Curbside Consult with Dr. Jayne 1/20/25

Several of my primary care friends got together tonight to drink margaritas. Partly because we’ve all got cabin fever from the weather, and partly to commiserate about our worries about what’s about to happen to public health in the United States.

We did the math and estimated that the group has easily spent over half a million hours in scheduled patient care during the last 25 years. If you figure a conservative four patients per hour, that’s more than two million times we’ve walked into an exam room asking, “How can I help you today?” and creating an individualized care plan for the patient in front of us. Some of the group have been practicing medicine for longer than 25 years, and especially once the tequila was flowing, the good stories started coming out.

On the whole, we think we have some well-founded fears. One member of the group has spent her career working in public health and is worried about the gag clauses that some states have put in place that prohibit conversations about vaccines, even ones that have been around for decades. As one does when one is a clinical informaticist and having drinks with other physicians, I asked my favorite generative AI tool to list the top 10 public health achievements.

Vaccinations are right up there, along with fluoridated drinking water and family planning. These have been under fire for years and the administration that takes office this week has them in their crosshairs. Also in the top five are tobacco control, which we’re improving upon in the US, and improvements to maternal and infant health, where we’re not doing well compared to other developed nations.

Another top item is workplace safety, where I agree that in thinking back over a century, we’ve come a long way. However, healthcare folks are still at high risk when they go to work, facing everything from infectious diseases and radiation exposure to musculoskeletal injuries and workplace violence. Families of police officers and firefighters have long faced the possibility that their loved ones might not come home from their scheduled shifts, but now healthcare workers are starting to have the same conversations. Additionally, physicians and emergency medical services staffers are more likely to die by suicide than the general public. I’m hoping that sobering statistics will lead lawmakers to allocate more resources to care for the caregivers, but I’m not sure how much state governments or our national legislature will take this on.

A couple of us had recently been at a former colleague’s retirement party and shared what we heard in his retirement speech. He was leaving primary care after 20 years in the patient care trenches, which seems short based on how much training you have to do to become a physician, but which can seem like an eternity when you’re working in a demanding, production-based environment where moral injury is occurring daily.

He finally decided to leave after a series of administrative disasters in his health system-owned practice, such as penalties for physicians who run late with their office schedules. The idea that patients should be scheduled for 10-minute slots and that spending 15 minutes on a visit was too much time was more than he could personally take.

Although a couple of us knew the full story behind his decision, most of the people at the retirement party didn’t. We expected him to throw at least a little bit of shade at his soon-to-be former employer. We were pleasantly surprised when he gave a recap of some of the things he’s been through in practice and some of the good things that have happened over the last two decades, reminding us that physicians have traditionally persevered during times of adversity.

Some of the notable events he mentioned included increases in discussions of end-of-life care following some dramatic court decisions and the creation of Medicare Part D. He talked about severe challenges physicians have faced, such as Hurricane Katrina, when patients were stranded in hospitals without electricity, water, or sanitation. He reminded us that it wasn’t just lobbyists that pushed for electronic health records, but patient safety advocates who saw what happened with that hurricane as well as Hurricane Rita, which came just a month later and where tens of thousands of patient records were damaged or lost.

As expected, he had a few choice words about Meaningful Use and excessive clicking in EHRs, but reminded us of some good things that have come with technology, such as no longer having to take our board exams in a convention center with hundreds of other test takers bearing handfuls of sharpened number two pencils. He reminded us that physicians have historically risen to the occasion when it seemed like the world went sideways, and that the majority of us had survived a global pandemic together. It was a nice reminder that although we may be facing difficult conversations with our patients about vaccine safety, fluoride in the water, and the risks of drinking raw milk, at least we don’t have a novel pathogen stalking the globe at the moment.

He told the assembled crowd that he plans to do volunteer work in a part of the world that has few medical resources. He hopes to regain some of the joy found in caring for patients, even though it will be a physically and mentally challenging environment. I’ve known him for a long time and am very glad to hear that he isn’t hanging up his stethoscope just yet, but based on his career and his involvement in medicine outside his practice, I know that both his patients and the community are going to miss him.

My margarita-drinking colleagues enjoyed hearing about some of the things we mentioned from the speech. Especially since for many of us, some of those events have moved to the far reaches of our memories or have been suppressed as a coping mechanism. Any that any time someone talks about the pandemic, I’m still prone to flashbacks of how I felt coming home from the emergency department, changing clothes in the garage, and trying desperately to not bring home a virus that could kill my family. Still, there were some good reminders that things have been worse and that there are still plenty of people out there who respect physicians, public health workers, and the experience and expertise that we bring to the table.

I’m sure things will look a bit less rosy when the tequila wears off, but we’ve agreed to try to get together regularly to support each other in the months to come. We also created a buzzword bingo card to help us find some humor to go along with the feelings of futility some of us are likely to feel. It will be interesting to see how many more of us retire early or move to a different type of practice with the continued evolution of healthcare. Some of the group are exploring alternatives, but given my work in clinical informatics, I don’t think I’ll be writing a retirement speech anytime soon.

What are you seeing in your healthcare crystal ball for 2025? Leave a comment or email me.

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