My daughter and I were standing on line in an upscale cross-country ski lodge near Sun Valley.  The man in front of us ordered for himself and then his somewhat younger and obviously starstruck female companion. Their order consisted of two hamburgers, two coffees, and two large chocolate-chip cookies, and their bill came to about $30. He handed the guy behind the counter a $100 bill and said, just a bit louder than necessary, “Keep the change.”

As I watched my 17 month old granddaughter decode the world, it was impossible not to marvel at the enormity of the task and wonder what was going on behind that so expressive face as she processes the flood of sights, sounds, feelings, tastes, experiences, and consequences. Some predictable, but many not.

Since I retired, I have repeatedly been asked two questions. “How do you like retirement?” and “Don’t you miss practicing medicine?”

Imagine that you want a boat. You tell someone to build or buy you a boat, and tell them to send you a bill. What would you get? A kayak? A windsurfer? A boat for waterskiing? A sailboat. A party boat? A cruise ship? A submarine? A battleship or destroyer? You probably would not get what you want. Very likely you would end up with something expensive - that you cannot use.

Before you build or buy a boat, you need a defined goal and a process:

This week, waiting at a local hairdresser for my appointment, I had an unnerving experience.

Two women came in together and sat down. They were talking enthusiastically about the previous night’s State of the State address by Governor Lepage, pleased with how well he spoke and looking forward to some of his promises. At one point, one of the women said: “It’s too bad they won’t let him do what he wants. If they did, he’d get rid of all those Somalis.”

After four decades in medicine, I retired from the active practice of primary care 15 months ago.  I still get asked at least once a day: “Well, how’s retirement treating you?” My usual reply is that it is a learning process. A more accurate response would be that it is like playing Tetris, but with pieces that change shape and rotate unpredictably as they fall.

(For those not of a certain age, here is Tetris:

This is a repost of something I wrote in 2012 about how I discovered that doing collaborative officie visit notes with patients transformed the process for both the patient and myself.

Nearly a year ago I embarked on an adventure that has been changing how I practice medicine. It is also changing how medicine feels. 

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.