Literally, “More.”

The talk I like gently to prod,

With my eyebrows, my smile and nod

I don’t like abrupt

So I don’t interrupt

Today, my smile was broad. 

Synopsis: I’m a Family Practitioner from Sioux City, Iowa.  In 2010 I danced back from the brink of burnout, and, honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand.  I followed 3 years Community Health Center work with more travel and adventures in temporary positions in Iowa, Pennsylvania, Nebraska, Canada, and Alaska.  2019 included hospitalist work in my home town and rural medicine in northern British Columbia.  Since the pandemic started, I did 10 months of telemedicine in my basement, staffed a COVID-19 clinic in southeast Iowa, visited family, attended funerals, and worked as a contractor for the Veterans Administration in South Dakota.  Recently returned from a family visit to Israel, I currently hold a part-time position in northwest Iowa, reasonably close to home.

The average physician interrupts the patient 17 seconds into the visit.  I try to work against that trend.  I say something like, “How can I help?” or “What brings you here?”  or “Tell me about your (ankle, rash, sore throat, etc.,etc.).  I take notes and I wait till they quit talking.  I gently encourage them to continue by using my eyebrows and by nodding.  When they stop, I say, “Tell me more.”

Today the patient said, “More.”

I didn’t get it, and his pandemic mask hid what was probably a mischievous smile.  So I nodded and said, “More.”

He said, “More.”  Then I got it, and I laughed out loud. 

I have been using the same interview techniques for 30 years.  Today, for the first time, the patient took the command literally. 

I complimented him.

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I took care of 5 patients in the morning and 5 in the afternoon.  One I had met before.  The youngest was 3, the oldest over 80.  Two with back pain, five others with disorders in the extremities, and three for women’s health problems.  I used Google images twice. 

When I was overworking myself in private practice, the ideal clinic day had 36 patients; 4 less brought paranoia, and I risked my sanity if I tried to get in 4 more.  At the time, I worked 84 hours a week.  If one full time equivalent (FTE) means 40 hours a week, I became, effectively, 2.1 FTEs.  Now that I work 3 days one week and 4 days the next, I constitute .7 FTEs.  So that the ratio of patients I used to see, to patients I see now corresponds to the drop in number of hours:  2.1/.7=36/12. 

I like to say I did not retire in 2010, but in fact my decision to bring sanity back to my life reduced the healthcare work force by 1.4 FTEs. 

Too many doctors worked too many hours for too many years.  The pandemic brought shocking amounts of death to our colleagues, patients, and coworkers, and, as a group, we started to wonder why we push ourselves so hard.

And a lot of us decided to stop pushing.