I'm making myself crazy. I'm working on Thanksgiving Day, seeing a trickle of patients (about one per hour). This is to be expected. But I am beating myself up because I am overdue for my next blog post (in my internal schedule it was due to be published a day or two ago).


In actual fact, I had about 70% of a post ready to go two days ago. But I decided that it just sucked, so I sent it to the WordPress trash bin.

Since then, I have been vacillating over what to write about. At the same time, I have been thinking to myself “Why bother?” It is Thanksgiving day. Nobody is at home. And if they are home, they're cooking or eating dinner. Or they're already in a turkey- (tryptophan-) induced coma.

(Please, don't argue this point – I know that eating turkey does NOT cause increases in tryptophan, or melatonin. As a vegetarian that doesn't eat turkey, I can attest to the fact that I still get very sleepy after Thanksgiving dinner.)

Oh – one other admission…

If I was a good blogger, I would not be fretting over this, because I would have several posts already written and in the queue. That's more evidence of my failure as a blogger.

Maybe I'm being too hard on myself. After all, I ‘m not a professional blogger.

But I am trying to instill good habits in my blogging. And two of the rules are:

  1. Be consistent and post on a regular basis, and
  2. Write posts ahead of schedule so that little “hiccups” do not interfere with following rule #1.

Unforgettable Patients

So, I decided to write about the types of patients I have seen over the years that gently, or not so gently, reinforced my goal to stop doing any clinical work whatsoever. I had already begun working as vice president for medical affairs full-time. But I was still seeing patients 2 or 3 half days each week.

Keep this in mind: when you transition from clinician to administrator in your home hospital (as opposed to taking a job in a new city), it is easy to end up working one full-time and one part-time job. But I digress…

My primary reason for stopping the clinical work was to focus 100% on my administrative duties. I was getting very busy with administrative responsibility for six clinical areas within my hospital:

  • Quality Improvement
  • Risk Management/Patient Safety
  • Pharmacy
  • Physician Services
  • Laboratory
  • Imaging


Needless to say, the clinical work sometimes interfered with some of that work. Juggling both could get challenging. I clearly remember, however, some of the patient types that made me dread certain days in the office. I certainly did not miss the following types of patients when I left practice:

  • The chronically ill and addicted. I had several Type 2 diabetic patients who were just NEVER able to get their glucose levels under control. I tried every kind of cajoling and combination of the  medications available. But they continued to drink alcohol, would not follow a diet, and refused to lift a finger to exercise. They were always surprised when they developed a foot ulcer or a scrotal abscess that would not heal.
  • The 30- or 40-year old with one day of cold symptoms. They were often planning to travel and wanted to make sure they would not be ill while on their trip.
  • The hypochondriacal patient with no confirmable medical illness. They came in weekly for whatever new hint of a symptom they had. According to my board prep CDs the treatment for this is to proactively schedule visits every week or so. What these patients really needed was reassurance and some face time with a physician. I get that, but it's hard to do when you're trying to care for several thousand patients with the help of a nurse practitioner and only 2 half days in the office.
  • The overly familiar patient. He thinks that he's in the office to shoot the breeze for 20 minutes. My least favorite one of these had such severe obesity and sleep apnea that he had a tracheostomy and was on a home ventilator. His respiratory tree was chronically colonized with MRSA. He'd come in the office coughing through his trach and the staff would scatter.

Working in urgent care now, I don't usually see many of those kinds of patients. But I see many trivial illnesses that could be cared for via telemedicine or simple home remedies. It makes me wonder about the future of medicine.

It being Thanksgiving Day, however, I am reminded to be thankful. And I am. For my wife and family; my career; and even my patients. And my opportunity to try to serve my audience here on the Vital Physician Executive.

I hope you had a great week.

Thanks for listening.