I’m leaving: now public knowledge


Communication is never a picnic

In any medical clinic

            I sign ASL      

            And I speak Spanish well,

Oh NO! He is schizophrenic!

Our clinic’s conference room used to be our medical records storage area till we got our electronic medical record system.  Quiet and tasteful with a very nice boardroom table and comfortable executive chairs, windows along the ceiling let in the weak winter sun.

My steps bounce as I walk in, smiling, to find our two office managers, our corporate CEO, and one of my partners talking, lighthearted discussion among female executives who are good at what they do in the health care world and who enjoy being in touch with their feminine side. 

One by one, the other partners filter in. 

Bryce, like me, is a second generation physician.  Jeff is the most recently added partner, and, like me, is pushing sixty pretty hard.  Janice, like me, enjoys the behavioral aspects of the trade but wouldn’t mind slowing down.  Delna, our youngest doc, could easily be described as smokin’ hot, like me has a keen intellect and a passion for learning.  

Shanin, the CEO, notes everyone is present, does some magic things to the telephone and brings Mike, our most senior member, the only doctor who has been in our clinic longer than me, to a disembodied presence from the other side of the state.

I announce my career decision, grinning.  I dwell on the positive points: I have more resilience now than I’ll have in five years, I’ve met my lifetime financial goals, I’ve examined my original mission statement which emphasized serving the underserved.  I’m slowing down while I can still enjoy it.  I’m very positive about my career plans.  While my non-compete clause runs out I’ll be journeying around, revisiting the places where I was before I arrived and seeing how things have changed.  I’m going to be doing a lot of hunting come fall.  When my non compete is up I’ll probably work part time for the Community Health Center for a year, and after that I’ll probably open up a small office in South Sioux City.  Bethany and I have been talking about this for a long time and she’s taking classes to become a Certified Medical Assistant.

While I talk I look around the room.  Delna looks absolutely stricken. 

My delivery is very upbeat and optimistic.

I answer questions.  My partners, who have the same contract, didn’t know that the non-compete clause is for one year and 30 miles.

(My lawyer assured me that if I wanted to fight the non-compete clause I would probably prevail; they are illegal in Maryland and Colorado.  I assured her that when two doctors square off in a courtroom nobody wins.)

I talk about my time table, giving a tentative end date of the Friday before Memorial Day. 

 There will be, I say, a lot of details that will need to be hashed out, and I bring up the nursing home.

I’ve been the Medical Director at a nursing home for just over twenty years.  The relationship has been a good one, and we have made steady progress on the measurable quality parameters: falls, infections, hospitalizations, deaths, skin tears, and medication errors.  That relationship is external to my clinic duties, but the patient care I deliver there is not.  I have no intention of violating my non-compete clause by rounding on patients in the nursing home.  Does anyone want to round on them during that year?  Every two months?  There are only a half dozen or so? 

My partners all shake their heads, indicating a firm no. 

The CEO tells me I can be an independent contractor, do the billing through Corporate, and not be in violation of the contract.

My partners speak.  They all wish me well.  Bryce notes that I’m blazing a trail here because all of us will eventually retire, and we talk about Dan.

Dan is a good, solid doc.  For two decades he did medical care and documentation every bit as thorough as mine, and he did as good quality of medical care as mine, but he did it forty percent faster, and he never seemed strained.  He and I shared a love of words and etymology, and we both kept a stable of dictionaries in our offices.  He retired two years ago and disappeared.  We miss him. 

I have no plans to disappear.  I’m planning to come back and cover the December 25th holiday.  Janice says that means that the rest of them will still have to work Rosh Hashana, Yom Kippur, and Pesach.  We all laugh.

Mike’s disembodied voice comes from the speaker phone and wishes me well.

Shanin announces that there’s a young physician looking for a place in Sioux City.  The news is unexpected and very heartening.

Delna has been working on her computer off and on during the discussion and asks if we can help with a case.

She presents a patient, starting with age, gender, race, and presenting complaint, and goes into pertinent details.  Janice says that there’s now a Sjogren’s antibody panel.  I express surprise, and say that the patient’s dry mouth (in medicalese, xerostomia)  can probably be handled most economically with pilocarpine eye drops. 

I suppress the urge to the convoluted history of pilocarpine; it’s interesting to me, but for the time being I embrace just being part of the easy going interchange of ideas that has been the strength of our group for more than a quarter century.  It’s a very quick colloquium and at the end we are better doctors; it’s something we do several times a day and we’re very good at it.

The tone of the meeting has been very optimistic.  I have emphasized the good; I haven’t mentioned my ambivalence.  I emerge from the meeting euphoric.  I walk through the lunch room and grab a handful of chips.  The nurses and the PA’s notice my smile.  I don’t break the news. 

I’m in my office at 12:30 when the office manager calls for a quick meeting of all staff in the meeting room, and right afterwards my middle daughter calls.

She suffered a traumatic brain injury three years ago in a rock climbing accident and has been making slow progress since.  In the last few weeks she’s been doing hyperbaric oxygen and acupuncture and other treatments in Phoenix.  Insurance doesn’t pay. 

Her voice comes strong and clear as she asks me a medical question about her back pain, and I catch my breath.  When she done talking I ask her if she knows that the music has come back to her speech and my voice breaks.  I bask in the moment.  Yes, she has noticed, and she’s grateful that Bethany and I are paying for the treatments and enabling her to make progress.

When we hang up I sit quietly, grateful for the call and what I’ve heard. 

When I open up my email the first message that pops up promises to double or triple my income, have me seeing 10 patients a day instead of 30, for an investment of only $80,000.  I write them back that my career is taking the opposite direction, on purpose.

The first patient of the afternoon has an unusual headache.  I do the usual questions, take a quick look at the back of the eye, note the veins pulsing normally and I’m about to sit down and do my usual headache talk when I remember the dictum from the first day of med school: always touch the patient where they hurt, an eternal verity that will not change with technology.

The heat rises from the scalp to my fingers; the patient doesn’t feel at all feverish, yet the skin temp is very high.  When I sit back down I listen more carefully and I get a history of palpitations and unexplained weight change.  In the end I conclude that the problem is probably the thyroid, and I arrange for tests.

Throughout the afternoon the nurses and other staff come in, and I take hugs, one after another.  They will miss me. But I’m not gone yet.


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2 Responses to “I’m leaving: now public knowledge”

  1. Ritch Says:

    interesting soliloguy. Glad you’re doing what makes you happy!
    Go for it!

    your good friend,

  2. 2010 in review « Walkaboutdoc's Blog Says:

    […] I’m leaving: now public knowledge February 2010 1 comment […]

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