here is the speech i gave at residency graduation.
it contains NO STATISTICS a miracle!
people often ask me what my intentions are, since i'm taking a career track that's different from most of ours.
i'm planning to work by myself as a primary doctor, without any nurse or other staff, and i'm going to just give my patients my cell phone number so they can call me directly, and i'm going to try to minimize my interactions with the insurance industry as much as possible, to maximize the interactions with patients directly.
i hope you don't mind if i take 5 minutes, to explain why i'm doing this.
i'm starting a practice in a university town in oregon that is less than one-quarter the size of the wisconsin city we live in now. it has about 140 thousand people.
i chose it because it has very progressive politics, including around health and spirituality, and because it's nestled in between two mountain ranges, and is only an hour away from the pacific ocean.
and there are a lot of vineyards nearby.
i thought it seemed like a friendly place to start trying to live out my vision.
a long time ago, i kind of became that one person you might go to for advice - if you didn't have health insurance - when you broke out in a weird rash, or got pregnant, or twisted your ankle.
it worked out that way basically because i was pretty fearless, and not easily grossed out, and i liked to buy old science books from the used book store.
my kids were young, and i had a couple of teenage baby sitters who would come over and hang around sometimes.
i was living in a place with a really great kitchen table.
so we'd sit at the kitchen table, and i'd tell them about birth control, and ask them about their self-esteem, and tell them what an immune system is, and why it's so cool.
and they would bring their teenage friends over, to talk about birth control and self-esteem and immune systems some more.
and i started thinking, maybe i could be more effective if i had some teachers.
so i went to college for the first time when i was 30.
but i kept having these conversations at the kitchen table, about health and self-esteem and science, because they were really fun and interesting, and plus, i had this really great kitchen table.
and that's one reason why i want to have my own practice. i want it to be kind of like that.
then when i was in medical school, i had this great teacher, who was this crazy neurology guy at the VA.
he was very funny. he wrote a book called "extreme clinic," that you should read.
anyway, when i told him i wanted to be a family doc, he said, "that's not medicine, that's a cult! you're too smart for that! you should do REAL medicine!"
and i didn't know what to say to that.
but later i thought... wait a minute!
what's wrong with having a cult?
i think i'd be a great cult leader!
so it's possible that that's another reason i want to start my own practice.
i'm pretty comfortable running my own show, and i'm pretty comfortable taking responsibility.
then last year, i had one of those days that just really illuminated what i DIDN'T want to do.
i had a fifteen-minute appointment scheduled with this one patient.
they'd been waiting in the exam room for a long time, because i was late.
they were very anxious about coming to the doctor.
they had some chronic illnesses that were pretty bad, and it looked like they probably weren't really taking their meds.
and it turned out there had been some domestic violence in the picture, and that alcohol was involved in some way.
so, not sure what to do, i played the efficiency-expert doctor card of asking, "which of all these things is the most important to you today?"
and they said, that, more than anything else, they wanted some advice for how to lose weight.
and they really did badly need to lose weight!
but by this time, most of my fifteen minutes were used up.
and i thought, i never want to say that to a patient again.
i never want to demand again, that a patient make a little priority list for me, of everything that's wrong with them, so i can pick one to pay attention to, all because i have to see 35 patients a day, if i'm going to pay my overhead - if i'm going to be able to pay my nurse and my receptionist and my medical assistant and my biller and my scheduler and my answering service and the rent for the building big enough to hold all these people, etc., etc....
but that patient is the whole reason i'm here!
and that person is NOT a walking priority list, of diseases and disasters.
they're a *person* who's having a particular set of experiences, body and soul, and their whole story matters.
we all say that, and we all believe it.
but we often aren't able to practice it.
and it *really* bugs us.
and that's another reason i need to have my own practice.
now, over the last 3 years, i've had a recurring dream about being a family doctor.
i'm walking down a road, going to a patient's house, and i feel a little ashamed and nervous, because i don't have any equipment with me, not even a stethoscope.
i'm empty handed.
sometimes i'm not even wearing any shoes - you know how dreams are.
but i go up to the house, because that's my real patient.
in the dream, my patient is the home, and everything, and everybody, in it.
so we start going through the closets and bedrooms, and the kitchen cupboards, taking stock of everything, and making a plan for how to to make things easier, and more efficient, and healthier for them.
this usually involves a speech about getting rid of the chips and sodas at some point.
and in my dream, i always start feeling excited and happy, when i finally realize, hey! i can do this!
i don't need to wait until i know everything and am always right.
these are my neighbors!
i can see it their way, and THAT'S my most important skill.
everything else is just a bunch of science classes.
so that's my vision: a kitchen-table cult, of long appointments, figuring out what matters, in a context of neighborliness.
so that's what i'm going to do.
thanks for listening.
thank you for being my teachers, and thank you for helping me get here.
my teachers are all very excited because they've never known anybody that started this kind of thing straight out of residency.