Hi everyone,

This has been an excellent thread, with numerous extremely well thought out replies.

I'm really not making any of these comments to brag. I'm sure that David or Jon or Jimmie or Adam or Todd could probably write exactly the same.

I am a 55-year-old solo family physician. I'm just short of my 25th anniversary in practice. My practice is much closer to a typical internal medicine practice, with older patient population, numerous medical problems, and numerous medications. Additionally, we are in a rather impoverished area, with high unemployment, much disability, lots of psychosocial problems, depression, and substance abuse issues.

I will typically see 25 to 30 patients daily, four days a week. Most of these are time and energy consuming, the easy ones we usually handle over the phone. At the end of the day, I am typically exhausted. But I believe I can truly say that I did my best for just about every patient I've seen.

What our patients need is our caring and our time. They need understanding, explanation, and reassurance. They need their medications reviewed, to try to figure out which other symptoms are coming from our best (or worst) efforts. They need us to listen to try to determine whether they need MRI, a referral, or an antidepressant (usually the latter.) They need us to be honest with them, to use our judgment, and for us to tell them what we really think they need or don't need, based on medical likelihood, not based on our chance of being sued. And they also need us to be able to tell them when they are approaching the end, and that we will provide care to the end.

In terms of cost to the system, I believe that the care that I (and probably most members of this forum) provide is extremely cost effective. This is not shown in the quarterly statements I get from the managed-care companies, looking at my immediate cost. But in terms of preventing hospitalizations, preventing unnecessary procedures, minimizing referrals, and overall keeping people healthy, I think I'm a huge bargain to the insurance companies.

Economically, I, too, am struck by the unfairness of the payment system. As many have observed, procedure oriented specialists, and surgeons make much more than I do.

But what else can we do? If you see the patient as a person, if you believe the Golden Rule is not just a nice saying, and (for some of us) if you believe that each of us was created and designed by God, and that Jesus gave his life for each of us, there is no choice in the matter. We have to practice the way we do. There is no other choice.

I, too, have been honored to participate in this User Board. The collection of wisdom, not only about electronic medical records and computers, but about medicine, finances, and life, found here is extraordinary. The willingness of users to share their knowledge, and contribute their time and talents, goes hand-in-hand with the willingness to provide excellent care to patients.

Thanks to all.

Gene

Gene Nallin MD solo family practice with one PA Cumberland, Md