Archive for August, 2014

Three doctors over breakfast discussing contracts, diabetes, trauma and hearts

August 31, 2014

At breakfast sat down doctors three
The advice that we gave was for free
We talked about cases
And contractual places
And what we should charge for a fee.



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 for adventures working in out-of-the-way locations. After jobs in Alaska, New Zealand, Iowa, and Nebraska, I returned home and took a part-time position with a Community Health Center. I still take short-term positions occasionally.

Three of us met on a Thursday at a popular coffee spot. Over trendy breakfast items and flavored lattes we discussed game theory and negotiating techniques.

A couple of Thursdays or Fridays per month have found us at a morning meal together for the last couple of years. We have guided each other through difficult items of a doctor’s career. We all face hard decisions for our lives and our life’s work.

We do not hesitate to give voice to good advice in the face of questionable choices, and we each have regretted not taking our own advice.

But yesterday we talked about getting a better offer. One who has no willingness to walk away from a deal has no bargaining position at all. We have all faced bait-and-switch situations; an employer has said one thing, made a deal, then unilaterally changed the circumstances. What can a doctor do?
None of us alone has more wisdom than all of us put together, and our group consciousness guides us to better decisions and actions.

We finished stronger than when we had started but we ran out of time and we still had cases to discuss. Because the business of being a doctor and the work of being a doctor are so intertwined. Come to my house tomorrow at 7:00AM, I said, I’ll make omelets and we’ll continue.

As dawn on Friday broke, I engineered quick but elaborate breakfast dishes. Jarlsburg cheese caramelized in the frying pan as the discussion started.

For reasons of anonymity, I will leave out who presented which patient.

An 18 year old female with thrush, or, at least, a painful mouth diagnosed elsewhere as thrush.
“Does she have HIV?” one asked. No, she didn’t, but that’s a good thought and the test came up negative. “How about the 3 P’s?” came the next question. Excellent, the presenter said, referring to polydipsia, polyuria, and polyphagia (drinking a lot, urinating a lot and eating a lot), the three signs of diabetes we all learned in medical school. Yes, she did; her sugar was 424. There followed a presentation about distinguishing Type I diabetes, where the patient will need insulin for the rest of her life, from Type II, where diet, exercise and pills can take care of the problem. We talked about 4 lab tests 2 of us had never heard of, and how the phone call to the endocrinologist (hormone specialist) went.

Then a case of wide-complex ventricular tachycardia with low blood pressure, a presentation classic from Advanced Cardiac Life Support, a course we’ve all taken. And after that, a death from massive trauma, complicated by legal and administrative issues and a difficult family situation.

As we ate mushrooms, onions, fresh basil, eggs and cheese, each of us filled in the human details, the heart-rending impact of disease as it ripples through the family, the community, and the hospital staff. By the time we finished we were better doctors.