Notes from a smaller conference


The conference seemed rather small

A hundred and sixty was all

I picked through the fluff

And brought back some stuff

And we’re all taking way too much call.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  I danced back from the brink of burnout in 2010, and, honoring a one-year non-compete clause, went to have adventures and work in out-of-the-way locations.  After jobs in Alaska, New Zealand, Iowa, and Nebraska, I returned home and took up a part-time, 54 hour a week position with a Community Health Center.  Since August I’ve done a working vacation in Petersburg, Alaska, Continuing Medical Education (CME) in San Diego, and a trip to Mexico for our daughter’s wedding.  I’m in Denver now picking up more CME.

As the older, balding male white-haired docs, my generation, lecture about transformation of the American Health Care System, the younger docs, mostly female, no gray hair, file in with their coffees.  The young primarily work for someone else, these lecturers work private practice, fee for service. Except for one who just started working for the govt.  But the guys at the podium attack the problem from a logical, systemic approach.

The whole conference amounts to 160 people and the intellectual intimacy makes up for the lack of world-famous speakers.

When interest lags, the subtle sounds of electronic devices accumulate.  From the back of the room I see screens showing recreational, non-topic displays.

In the hallways and the lounges the practicing docs pass the students.  It’s not that they seem so young or naive, it’s that they seem energetic and passionate.  The phrase dilapidated, meaning literally to have polish removed, comes to mind when I look at the older physicians.

In a lecture on sinusitis, the doctor next to me falls asleep.  His face shows the stress of too many life-and-death decisions made in the middle of the night, the slings and arrows of healing without the healing balm of sleep for the healer.  I want to fall asleep, too.

In the evening I find my right rear tire low and I inflate it at a service station, but in the morning the tire gauge reveals pressure loss.  I pass a leisurely hour in the tire center and avoid horrendous traffic to arrive two hours late.  I have missed two lectures but neither topic interests me.  The first lecturer I listen to goes long because the next lecturer arrives late. He got stuck rounding by difficult cases.

The speech speed of two lecturers trumps intelligibility; twenty minutes into each talk the attendees start to whisper to each other about it, and the recreational screens light up again.  I suspect inappropriate pharmacologic use but I don’t say so.

I quit OB as my 60th birthday present to myself, in 2010, and I have no intention of making a comeback.  So I skip the day’s last lecture on prenatal care.  But I stop to chat with an ER doc and an OB/GYN next to the depleted snack table.  Conversation soon turns to Colorado’s legalization of recreational marijuana, and we start volleying data back and forth.  Children who show up in ER after getting into the now legal brownies and cookies never go to ICU and never die from the toxicity.  Too much marijuana causes terrible vomiting in the cannabis hyperemesis syndrome.  Those who toke before driving having more car accidents and fatalities than those who drink.  We fired facts back and forth like this in undergrad and med school instead of coming to blows, now we try to inform rather than convince.

Between lectures, consistent themes from the docs revolve around the amount of time that the EMR demands; we’re all spending more hours with the computer and less with the patient.

A professor emeritus lectures on William Osler, the premier physician of the last century.  The speaker’s voice is high and doesn’t project well.  He shuffles when he walks on the stage, his arms don’t swing, and the diagnosis of Parkinson’s shows painfully obvious.  But the talk goes well.  The startling news that Gertrude Stein went to med school and washed out in her 4th year brings the proper gasp of amazement, as does the fact that the founding 4 female philanthropists of Johns Hopkins Medical School demanded admission of women.

At the end of a week of lectures, we all agree we work better than we sit.

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