I keep seeing patients and trying my best. I sometimes wonder if it’s the right thing to keep doing. I’m sure there are younger, smarter, more agile providers out there who could be doing this work. But whenever our clinic tries to hire someone, it can be 6-12 months before we get a bite and sometimes, we don’t land them.

I enjoy seeing the patients. I know they sometimes don’t enjoy seeing me. That makes the work a bit harder. But I have never thought my job was to provide customer service. That’s a big part of the job, but it’s not the whole job. I had some very long and arduous training that instilled in me the sense of a higher purpose. I was trained to serve health, not to just give the customer whatever they wanted. Prescribing antibiotics to every child with a cold might make the worried mother feel better, like she was doing her best so she could then go off to work, leave the kid at daycare, she’d done her best, might make the customer happy. But it did not serve the child, the community.

When I first started practicing primary care in 1989, the most common prescription in the United States was Amoxicillin. It was commonly prescribed for children with colds. Many children with colds have the yellow snot draining out of their noses back up into their middle ears. Ah, an ear infection! We can treat that!

Amox 250/5ml I tsp tid for 10 days.

The kid gets better, and we glorious physicians get credit. But I had read the study that showed ¾ of middle ear infections get better in 2 weeks whether they are prescribed antibiotics or not. But then, we get no credit, do we? And it takes a while to convince the working mom her kid just needs some care, not drugs. And I need to see 25 patients a day to make my exorbitant salary. I can see why Amoxicillin was popular.

Ten years later the most popular drug was Oxycontin. You know how that turned out.

So, I work at this clinic a few days a week and I try to teach my fellow providers and the patients I see how to be healthy in the lives we live and the work we do. Two weeks back I came out to my frosty pickup and found a parking ticket. I had not gone home for lunch. I had brought a sandwich, thinking the noon drive home was wasteful. But the $25 ticket hurt.

I get to the clinic at 7AM and leave at 6PM. My lunch is from 1-2. We have a three-hour parking limit downtown. I guess the drive home made the parking enforcement people happy. The ticket irked me.

I tried another spot last week. Under the snow I scraped off in the dark was another ticket. This week I have decided to walk to work. It’s only about a mile.

My new knee is fine but the old left hip hurts. I don’t want to fall on the ice and snow. Send me your prayers.

If we want good healthcare in this country, we need to be thinking about just what that means. Do we want whatever we want whenever we want it? A patient’s partner last week called me an ignorant old man because I wouldn’t order all the wasteful blood tests his partner requested. “You need to get with it old man!” he glared at me. The ticket felt worse.

I know medicine. I do my best to practice that way. I can’t say I know the body politic. I wish we would have this discussion.

About ddxdx

A Family physician, former county coroner and former Idaho State Senator
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