Come And Knock On My Door
The house was getting cold. My wife and kids snuggled in their blankets as I crept out of bed and checked the thermostat. The subzero winter air howled as a blustery morning took shape outside our windows. I looked at the digital display with disbelief and manually tapped the screen with my finger, hoping that the jarring motion would loosen the exact faulty screw leading to our frigid state. No luck. The thermostat was working just fine. The problem was much more sinister. I covered myself with a blanket and ran to the basement. I paused for a full minute to listen. ...
Source: In My Humble Opinion - July 22, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
The Novice
It's a strange thing to be driving about in your car in the middle of the day. For one who has spent the majority of his professional life sheltered in dark offices and aseptic hospitals, the summer sun and fresh breeze is quite lovely. One almost begins to approach humanness. Normal. This must have been what it felt like before immersion into the tribe of medicine.Sometimes I have trouble remembering my premedical days. The divide seems vast. It is not only the effects of age but an emotional chasm that has formed over the years. The optimist says I was naive, inexperienced. ...
Source: In My Humble Opinion - July 14, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
We Can Barely Dream In The Place That Empathy Dies
It was a vulnerable time.The man sitting next to me in the car shifted gently. His arthritic hands curled into a bow and rested on his lap. He melted into the seat as if all those years working on automobiles had somehow strangely made him part of one. I self conscioussly placed the key in the ignition and glided out of the parking spot. I could feel his gaze upon my shoulder as we both strained to listen. After the accident, almost the whole body needed to be repaired. I marveled at the clean finish and drove home overjoyed to forget all that had just happened in the last few weeks. The...
Source: In My Humble Opinion - July 7, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
A House Divided
If you put ten physicians in a room, you will get nine different opinions. It doesn't matter if you are discussing policy, diagnostics, or politics. Indeed, medical training develops deep independent thinking. We often feel alone in the care of our patients, we picture ourselves the sole barrier between illness and well being. We battle our fellow physicians, administrators, and insurers. You can argue the pros and cons of siloed thinking, but there is no denying the reality of the barriers that we have built around ourselves. One wonders if a house divided against itself can contin...
Source: In My Humble Opinion - June 29, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
You Create The Cage That Imprisons Your Mind (My response to the comments on my KevinMD post)
I am only going to say this once (my response to the comments on my KevinMD post).You are far more powerful than you think. Your hard edges are chiseled in flesh from the molten steel of apprenticeship and add depth, character, and knowledge. The fibrous scar tissue is experience layered upon experience learned from each searing blow. Your brow furrows, locked in place by years of leaning over texts, squinting to decipher the tiny letters.Your stamina is unique. Tested by years of restless nights, interrupted sleep, and sequential emergencies, your brain reacts with clarity even in the midst of the deepes...
Source: In My Humble Opinion - June 20, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
Is Primary Care Sustainable For Physicians, My Conclusion After A Decade Of Research
I have a confession to make. The purpose of my last blog post was to set up this one. What I questioned, at that time, is whether the future of primary care will come from outside change (business, politics, or even specialist physicians and administrators) or internally, hence creative destruction vs internal combustion. When I entered my first primary care practice in 2002, I had great doubts that the traditional model was sustainable. So I spent the next 12 years studying. My field research included stints as a hospitalist, Corp Med doc, private practitioner, and concierge physician. In the...
Source: In My Humble Opinion - June 15, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
Creative Destruction Or Internal Combustion?
Everyone seems to have a solution for the primary care crisis. Businessman and venture capitalist Vinod Khosla thinks technology and big data will replace the imperfect physician. Tony Hsieh and Zubin Damania (x-hospitalist and comedian/rapper) are banking on the direct practice model created by Iora Health. Politicians, economists, and technologists all chime in with their perspectives.Below the surface bubbles a provocative and troubling question. Many of these entrepreneurial "experts" have little previous experience actually running a primary care practice or taking care of the average outpatien...
Source: In My Humble Opinion - June 12, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
Destiny
It was a sunny spring day as the bus turned the corner. It was a yellow school bus filled with young children jumping up and down in their seats. It was an average day in an average school year. Nothing about it stood out. Let’s take a closer look.The boy sitting in the front of the bus holding tightly to his lunch box is named William. His clothes are tattered and his jeans have patches. The lunch box is empty, but no one around him knows that. His is quiet and withdrawn. He doesn’t play with the other children. He is much too thin. He will grow up to be a su...
Source: In My Humble Opinion - June 7, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
Be Not Brave (My Advice For New Residents On July 1)
Be not brave,For bravery is the crutch of the buffoon, a poor substitute for knowledge and skill. Experience is a tireless teacher, and practice is the master's apprentice. Mastery precludes audacity. Fear and pain will neither be your foe nor enemy, they will be a constant companion. Much like a shadow, they may progress or recede. But they will never disappear. The walls you so expertly build will only create new reflective surfaces, they will obliterate nothing. Intention is always the first principle. You will help many but harm a significant few. Intention is the common ...
Source: In My Humble Opinion - May 30, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
We Will Always Have This (My Response to @vkhosla)
As I have said before, when done correctly, doctoring is an act of love.It is founded on the most basic of human interactions, intimacy. Patients open their doors and closets revealing a treasure trove of brutal humanity. Physicians dedicate themselves to healing, to upholding a sacred covenant born of tears and blood. It is a partnership, a carefully rehearsed choreography.The dance is ancient. To speak and be heard. To be studied, To have one's shoulder caressed gently, one's joints manipulated, and the pitter patter of one's heart auscultated. This is the birthright ...
Source: In My Humble Opinion - May 24, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
Why Physicians Are So Pissed Off
The process of becoming an excellent physician is one of mastery. The passion of the child is replaced by the studiousness of the teenager, and the bottomless energy of the young adult. The leap from decision to clinician takes decades. Forged in the steel of experience, trampled by pain and tortuous repetition, ability accrues. The apprentice guards his knowledge closely. He bows to the alter of the sacred skill that he will do anything to attain. There is nothing above becoming. The mountain has many peaks and valleys. One never quite reaches the summit. There are only gradations...
Source: In My Humble Opinion - May 17, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
Can I Get An Amen
It's time for the American physician to stand up.We will no longer bend to the tyranny of bureaucracy, the venom of litigation, or the naivete of legislation. For we have spent many a night sweating on the phone as our dear administrators slept comfortably in their beds stuffed with hundred dollar bills. Our experience standing in the line of fire dwarfs that of any attorney questioned by his client's peers. And we have tended to more constituents personally than any verbose and hyperbolic politician.Yet the doom and gloom of our current healthcare system is being flung belligerently at our feet. Th...
Source: In My Humble Opinion - May 10, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
A Jordan Grumet Blog Delivered In Person
If you have 20 minutes and want to know what it is like to experience one of my blog posts in person, check out my comments from DotMed2013. (Source: In My Humble Opinion)
Source: In My Humble Opinion - May 3, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
Why I Don't Agree With @aaronecarroll
I have often spoken of the doctor-patient relationship as a covenant. Our patients bear their bodies and souls in exchange for a thoughtful, engaged, respectful partner in navigating health and disease. This dyad, this trusted space, allows for the breaking of cultural norms and full disclosure. Proper healing is an agreement, it is a relationship. Although often not spoken of, any successful flourishing healthcare system also requires another sort of covenant; one between provider and society. Let me explain.Being a physician has changed me. For someone who naively went into this profession hoping to help peop...
Source: In My Humble Opinion - May 2, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
Are Physicians Becoming Distracted Drivers?
He was rather tall. Or at least he appeared so with his long erect back jutting from the bicycle seat. The cringe worthiness of his helmetless head was assuaged by the gigantic headphones covering his ears. I figured they would provide minimal protection during a crash, but at least he would be listening to groovy tunes.He weaved in an out of traffic on a busy two lane road. He peddled effortlessly, bouncing to the music that undoubtedly pumped through his brain. His arms were bent, thrust forward towards his head. Did I mention that his hands were no where near the handle bars? That's r...
Source: In My Humble Opinion - April 27, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
