The Steepest Learning Curve

Becoming a physician is hard work. No doubt about it.

Each phase felt like the steepest of learning curves. 

Remember your MS-1 Anatomy class? So many names and terms to memorize. 

How about that first clinical rotation in your 3rd year? It took me at least an hour to get a simple SOAP note written in a patient chart. (yes, hand written notes back in those days). 

And then there was the dreaded internship year, PGY-1, that was riddled with problem lists, admission orders and diagnostic codes. 

            Although those early years were tough and I learned A LOT, it was my PGY-22 where the steepest learning curve seemed to catch me off guard. Yes, that is right: In 2016, exactly 22 years after I received my medical degree, I learned more about medicine and healthcare than ever before. It just so happened that 2016 was also my first full year of direct primary care. 

Coincidence?  I don’t think so.

            After practicing as a traditional network-employed physician for almost 2 decades, I made the leap to DPC. I never imagined that leap would allow me to learn more than when I was in training. Suddenly the blinders of “this is how we do it”  and “these are the guidelines” were off. I was able to think critically and question “why?” And wow!  

Some of what I learned was eye opening. 

Here is a quick list:

*Not everyone has insurance. And those who don’t aren’t necessarily broke or ill prepared for an emergency.

*Insurance, many times, is actually a barrier to good healthcare.

*Prices are falsely inflated all over healthcare: medicines, imaging, hospitals, labs. You name it. Its overpriced and patients get scammed.

*If a dpc doc can dispense a 30day Rx of lexapro for $2.10, why is CVS selling it for $18? Worse yet, why are some insurance plans selling it for $127?

*If a DPC doc can get a lipid panel done for $5, why on earth is BCBS charging their “covered lives” $65?!  RIP-OFF. 

*Guidelines and cookbook medicine don’t work, especially if patients can’t tolerate or afford their meds. And many can’t.

*Creative clinical solutions don’t mean a physician is a quack or should not be a “preferred provider;” it means a doctor is a true patient advocate. 

*EPIC is the worst thing that ever happened to the practice of medicine and communication between doctors.  ( more on this in a later post) 

*The best medical note is concise, accurate and with a clear assessment & plan. Sometimes that only takes 2-3 sentences. No need to count VS, organ systems or complex diagnosis.

*Don’t get me started about coding… 

*Patients don’t get better care from fancy medical facilities or from doctors with world renowned titles; they get the best medical care from a doctor who knows them. 

*Patients want a doctor who has time to listen, can answer questions and offer some insight.  That is all. 

My list could go on and on and on. 

            I think the most surprising fact I learned in my PGY-22 was that most doctors have no clue about these things. They are so busy on a day to day basis, they never get a chance to take those blinders off and question the very system that is burning them out. They can’t understand how health care can be cheaper as cash pay, how well medicine functions without insurance, how happy patients are when a doctor simply listens, and how rewarding medicine is when you get to take care of patients the right way.

            It’s ironic isn’t it? I learned more about medicine and healthcare when I left the system that was responsible for training me. I have said DPC was the best decision of my career.  And why you ask? Why was it the best decision ? 

It’s all because of that PGY-22 steep learning curve.