care outside of my office.
- A personal care plan summarizing scheduled care done, due now, and due in the future.
- Regular review of the personal health record and care plan to assure it is up to date.
- Enhanced coordination of care with specialists, hospital physicians.
- A health library of information for patients to answer questions when they come up.Q. Why did I do this?A. I get to be a doctor again (perhaps for the first time). I got tired of giving patients care that wasn’t as good as it could be. I got tired of working for a system that pays more for bad care than for good. I got tired of forcing patients to come in for care I could’ve given over the phone. I got tired of giving time that should be for my patients to following arduous regulations. I got tired of medical records not meant for actual patient care, but instead for compliance with ridiculous government rules. Making this change gives me the one thing our system doesn’t want to pay for: time devoted for the good of my patients.Q. What makes this better for patients?A. The main advantage is that I am finally able to give them the care they deserve: care that is not hurried, not distracted by the ridiculous complexity of the health care system, and not driven by the need to see people in person to give care. This means:
- I don’t ever have to “force” people to come to the office to answer questions. This means that I will let people stay at home (or work) for most of the care for which I would have required an office visit in the past.
- I will be able to give time people deserve to really handle their problems.
- I won’t have to stay busy to pay the bills, so I can take care of problems when they happen (or when they are still small), rather than having to make people wait to get answers.
- Patients won’t get the run-around. They will get answers.
- I won’t wait for patients to contact me to give them care. I will regularly review their records to make sure care is up to date.
- I will help my patients get good care from the rest of the system. Avoiding hospitalizations, emergency room visits, unnecessary tests, and unnecessary drugs takes time; I will have the time to do this for my patients. This should more than make up for my monthly fee.Q. What’s the advantage of patients having their records?A. Health care is disjointed, with little communication occurring between different locations of care. Care is often done blindly, not knowing the overall picture of the patient’s care done elsewhere. This means patients repeatedly answer questions about their care, care they often don’t understand or remember. My patients will have an accurate summary of their care which they can print out or bring up on their computer, phone, or tablet when information is needed. I will work with them to keep this summary up to date and as useful as possible. While others may be afraid of the consequence of patients seeing their records, I am far more afraid of the uninformed care they get when those records are not available.Q. Will this mean patients will need to come in more often to “get their money’s worth?”A. There certainly is a risk of this happening, but my intent is to empower my patients, not coddle them. The ideal for every patient is that they spend as little time dealing with doctors and hospitals as possible. My goal will be to use my time to give my patients tools to make good decisions and stay healthy. My old business (and the rest of the health care system) depended on people being sick or uninformed to pay the bills, but my new system has no such motivation. I can finally have the same goal as my patients: their health. I think this will ultimately save them a lot of money, and (most importantly) keep them healthy, informed, and away from doctors.Q. What are my future plans?A. If the business is successful, my hope is to add staff to offer more services. I hope to hire a dietician to educate my patientsabout their diets. I hope to hire a social worker to deal with the non-medical burden many of my patients carry. I hope to hire nurses to visit complicated patients to make sure they are taking medications properly, or to deal with small problems before they become big ones. I hope to hire a counselor to improve the emotional welfare of my patients. This will enable me to grow the size of the practice without becoming overly busy.
Big stuff has been happening over the past few days: I agreed to the construction plan and will begin on the renovation of the office as soon as possible. My initial thought was that I’d be open for business in December, but that’s not seeming very likely now. I am screaming on the inside, but [...]
Thoughts of an odd, but not harmful primary care physician.
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.
Big stuff has been happening over the past few days:
- I agreed to the construction plan and will begin on the renovation of the office as soon as possible. My initial thought was that I’d be open for business in December, but that’s not seeming very likely now. I am screaming on the inside, but am trying to meditate those screams away since there’s nothing I could’ve done differently. Thanksgiving and Christmas also get in the way of getting things done quickly, so I’ve just got to accept what is.
- I’ve made a brochure which will mail out next week to former patients and which I will hand out with evangelical zeal.
- I’ve started the process of interviewing people to work with me.
- I changed the name of this blog from “More Musings” to the old name of “Musings of a Distractible Mind.” I have imported the old posts to this blog and will begin the process of redirecting traffic from “distractible.org” over to this blog. More changes will soon follow.
- I’ve filled out a bunch of paperwork to do such amazing things as dropping out of Medicare, getting contracts with labs, and being able to run labs in my office.
- I was contacted by the producer of the NPR radio show/podcast Science Friday about possibly being on a show about the future of health care. While I am not sure how scientific my part will be, it’s a show I’ve listened to a lot and should be fun to be on. It’s a live show, so the pressure will be on me to not screw up too badly. Perhaps you could make a drinking game based on how many times I say “you know” (which I realized I do a lot after listening to my last live appearance on a show). I will be on the show between 2 and 2:30, and it probably won’t be all that long. Go here if you need to figure out how to listen (live or recorded). Ira Flatow is the host, which means I am one of the few people who’s been interviewed by the holy pair of public radio Iras (having spoken with Ira Glass on This American Life a couple of years ago). Do I get some of award for that? Perhaps they’ll put money in my IRA.
- Am making final preparations for my trip to Washington DC to speak at the mHIMSS mobile health summit on Monday.
- I’ve gotten dirty looks from my wife who is afraid I am getting a big head.
- My hats don’t fit me any more, but I think that’s just a coincidence.
- I wonder if Ira Flatow had a penguin named “Bucky.”My New Practice4
“This could be big,” he said after I told him about the company who wants me to cover their 100+ employees. I pay him to give me the stark reality of things, but his optimism made me uncomfortable. ”You’ve got to go for this. I know you don’t feel ready for it yet, but this [...]Health Care - How it's Broken11 comments
It seems both ironic and inevitable: I won’t be getting any more “meaningful use” checks. It’s not that I didn’t qualify for the money; I saw plenty of patients on Medicare and met all of the requirements. I was paid for my first year money without much hassle. The problem I am facing is this: [...]My New Practice6 comments
I had an amazing day on Friday. It started with a phone call from a local physician, one who I have never seen as an outside-the-box thinker, who was very excited about what I am doing. He feels much of the same frustrations as me, and thinks my approach to the problem is intriguing. He [...]Just Stuff Kind of Thingys4 comments
When I restarted blogging at the start of this year I made the decision to start a new blog instead of re-starting the old one. I did this for several reasons: I felt the old blog was something of the past and wanted a fresh start, as I had changed in the interim. The old [...]6 comments
What is a “portal?” In it’s broadest definition, a portal is a doorway from one place to another. On the internet, a portal is a site that has links to other sites. In health care IT, the term refers to a feature of an electronic medical record that gives patients the ability to see parts [...]My New Practice2 comments
Sun went down looking like the eye of God Behind icy mist and stark bare trees Inside the dim empty cinema two guys in leather jackets Glance at each other and shiver “They never built these places with winter in mind” Out the window down the gray road You can see old walled monastery Now [...]My New Practice15 comments
This is my new office. I signed the lease for this property yesterday – another big step in the process of getting my new practice off the ground. I should feel good about this, shouldn’t I? I’ve had people comment that I’ve gotten a whole lot accomplished in the 4 weeks since I’ve been off, [...]My New Practice8 comments
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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- The material on this blog is written by me, and is free to re-post and share under the Creative Commons License agreement. In other words, use it all you want; just give me credit.
- There Once was a Grand that was RoundMarch 6, 2012Rob
- A Submission From an Aspiring LlamarickeristFebruary 4, 2012Rob
- Lola the LlamaJanuary 29, 2012Rob
- Golden LlamaJanuary 23, 2012Rob
- Six Little PillsJanuary 12, 2012Rob
- What is a Llamarick?Rob
- Out by RequestSeptember 22, 2011Rob
- A Fresh StartAugust 18, 2011Rob
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