Dr. Iliff’s 2009 Practice Newsletter
2008 in Review: This was a terrible year for anyone who lost a job, and a pretty bad year for all the rest of us. In the past I’ve had fun with rumors that I was going to “retire” (as if I could have fun doing anything else full time), and joked that I’ll be right here in Fleming Place until I’m 70½, at least. Forget that. At the rate my retirement savings are going, I’m going to be buried with my stethoscope on. But on a more positive note: What’s so bad about that? Could anyone ask for more than to remain happily productive until the last day? Hoping for a “Well done, thou good and faithful servant” on the next? Happiness, rightly understood, is the proper goal of life on earth. From a material standpoint, it requires just four things: 1. A productive occupation (whether or not we are paid for it); 2. Good relationships with at least a few worthy people; 3. Enough money to be comfortably supplied with food, clothing, and shelter, and free from the fear of losing those necessities; 4. Good enough health to enjoy the first three. So whatever 2009 may bring, resolve to concentrate on what is important. Thus endeth the lesson. Now back to Health.
Points of Emphasis for 2008: Electronic prescribing has, in general, gone well. There have been technical glitches which have wasted a lot of Jackie’s time, but we still think it will save time, and more important, eliminate inconvenient or dangerous errors. By now all of your chronic medications are entered into our iScribe system. What’s Your Mile? has been a failure. I still think it’s a great idea, but I only have so much time to promote it to you. If any of you have any ideas to make it easier or more accessible to test your own fitness level, please give me your thoughts. In the meantime, you can still read about the test and enter your data on the Healthy Kansas website. Unless you have a lifestyle which naturally lends itself to physical activity, you absolutely have to find some way to get supplemental exercise, and learn to like it.
Point of Emphasis for 2009: Reducing the time my nurses spend on the phone unnecessarily. I know it’s frustrating for patients to get a busy signal when you call. It’s also frustrating to wait on hold to talk to a nurse. Here are some random thoughts on this problem.
Breakfast of Champions: At least once a year we make all of you measure your body fat. Then we tape it to a sheet with some explanatory material, which includes what I began calling the Breakfast of Champions as a joke many years ago. The title is a joke. The substance is real. Because I spent a lot more time the past year (reason?) answering questions about what vitamins I would recommend routinely, or whether I really mean what I wrote, let’s spend some time on this. I really mean what I wrote. There is a reason for everything on that list, but some of the reasons are better than others. Here are the high points:
Paying Attention: Recently we lost another patient prematurely. He was a really nice guy, and I always enjoyed his visits. I take these things very, very personally. It is a slap in the face, and I think about it every day for months. It’s the worst part about being in family medicine: losing a friend, and wondering what I could have done to make a difference. We always do an “office autopsy”, looking for what we might have missed. One common denominator in almost all these cases is that the patient has failed repeatedly to do the database physical we recommend, and so he eventually died from a condition which we could have caught a long time ago. Here’s a line from the movie Hardball: “The most important thing in life is just showing up.” The application here is that you just have to show up, and we’ll do the rest. For some of you, all that means is an Attaboy. For others, it means a lot of work and a lot of pills. But if you’ll do it, your family, friends, employer, insurer, and you, yourself, will be a lot happier in the long run. Maybe, for males, I need to start asking for database physicals every two years starting at 40, instead of 50. 50 is fine for females, as long as you’re getting pap smears and mammograms-- heart disease hits a decade later for you. That would mean some wasted money for guys who are healthy, just to have a better chance to wear down the resistance of the knuckleheads who really need it. I don’t know. Life’s full of tough calls. In the meantime, ladies-- make that appointment for your man. He won’t thank you, but it’s for his own good.
Family-Centered Maternity Care: I don’t advertise our practice in the Yellow Pages, or radio, or TV. The vast majority of our new patients come from your recommendations. I haven’t asked for those, but I appreciate your trust in our service, and we couldn’t exist without you. Now I’m going to ask for something specific. Dr. Laccheo, and several other local family physicians, are giving up OB. It’s not that they don’t enjoy delivering babies-- but with C-sections more frequent, and lots of good obstetric specialists in town, they’re just not doing enough deliveries to stay good at it. I’m not there yet, but my numbers are dropping. Just because I enjoy delivering babies isn’t a good reason for recommending us to friends. We have some advantages, the most important of which are convenience, cost, and continuity. We don’t waste money on ultrasounds just to pad our net income. We answer questions about other family members, and take care of other problems (don’t ask your obstetrician about that rash, or your sister‘s arrhythmia) during a one-stop-shopping visit. We don’t schedule deliveries for “convenience”-- either yours or mine (deliveries between 35 and 39 weeks have recently proved to cause problems for baby). And I deliver about 95% of mothers I’ve followed during pregnancy myself (obstetricians deliver on a call rotation). I’m always on call for deliveries. So if you know any candidates, I’d be glad to talk to them.“Alternative Medicine“: The Touch That Doesn’t Heal: Those of you who know me know that I’m open to new ideas and new ways of doing things. I don’t ever want to have a closed mind, but I don’t like the whistling sound of flow-through ideas, either. Alternative medicine is just a stinker of an idea. I know I’m going to offend some of you who appreciate the opportunity to spend a hundred bucks a month on specially formulated vitamin concoctions to treat your ailments, but I’ve got a long-time friend in jail for his complicity with an “alternative medicine” hoax. Just don’t go there. I appreciate the faith of Americans, but there is a difference between faith in the preaching of Billy Graham and Elmer Gantry. Believing one of them just makes you a sucker.