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A Two-Biscotti Physician

[Recently] I ate at one of my favorite Italian restaurants. I had eaten there many times before, but the experience this time was different. After ordering, I received a vacuous bread basket with precisely two pieces of bread. At the end of my meal I was offered two biscotti — and no more. Only the manager could offer an explanation: As a means of containing costs, the decision had been made to capitate bread and biscotti distribution.

I was disappointed. I had been eating here for years. When Colic Solved was released, my publication party was held here. After all those anniversaries, New Year’s celebrations, and birthdays, I’m shortchanged on cookies? It’s remarkable how a great experience can be shadowed by something so small.

Then I got to thinking: Perhaps I’m a two-biscotti physician. Like this restaurant, there are times when I don’t finish well. I may do a phenomenal job with assessment and diagnosis, only to delay a callback on biopsies or X-ray results. Perhaps I get it all right, but fail to get the detail right on the home health orders. Are there small pieces missing in my encounter that represent everything a parent remembers? I know that there are, and I know there are things I have to work on.

There’s a lot we can learn from a restaurant. I don’t want to be a two-biscotti physician.

*This blog post was originally published at 33 Charts*

The End Of Private Practice?

I didn’t need the Wall Street Journal to tell that the days of “private practice” are numbered. According to recent numbers, fewer and fewer medical practices are under the ownership of physicians. Even in my corner of the economically secure State of Texas, small practices are folding faster than beach chairs at high tide.

I was driven out of private practice in 2004 by rising malpractice premiums and plummeting reimbursement. In Texas at the time the trial attorneys ran the place and medmal insurance carriers simply couldn’t keep up with the greed.

Medical practices are just too expensive to run and the services that physicians provide are dangerously undervalued. You do the math. Sure it’s a complicated issue. But the end result is institutionally-employed doctors with institutional pay and the risk of institutional service. Read more »

*This blog post was originally published at 33 Charts*

Reaching Doctors In The Virtual World

It’s the great migration to digital. And as civilization makes its move, the pharmaceutical industry is trying to figure out how to reach out to physicians. Pharmaceutical reps are slowly becoming a thing of the past. Branded medication portals leave most doctors cold. Email outreach is marginal.

Pharma strategists ask me how to reach doctors in the new world. I don’t have an answer. It isn’t that I can’t come up with an answer. It’s just that a good one doesn’t exist. Why?

Doctors aren’t anywhere right now. They’re stuck somewhere between the analog and digital. Socially they’re nebulous. Their virtual communities are non-existent. Public social networks are sparsely populated. When they participate they watch and rarely create or discuss. Our profession is going through a lot right now and it’s evident in anemic digital adoption. Read more »

*This blog post was originally published at 33 Charts*

Social Neighborhoods: How Many Can A Doctor Have?

Recently I was speaking to some physicians about social media. As we discussed the evolution of public social platforms and physician-specific networks the question came up: “How many social networks can a doctor have?” In other words, if a doctor dedicates time to Facebook and Twitter, will he or she then also spend time on Sermo, iMedExchange, or Doximity? This is an important question if you’re in the business of attracting doctors to a specific network.

As part of the attention crash, we’re facing the reality of human bandwith. We can only socialize in so many places. I always tell physicians starting out to pick their social spaces carefully. You can only dedicate so much time to social. For me, my attention is spent here on 33 charts and on Twitter. I’ve been tempted to get into podcasting, video and other media, but time is a limited commodity. Read more »

*This blog post was originally published at 33 Charts*

When I Really Felt Like A Doctor

PalMD over at The White Coat Underground recently asked: “When did you really feel like a doctor?” Interesting question that I could answer in a number of ways.

While I didn’t know it at the time, I felt like a doctor around 4am during my first night on call. I was an intern on the hematology ward at Texas Children’s Hospital. I was fresh out of medical school, I had chosen a residency known for its mind-boggling volume, and the kids were really sick. I had hit a point where I simply couldn’t keep up with what was in front of me. I stole away into the 6th-floor stairwell in the Children’s Abercrombie building, put my face into my hands, and began to cry.

My first call night was a metaphor for my career. I had no idea at the time that the idea of simply keeping up would be a theme that would follow me through my training and into my day-to-day work.

While I can’t remember the last time I cried at the hospital, I continue to struggle with input. I work to keep up with inbound information and professional social dialog. How I handle information or how I appear to handle it defines me as a physician. Harnessing this attention crash through technology will represent a major defining moment for the next generation of physicians.

*This blog post was originally published at 33 Charts*

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