My last day of work was April 3rd, 2021. I remember it well. I went home and poured my husband and I a shot of Johnny Walker Blue that we had bought for the occasion. It was a celebration of the end of my clinical career in medicine. Over a decade gone since I graduated residency. Down the hatch it went, burning the whole way down.
That nasty turpentine like taste stayed with me long after that night. In fact, whiskey happened to be a great metaphor for my last 10 years in medicine. It’s sterile, hard to swallow, heartburn inducing nature is either something you can get used to or a bitter liquid that gets harder to choke down every day. Indeed, medicine today has gone so far away from the sweet, bubbly, prosecco like quality that we all either remember or expected to find that I doubt you could locate anyone other than medical students who are still excited about the practice. The ability to save someone’s life, change someone’s family tree or work with them to meaningfully improve their quality of life lies in stark contrast to the day-to-day existence of documentation requirements, billing and coding denials, HIPAA regulations, organizational KPIs, online training, etc. etc. etc.
No one really knows when the wine changed to whiskey, but the insidious nature of it indicates it started with our language. Years ago, when physicians were owners of their clinics and leaders of their hospitals, people were patients and not customers. Patients were neighbors, friends, coworkers, and family. Doctors provided care, not services. Surgeons performed surgery, not billable procedures. The focus was on how people felt, not outcomes. The language described what people did, not what insurance billed.
When our language changes, so does our perspective. With layers of administration, come new terms like ROI, value-based care, market share, etc. Business terms previously had no business in the doctor patient relationship and in my mind, they still shouldn’t. We all know this instinctively, so we change our wording to make the words that burn more palatable and easier to swallow. Sales becomes marketing, payment becomes compensation, and mistakes become medical errors. In the numbing process, we lose the humanity of medicine. Hugs become handshakes, time in the room gets shorter and everyone feels rushed. No one (doctor or patient) feels heard. Interactions become about conveying information and less about the feeling and living.
April 3rd, 2021 was my last day of work. My last day of working within a system designed to separate the patient from the doctor. After 8 months of decompression, deep introspection, and a lot of long runs, I was ready. In 2022, I started a clinic designed to strengthen the doctor patient relationship. Discreet Reductions is my answer to the question “What will I do now, now that I can do anything?”. There are no layers of staff between myself and my patients. When you call, you talk to me. If you email or message through the patient portal, I answer. I take your vitals, examine you, listen to your concerns and dispense medications and advice. Discreet Reductions is not a business, but a passion project about bringing the joy back to medicine for both the patient and the doctor. I want to show the world that the impossible can be done. That medicine is not a business but can pay a fair wage. That we should work towards improving health, not treating disease. That while the doctor customer relationship burns, the doctor patient relationship can still effervesce.