COVID-19

Are you all as sick of this COVID disaster as I am? I am absolutely done with it. I have one patient that has had COVID 3 times. One was before vaccine and the second was post the booster and the third was Omnicron. Just about every positive case I have seen in the past three months was vaccinated and boosted. Now I hear that having had one of the earlier Omnicron variants does not give significant protection against the B4 or B5 variants.

What has happened to Internal Medicine?

Why don’t medical students want to go into general internal medicine? I must admit I really miss the exciting challenges I faced when I admitted my own patients and cared for them in the ICU and the general medicine units. But, and this is a BIG but, I don’t miss the all nighters and long weekends of call. Outpatient medicine can be very satisfying but one needs to let go of the hospital based physician identity and be comfortable with the idea of letting someone else (hospitalists) take over the care of your patients when they require hospitalization.
I think physicians specializing in outpatient internal medicine are still desperately needed to manage the complex adult patient. We bring a great fund of knowledge into the outpatient setting and I believe we can do it more efficiently than using a boatload of sub-specialists for every complicated patient.

Generational differences in the way physicians approach the future of healthcare

I used to think that physicians and the medical staffs that they belonged to did not reflect society’s attitude toward the more senior members. As a young resident in Internal Medicine I was in awe of those grey haired giants of medicine that would lead us on rounds and challenge us to excellence. But now when I look in the mirror I see to my utter disbelief that I have become one of those grey haired elders of medicine. But what is different is that the younger physicians don’t seem to think that wisdom comes with years.

It would appear that we are no different than society at large. Just take a look at politics where there are a large number of politicians who are quite “senior” that are being marginalized by players like The Squad. Don’t get me wrong, I believe new ideas are very important if we hope to get healthcare on the right track but I believe older and experienced doctors can still have new and vibrant ideas.

How to keep physicians engaged

I really want to be positive and presume we all want the same thing; that is to be successful, enjoy caring for our patients and to be reimbursed commensurate with our efforts.

Physicians are typically self motivated and value their autonomy. If we want physicians to be engaged we need to recognize and encourage their strengths rather than boxing them in and limiting their creativity. It can be a fine line between a disruptive physician and a free thinker with out of the box ideas.

When we look at physicians that are “burned out” we typically see physicians that are not engaged and it has been my observation that they have not been engaged in quite some time. Frequently these providers have not been interested in social interactions with colleagues and don’t take part in functions sponsored by the medical staff or hospital organization. By not being part of the medical staff “family” they lose a valuable source of peer support and may not be considered team players.

Trust?

So how do you know if your organization is putting your best interest first and foremost? I would hope that putting patient care first also translates into keeping physicians happy and satisfied. A happy physician is much more likely to keep their patients satisfied and provide top decile care.

First post to my new blog.

I have practiced Internal Medicine for the past 35 years. The last eight years have been only in the outpatient setting. Until recently, I chaired the Utilization Management Committee but I was recently replaced by one of the Hospitalist physicians.

I have seen major changes in the way medicine has been practiced over the years and I hope to make observations and comments that may help my fellow healthcare providers deal with the rapidly changing landscape. You will note that I referred to myself as a “healthcare provider ” not a physician, which tips my hand as to what I think about some of the recent changes.