Opinion | A Brief Missive From the Lake

As many longtime readers of this column know, the place we go as a family to recharge over the summer is a tiny little wooden house perched out over a lake in central New Hampshire. It’s a little orange-and-yellow-painted gem that has been in my wife’s family for over 120 years, with a porch hanging out over the water that’s perfect for breakfasts in the morning breeze and watching gorgeous sunsets to end the days.

The interior of the house screams the 1970s. My in-laws picked some wild wallpaper patterns for every room, none of them the same — pop-art-colored stripes, bunches of wildflowers, nature scenes, an onslaught of sunflowers. Much of the interior needs restoring and renovating, from the furniture to the carpeting to the appliances to the plumbing to the electrical system. But it’s got character, and it’s worth saving.

Spending even a few days there — whether it’s mostly cloudy and rainy, as it was this trip, or sunny and bright — always puts me in a good place, makes me think about all the things I want to get done for myself, my family, my practice, and our patients.

I’ve told you guys before how terrible I am about To-Do lists, and how they always become Meant-To-Do lists. But during one quiet stretch of time, when my wife was in one room doing some work for her foundation, and our kids were off reading and doing jigsaw puzzles on their own, I sat down and put pen to paper. The lists came pouring out.

Looking back over all the things I wanted to do, they ranged from the small to the gargantuan, from the easy, simple fixes to the things that are going to need mountains moved. Everything was designed to move something forward, to try and bring back a little bit of the joy that of late has been missing from the modern healthcare system that’s grown up around us.

The work-related items ranged from the sublime to the ridiculous, the hopeful to the hopeless, lofty goals and simple demands, heavy lifts and easy fixes. How do I make sure that the candy bowl next to my desk is always filled? And why doesn’t anyone ever eat the mini Three Musketeers bars?

Why have we installed a system for e-faxing that doesn’t let us fill out and sign forms and then e-fax them back whence they came? Now these e-faxed documents further clutter the Media section of our electronic health record, making it even harder to find the useful stuff contained therein, such as outside scanned consults or digital photos of clinically important findings.

This administrative stuff should be housed elsewhere, in a separate field in the electronic health record, away from anything clinical. And right now, we have to click on the e-faxed image, print it out, fill it out, then give it to someone to scan back into the system, and then fax it to its destination. That defeats the whole purpose.

Printers never work at our practice, because of the arcane and twisted way in which the print function has been set up in the electronic health record, and the daily challenge of finding a printer that’s working and filled with the correct paper adds to the chaos as we try to print out copies of our notes, lab results for patients, forms, and durable medical equipment prescriptions.

The builders of our electronic health record have added incredible functionality, allowing us to successfully and easily screen our patients for a variety of conditions — from social determinants of health to mental health issues — and to perform Medicare annual wellness visits and annual health reviews. But we have not yet been able to figure out a streamlined system for making sure these screenings and visits happen for every patient that needs them. Just telling the doctors that they need to make sure those are done only adds to our burden and burnout, so this cannot be the answer.

And don’t get me started on screening for mental health needs when our institution is lacking in resources for where to send patients once we’ve figured out that they need more complicated mental health care than we can provide in a brief primary care visit. And the lists go on.

So I’m not saying that I figured everything out, that I’ve solved all of these pressing issues, small or large. But as usual, these few rejuvenating days at the lake make me feel poised to bring about change, to re-energize myself, the staff, our faculty, and our residents, and maybe even the institution as a whole, to help us all move our patients to a better state of health.

I think the faculty know that on my return there will be a burst of new agenda items, committees, and task forces. Population health, quality improvement and quality assurance for a huge swath of topics, research, mentorship, AI in healthcare, education reform, scholarship, wellness, promotions, and more, all in need of champions.

Looking forward, I’m ready to head back to the city. Hope everyone is ready for me.

And I will be setting the bulk candy order for 3-month auto-refill — but hold the Three Musketeers.

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