My blog represents my personal experiences and perspectives. This includes many anecdotes from my life and from my medical practice. I have been scrupulous to anonymize all medical anecdotes and to avoid ever belittling or making fun of patients. (I often make fun of and criticize myself, my colleagues, and the institutions where I have worked.)

Dear (Patient) John letter

PeterElias
31 Jul 2012

This imaginary letter, penned after attending a Quality Initiative meeting, is fictional today, but I suspect something like it will appear in the near future and be sadly common within five years. I hope I have retired by that time, because it would be truly shameful to actually sign and send such a letter.

Dear (computer generated patient name),

I am writing to express my deepest regret that I can no longer serve as your PCP.  I will continue to provide you with all appropriate care during the next sixty days while you arrange an alternative provider.

The best defense

PeterElias
28 Jul 2012

This folk wisdom is variously attributed to Sun Tzu (The Art of War), Carl von Clausewitz, Mae Zedong, and the heavyweight prizefighter Jack Dempsey. Regardless of origin, it deserves its place in the pantheon of behavioral truths.

During a recent conversation with a patient about her irritable bowel syndrome, I asked about possible stressors:

“So, tell me, I know it’s hard to manage both full time school and a part time job, but I wonder if there are any other things going on for you that you wish you could change?”

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