A Country Doctor Writes:

I thought I moved everything successfully to Substack. But I still get a lot of views here. Please comment below if you are still here , looking for new material and not moving to Substack. Thanks.

I started this blog in April 2008. Over the past 15 years, I have moved three times, twice to the same house in northern Maine, changed jobs a couple of times, and gone through a divorce. I have published almost 1,000 posts here, inspired by my work with patients. I believe I coined the phrase My work inspires my writing and my writing inspires my work.

Sometimes, because I was actively trying not to feel burned out, I saw uplifting or thought provoking things in my ordinary patient encounters that I might have missed if I hadn’t resolved not to sink into despair about how things work in medicine today.

Less than a year after I started this blog, I left the clinic where I had spent most of my career, where I was Medical Director and originator of all kinds of improvements and program expansions, even a major contributor to a massive building expansion design. Then I started over, from scratch, at age 56 in Van Buren, a part of the state where nobody had heard of me.

Writing helped me through the difficult time of not yet having an established reputation and position, and it helped me see everything as a new opportunity; if nothing else, this big move gave me something to write about.

Life happened, my marriage ended (early followers may remember many, many posts about the good days) and primary care changed. To an outsider it may seem petty or even pathetic that a physician might leave their position because of its computer system, but I know for a fact that the EMR is a common and important consideration for physician applicants when considering a new practice.

And this year, I knew I had to do something different. And there, suddenly, was a LinkedIn message from a Galileo recruiter. Housecall practice, first in Maine, backed by a large organization, large territory. I, who put 300,000 miles on my big SUV driving back and forth working on the coast and in the north woods, used to joke “If it paid better to drive for a living, I might want to do that”. Now I drive and make housecalls. Seems like I manifested this life change.

So, I’m starting over, at my age.

And this year, my new lady friend, a retired grade school teacher, returned to work part time and is now the official, full time third grade teacher in Van Buren, where she grew up. She tried being retired, but decided to do more, to start over, doing what she loves.

And last night, after half a year playing with Substack, a bigger platform for my writing than my own little blog, destiny knocked on my door, it seems. I’ve had the same theme (template) for my page design since 2008. WordPress announced years ago they would not be supporting it. But it always seemed to work – until last night. All of a sudden, all you see on a laptop or an iPad is the masthead and the sidebar on regular blog pages. Fortunately, the iPhone still displays everything. The words you are reading right now are not a blog post but a “page”.

So, I could choose a new theme, but that means my masthead would have to have different proportions and all kinds of similar fuss…and the viewership on a day to day basis is multiples more on Substack. Plus I even get occasional paid subscriptions (in case I eventually decide to slow down in my clinical work).

So the more I think of it, the more I think I might just park the WordPress blog and concentrate on Substack. A freestanding blog is almost like when wife #1 (don’t ask) had a BBS, a dial-up bulletin board before the Internet, with only one or two viewers at the same time and she, the “Sysop” (systems operator, I think) chatting via text with them.

Substack is more like YouTube or TikTok, a platform where readers follow their writers but also get glimpses of other writers they might also want to follow.

So that’s the way I feel tonight, two days before Christmas the year I turned 70. All fresh and new. Age is just a number.

I just realized none of the posts show on an iPad or a computer, but they do show on an iPhone. WordPress is working on this. In the meantime, please visit my Substack.

https://open.substack.com/pub/acdw/p/time-to-think?r=254ice&utm_medium=ios&utm_campaign=post

This week I posted two brand new pieces on Substack and brought back several posts from the blog archives.

In THE WAY HEALTHCARE IS GOING, WE NEED MORE NURSES, NOT MORE DOCTORS, I make the argument that so much of what doctors have to do today could be done by nurses, and therefore the doctor shortage is just an illusion. Americans don’t understand that public health doesn’t necessarily have to be shouldered by physicians who are trained to diagnose and treat disease. Many other western countries have a robust public health system.

In THE HIGH COST OF SPECIFICITY, I audaciously claim that primary care doctors are used as free labor shoveling data into our EMR so that researchers and actuarians have the data they need, while we have less time to do OUR jobs and less time to address our patients’ priorities.

Republished from the archives were BRIEF IS GOOD; BRAND-NAME DRUGS AND GENERIC PRESCRIBERS; SEIZURES: LOW P, LOW D AND LOTS OF THC; WHEN A HOUSECALL IS WORTH A THOUSAND TESTS; PAIN AND SUFFERING and A SAMURAI PHYSICIANS TEACHINGS.

In the coming week, I will repost a few pieces about doctoring at Christmas, including words by Osler that speak to frontline physicians like myself. I am also planning some new material, looking backward and forward before anchoring firmly in the present moment with insights from Eckhart Tolle and others.