A short letter from the lake

As many long-time readers of this column know, the place where we recharge as a family in the summer is a tiny wooden house high above 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. The porch juts out over the water and is perfect for breakfast in the morning breeze and a glorious sunset to end the day.

The interior of the house screams 1970s. My in-laws chose wild wallpaper patterns for each room, no two are the same – stripes in pop art colors, bouquets of wildflowers, nature scenes, a flood of sunflowers. Much of the interior needs to be restored and renovated, from the furniture to the carpets and the appliances to the plumbing and electrical. But it has character and is worth saving.

Even if I only spend a few days there – whether it is mostly cloudy and rainy, like on this trip, or sunny and bright – I always feel good and think about all the things I want to do for myself, my family, my practice and our patients.

I’ve told you before how terrible I am with to-do lists and how they always turn into actual to-do lists. But during a quiet period, when my wife was in a room working for her foundation and our kids were reading and doing puzzles on their own, I sat down and grabbed a pen and paper. The lists just poured out of me.

When I look back at all the things I wanted to do, they were all small things, but also gigantic ones, from simple, easy solutions to things that require moving mountains. Everything was geared towards making a difference and bringing back a little of the joy that has been missing lately in the modern healthcare system that has sprung up around us.

Work-related topics ranged from the sublime to the ridiculous, from the hopeful to the hopeless, from noble goals to simple demands, from difficult tasks to simple solutions. How do I make sure the candy bowl next to my desk is always full? And why does no one ever eat the Three Musketeers mini bars?

Why have we installed an e-faxing system that doesn’t allow us to fill out and sign forms and then e-fax them back to where they came from? These e-faxed documents further clutter up the media section of our electronic health record and make it even more difficult to find the useful information they contain, such as external scanned consultations or digital photos of clinically important findings.

That administrative stuff should be put somewhere else, in a separate field of the electronic health record, separate 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 who scans it back into the system, and then fax it to its destination. That defeats the whole purpose.

In our practice, the printers never work because the electronic medical record’s printing function is set up in a mysterious and complicated way. And the daily challenge of finding a working printer with the right paper adds to the chaos as we try to print copies of our notes, patient lab results, forms, and prescriptions for durable medical equipment.

The designers of our electronic health record have added incredible features that allow us to successfully and easily screen our patients for a wide range of conditions—from social determinants of health to mental health issues—and conduct annual well-being exams under Medicare. But we have not yet developed a streamlined system to ensure that these exams and visits happen for every patient who needs them. Simply telling doctors to make sure this gets done only increases our burden and burnout, so that cannot be the solution.

And I won’t even get started on the question of whether mental illness needs to be diagnosed. Our facility does not have the resources to send patients there when we determine they need more complex mental health care than we can provide in a quick primary care visit. And the list goes on.

So I’m not saying I have it all figured out and solved all of these pressing problems, big and small, but as always, these few relaxing days at the lake leave me feeling ready to make changes, to re-energize myself, the staff, our faculty, our residents, and maybe even the entire facility to help us all get our patients to better health.

I think the faculty know that when I return, there will be a flood of new agenda items, committees, and working groups. Population health, quality improvement and quality assurance for a wide range of topics, research, mentoring, AI in healthcare, education reform, fellowships, wellness, promotions, and more—all of these need advocates.

I’m looking forward to coming back to the city. I hope everyone is ready for me.

And I’ll set the bulk candy order to automatically refill three months – but without the Three Musketeers.