Here’s my column in this month’s Emergency Medicine News

https://journals.lww.com/em-news/Fulltext/2010/10000/Second_Opinion__How_to_Have_a_Successful_Practice,.6.aspx

I have practice with the same group, in the same hospital, for 17 years. Because we have been together so long, our group is a family. So it was with enormous grief that we buried our founder, Dr. Jack Warren, 11 years ago after a tragic car crash. That wound is still open, but we still tell stories about his humor, his compassion and his grace.

As I write this, I am tending another wound; or I should say, our group is tending another. A second partner passed away last week. Unlike the sudden horror of the first death, the second was progressive, as our friend and partner, Dr. Howard Leslie, left us by degrees, the victim of metastatic melanoma. Jack and Howard founded our group before any of the rest of us arrived. Both of them are buried in the same wooded, hillside nature preserve. Pieces of our group, pieces of ourselves, interred in the red-clay earth. Just as they practiced before the rest of us, so they went to sleep before the rest of us. I think they’ve gone ahead to show the way. So they can one day help us adapt to peace the way they helped us adapt to practice.

But both deaths remind me of partnership. Medicine today is chaotic and difficult for many reasons. Part of the problem is that government and regulatory bodies overwhelm us and litigation threatens us. Part of the problem is that we, and our patients alike, have untenable hopes and impossible standards for the practice of medicine.

However, a large part of our struggle comes down to the fact that we have abandoned cameraderie for money, and cooperation for individual advancement. We worry more about the contract than the individual. And too often, physicians are viewed in a vacuum, not as persons with spouses or children, humans with brilliant minds and broken hearts, but as worker-bees who can either do the job or get out while we all race for higher salaries and better retirements.

Our group has remained for 17 years through financial struggles and legal battles; through increased volumes and crushing mandates. We have seen our hospital’s fortunes rise and fall. And yet, here we are, doing the same things we always did with many of the same people. Why? Because we have cared about one another. Not just about whether we could ‘deliver the goods,’ but whether we were crazy or sane, sad or happy, rested or weary. We have tried to make the schedule manageable, to move partners to the shifts that were best for them, to give as much vacation as possible. And recently, to encourage our friend and his wife as he left us.

I say all this to encourage other groups to treat one another with kindness. I say this because in medicine, we physicians frequently have only one another. One of the great strengths of medicine as a profession used to be the fact that doctors were a clique, a society. Yes, it posed some problems at times, but we cared for one another.

Now, divided by specialty and HMO, divided by politics, split between private practice and academia, rural and urban, we are a profession of tiny camps, of tribes, all competing for money and position. We should be caring for one another, helping one another, easing the suffering of fellow physicians as surely as that of our patients. We should be reassuring those who are broken, those who are sued, those who are burned out. Instead, we read business journals and apply business models with varying success when true concern would be the healing oil for most problems.

And while all of it would be wonderful across the lines of specialty, it has to begin at the level of individual groups. Partnership in a medical practice is not merely a question of money and benefits, shifts and ownership. Those things are important. But it should be, first and foremost, a working relationship where everyone has the interest of the others in mind, and all are committed equally to good patient care and good partner care.

I remember when my wife and I interviewed, years and years ago. Jack Warren said, ‘I know you’re qualified. I want to know if your wife will be happy here!’ How often does anyone ask that question? Well, Jan is happy and I am happy and our life here has been wonderful.

My partners and I have passed through the joys of children, the grief of death, the agony of divorce, the vagaries of national politics, the madness of critical letters in the newspaper, the uncertainty of litigation. We have hired physicians and had good partners leave. We have all wondered how we would keep going.

If it weren’t for the love of our families, and our mutual concern as partners, we would all have left years ago, searching for greener pastures. Instead, we stuck it out. We worked for one another when needed. We stood up against other physicians when there were conflicts. We tried to give the hospital the best we had. I believe, in my heart, we gave each other the best that we had.

The down-side to all of it is loss. We worked together so well over the years that it was with that same, long-cultivated and now natural cooperation that we carried our partner’s casket, and helped to lower it into the soil, just above the Chauga River. A place in such stark contrast to the chaos of all those nights and days in the ER. It was with the same cooperation as always that we helped his family shovel in the soil, while we all choked back tears even as we told jokes about how he just had to buried on the hottest day of the year.

I have lived here a very long time. I have worked with these fine physicians I call partners for my entire practice lifetime since residency. It has been, and remains, an inestimable honor to me.

And because we love one another, not just because it gets us a living but because we are family, I will be honored if they are the ones who lower me into the earth one day.

That, dear friends, is how to have a successful practice. Sometimes, only a funeral puts things in perspective.

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