Mea sententia

It was our first Fall in Maine...

It was the week before final exams at the end of my first year in medical school when the pain in my back lower left molar finally reached a point where it could no longer be ignored. And I had ignored my teeth for some time.

Four years ago this month, my family practice elected to join a local hospital owned and managed outpatient medical group. It has not gone as planned.

The language of medicine is highly evolved and complex and allows clear, detailed, specific and unambiguous descriptions. Except when it’s not.

They say, life imitates art.

Christopher Kedzie coined the term Dictator’s Dilemma in the early 1990s in reference to the fact that a dictator’s attempts to prevent opposition by controlling access to information and limiting the ability to use the internet for communication or community building has the inevitable effect of harming business and damaging the economy, resulting in conditions more conducive to rebellion.

Our group of four family physicians had just recruited a fifth physician to join us. We knew him pretty well, having served as preceptors both for his inpatient medicine experience as well as a six-week rotation seeing our patients in our office. He was born and raised in the local community and already had longer-term relationships with some of our patients than we would ever have. The negotiations were complete, the papers were signed, and the five of us were celebrating over dinner.

Even knowing I would end up running late, I always looked forward to my biweekly visits with Charles in Hospice.

Primary care medicine is intense and chaotic, a constantly mutating kaleidoscope of information, emotions, goals and obstacles. It is designed to confuse and distract, and will find and magnify any tendencies towards ADD in even the most organized clinician.  During my 30+ years as a family doc, I’ve come to depend on some core principles and concepts to stay grounded and maintain focus. Below the fold are my Ten Rules.

There are four questions that should be asked AND ANSWERED as soon as a project is initiated, a problem solving process is started, or an issue is identified for analysis.