Melissa Young, MD

We have been in the process of preparing for meaningful use attestation. We have had to make some changes in how we practice. Not how we practice medicine, mind you - just how we play the game.

One of the reasons that I left my former practice to go into solo private practice was my desire for autonomy. I wanted to set my hours, my days off, my schedule. How silly I was to think getting those things would be easy.

Sometimes when I am ordering tests for patients, they request that I “throw in” some other test. What do you do when patients or their other doctors dictate what tests to do?

An office’s staff is its face and voice. That’s why I hope to keep mine happy.

When you are in med school, you are taught how to do things by the book. You read about and are tested on “textbook cases.” You are instructed on the “one most appropriate initial test” and the gold standard of diagnosis ... And then you actually get to see patients.

As a former full-time faculty member, I regularly had to rate residents in six core competencies ... I had often felt that the most crucial of them all, and the one that is the hardest, if not impossible, to teach is professionalism.

I have had sleepless nights, palpitations, and tantrums over the last couple of weeks just trying to get myself and my practice ready to for meaningful use attestation.

I can easily see what we’ll need to do for the meaningful use thing. But there are a few things that will need to be explained to me and my staff.

The physician in me sometimes conflicts with the business owner in me. I’m curious to know what other small practices do.

Unless I can find a way to learn about ACOs through osmosis while I sleep, I’ll hold off on weighing in.

When a staff member needs a little extra cash immediately, does giving her a salary advance set a bad example for the rest of the office?

When I added another physician to my practice, I underestimated two things, and expenses exceeded income for a while. Today, bills are paid and there’s money in the bank.

We knights in the medical community want to fix things. We want to get things done. And when we can’t, it’s frustrating.

We have good sharps, containers … fire extinguishers, and the major exits are labeled as such. The hand sanitizer dispenser is not above an outlet. Never even occurred to me that stuff is flammable. Do you still want your kids using that?

I love my staff, and I want to do right by them. But I have a business to run, and I don’t have indefinite funds.

Most of my patients appreciate that I run on time. Many of them plan other things around their visits with me because they know approximately what time they will be done. I’d rather lose the late-comer than have patients complain that they had to wait too long.

Sometimes your "easy" practice days get very difficult and finding five minutes for others is not as easy as it seems.

I see patients and patients’ families everywhere I go: the grocery store, church, school, restaurants. I quite honestly miss the anonymity. Now, I feel like I am always “on.”

A lot of practices have decided to adopt electronic health records because they “have to.” They want the stimulus money, and they know that down the road, they will be punished (financially) for not using one. And many physicians, especially the ones who have been practicing for over a decade, are doing so kicking and screaming.

As a mother of two young children, I very often find myself using lines from the “Handbook of Motherhood,” subtitled “because I said so." This week, I felt like using a couple such lines at work - “I don’t care who started it” and “think before you speak.”

Last week, I talked about patients who do not tell the truth, the whole truth, and nothing but the truth, and how that impacts their care. Today, I’d like to talk about other behavior that can be deemed unacceptable, annoying or just plain freaky.

You know patients lie. No, not all of them, but a significant number do. Often, it's harmless and at most annoying. But sometimes, patient lies not only make it difficult to treat them, it makes it darn near impossible.

Now that I have an associate, I could actually go away on vacation and not worry - in theory. In reality, while I did go out of town and enjoy a week with my family, I still checked in.

We talk all the time about maintaining patient privacy, and I agree, it should be held sacred. But what about physician privacy? I spend all day talking to patients, and when necessary, their family. For the most part, I enjoy that. But at the end of the day, I would like to be home with my family, and I want to keep my professional life and my home life separate.

The hospital I am affiliated with has just instituted a new policy - all patients with septic shock must have a critical care consult ordered. The rationale was improved patient care; early implementation of aggressive intervention; early and appropriate use of central lines; activated Protein C, etc. The objective: decreased morbidity and mortality, and improved patient outcomes. So what’s the problem?

I realize this post comes a little late, but in my post-Thanksgiving haze, I decided to share with you some of the practice-related things I am grateful for.

I could never be a pharmaceutical rep. First of all, I would probably weigh 300 pounds with all the lunches and dinner programs.

In many ways the transition from solo to group (albeit a group of two) has been seamless. It helps that there were plenty of exam rooms to go around, enough computers, and a steady flow of patients. It also helps that she is fresh out of fellowship and is flexible in her ways. And the fact that I’ve known her for more than five years helps, too.

I can ramble on. I can write lengthy sentences without punctuation that would make any English teacher cringe. I can carry on and on. On the other hand, when I am speaking to a patient, a pharmacist, a nurse, or a referring physician, I can’t just click on an X and make them go away. I can’t fast forward to the good part, the stuff I really care about.

I had completely forgotten that someone from the Department of Labor was going to call me about my former MA’s departure. Perhaps I had subconsciously blocked it from my memory. So I was a little surprised when my receptionist held the phone out to me and said, “Do you a moment to speak to someone about Ms. MA?”