Most docs aren’t happy. I wasn’t either. Until I left assembly-line medicine.
In 2004, I held town hall meetings where I invited citizens to design their own ideal clinic. I collected 100 pages of testimony, adopted 90 percent of feedback, and we opened one month later. Now, my job description is written by patients, not administrators. I’m finally practicing medicine the way I had always imagined. And I’m happy. Here’s why:
Disintermediation: I “removed the middlemen” so now I enjoy direct relationships with clients in a cozy office with no staff. I’m 100% solo. I don’t miss the bureaucracy. Nor do patients who get uninterrupted 30–to–60-minute appointments.
Autonomy: No more committee meetings. If my patients and I want to change an office policy, we do it. I’m available 24/7. I even do housecalls! I control my schedule. That means I can take vacation whenever I want. Problem is last time I left town, I missed my patients.
Finances: Without a bloated bureaucracy, I have super-low overhead. I pass on the savings to patients. Care is VIP with no extra fees. Insured and uninsured are welcomed. Nobody is ever turned away for lack of money.
Authenticity: I dress casual, not corporate. Mostly Levis and clogs. Patients like me to be me. A recent thank-you card reads: “It’s so refreshing to meet a doctor who is a real person with a real personality.” Forget professional distance. Let’s be real. Professional closeness is what people want.
Fun: I’ve got a giant gift basket with prizes for patients who lose weight, quit smoking, or reach other goals. Other gifts award folks who bicycle or walk to the office. Plus Fridays are Patient Appreciation Days with balloons and dark-chocolate hearts for everyone!
Inspiration: The best part: I stopped complaining. If doctors are victims, patients learn to be victims. If doctors are discouraged, patients learn to be discouraged. If we want happy, healthy patients, why not start by filling our clinics with happy, healthy doctors? By enjoying medicine, I inspired my colleagues to find joy too.
Oh, and patients are happier than ever! Happiness is contagious, ya know.
Pamela Wible, MD, is a family physician in Eugene, Oregon. She is author of Pet Goats & Pap Smears: 101 Medical Adventures to Open Your Heart & Mind. She hosts biannual retreats to help doctors love being doctors again. Many have opened ideal clinics too! Photo by GeVe.
I love your ideas :D. I do hope you don´t mind I put your picture on my blog… And greetings from Finland.
Repost anything you like. Don’t mind at all! 🙂
Do you have any happy doctor friends in Washington State?
May I ask if there are any Dr’s in Boston or further north of Boston?
hi, I love your book and your post about profiling, and this post. I’ll be retiring in about 10 years if the economy allows, and can move anywhere in the country I choose. I’ll be looking at your map of happy docs, and maybe that post explains it, but do you take Medicare patients? I’ll be one by then. I love everything so far, including the doc in jeans. I work in a large academic medical center, and can always tell when the corruption index is rising, bc the administration starts to roll out odd dress codes (the last one included “no skirts” at work–not sure what that means).
keep it up! and let me know if I can help, you have my email. I am a mole person in my hospital (non-MD, not management but I have a big job that requires me to know all 70 of our accredited residency and fellowship programs, and I also do some surgical photography). I got to know one of our administrators when he wrote the word “fun” in two separate emails in one month, so it isn’t all bad here, but we are pretty typical, grim and complaining. I’d be very interested to hear if/how you think the happy stuff could apply to a big hospital, or how you think it might be modifiable.
ugh, please correct previous comment, i hate autocorrect. i was trying to say that the last odd dress code we had included “no SKORTS” (!)
What i do not understood is in fact how you are now not actually much more neatly-favored than
you may be now. You’re so intelligent. You know therefore significantly in
terms of this matter, made me individually believe it
from a lot of various angles. Its like women
and men aren’t fascinated until it’s something to do with Lady gaga!
Your individual stuffs outstanding. All the time handle it up!
Hello! My name is Taylor and I’m currently an undergraduate student in Wisconsin studying to hopefully become a doctor someday. I found your blog randomly the other day and I have to say you are incredibly inspiring. Your posts make me have faith that I don’t have to become a cookie cutter doctor who patients perceive as cold or distant, and that I can possibly help break down that barrier someday like you have (or seem to). It’s refreshing to hear from a doctor who is so open and has so much love for her patients. I’ll be reading your blog for years to come most likely!
Hi Doc, I just watched your Ted Talk and I’m so inspired. Thank you. I’m not even graduated yet and I already feel fatigued and disillusioned. My situation in South Africa is really different to the USA’s, but I’d love to continue to ideal clinic idea here, one day. I so wish I had a mentor like you. Thanks for the inspiration. I wish all doctors were like you!
Aha! Now you do have a mentor like me! We can Skype sometime if you like. I am happy to answer any questions you may have. Maybe I should post some videos of taking care of patients in my clinic so you can “feel” like you are shadowing me.
Hello Pamela,
I hope you are doing well! I too am a student preparing to send in my application to medical school (tomorrow!) and I was just googling randome articles right now and was blessed to find your page! You are the type of doctor I have always dreamed about yet never saw! Could you please post the video of you taking care of patients as you suggested above? It would be such a pleasure to shadow you from a distance. Thank you for everything you do!
Best wishes,
Zara
Here are 2 photoessays that you’ll enjoy! (I need to do a video):
https://www.idealmedicalcare.org/blog/house-call-on-a-hundred-foot-cliff/
https://www.idealmedicalcare.org/blog/why-i-love-house-calls/
I am a health information technology student and will graduate in May. I am interested in participating in health care that is run by and for humans, not robots. I would like to know more about your approach. My grandfather was a doctor in a small Kansas town in the 1940s, and he was a lot like you. He knew everyone, and was part of the community in a wonderful way. We need to regain that!
Please reply and show me how I can stay connected to you and this approach!
I am hearing more and more physicians are ditching the “assembly-line” model of medicine. I want my doctor to be happy, but I cannot dictate the practice-style she or he chooses. If they choose to be miserable and make more money, it impacts me. I get assembly-line care. I am so glad you took the step you did. My question is how do you function without ANY staff?
Hi Nick ~ Most docs before 1965 had no staff. When Medicare and all the third-party insurance began then we needed more infrastructure to handle all the admin tasks. However with streamlined offices and smart use of technology, a staffless office is possible. Been a one-woman show for nearly 9 years now.
I can’t believe it! I’d hit myself with my stupid stick if I could find it. Can you believe I retired from the VA in Roseburg and much of my medical care and that of my husbands was in Eugene. Rats and double rats.
Having moved so many times with my career, we continued moving from coast to coast and then back again until we finally landed in the middle and found the best psychiatric care my husband has ever had. It’s an absolute joy to read your blogs and here you on Ted talks. Bravo for you.
Wow, your story is amazing! I feel like you found the key to your happiness and now you can unlock the door any time! I am currently studying biology at USF and I will be graduating next summer. I have been spending most of my free time trying to figure out which MDs are the happiest because I want to be a happy doctor. I really wanted to be a primary care physician, but many website’s show stats that Dermatologist are the happiest. I’m not sure what to do. I know I love people, and the science of medicine for the whole body, but I also want to be happy. Do you have any advise? Thank for your time!?
~Keith
I have an amazing FAQ I will send you with instructions on how to be the happiest doctor!
You’re what the patients ordered…This needs to be spread everywhere. Thank you for being you, A Dr. That truly cares and used what others have done in a positive way and we really need more like you…
Tried to email you Keith Ballou but it bounced so please contact me.
May I just say a couple things? I am a patient and you can be the happiest dr. By being you and not falling into what alot of dr.s are. Talk to your patients and listen to us. Really listen. You are who controls your happiness and by giving your patients the best care and showing us you care is so big. Dr.s have changed and they never had to. They just stopped listening and talk over us and we suffer because the dr refuses to listen. You’ll learn your patients more by just listening and showing you care and are there to help us. Don’t ever let anyone take away how you do your care or your job as a dr..you’re your own person and be him…you’ll learn your patients and you’ll love your job cause of that. Be the person that you always thought about when you first thought you wanted to be a Dr..How you envisioned yourself being a dr and never question that no matter what and live the dream. Don’t ever lose sight of that because others say what is the happiest job. No matter where you work, You control how happy you’ll be. You want to be an family Dr and because others say the happier job is here? Is it? Or have they lost their love for what they always wanted to be and gave up on there dreams cause they allowed it to ruin their dreams…its who you are as a person and don’t be a follower cause you are already allowing ppl to control your dreams. Be a leader and make your dreams a reality and love your work cause you control your world…from a patient who hopes you become the best dr.for family or just someone like me who needs a good primary care physician that cares…Live your real dream…God bless you always
Sorry about the spelling and punctuation. I just didn’t pay attention to it cause I was so deep in my words and thoughts.
Sure wish I could find just one doctor like that. Sure must be wonderful❗️
Kudos to U
I am a 45 year old Healthcare provider (dentist in solo specialty practice). I recently had a hospital encounter (prior to this I have never been admitted/stayed overnight in a hospital). It was an eye-opening experience. The hospital encounter occurred when I had woke up at 2 am with extreme testicular swelling and pain ( I only did it hurt like hell but I had never seen testicles that big on anyone let alone myself) and could not even roll over in my bed. My daughter thankfully heard me screaming in pain, which is a miracle because I am on the second level and she is in the basement. I crawled into the emergency room pretty much on my hands and knees. Everything went fine until they admitted me ( trying to rule out testicular torsion) or pain control and observation. The pain that I experienced was unlike anything I had ever had. The medications they were giving me did nothing. After a while I got the sense that the staff thought I must be an opiate abuser because of my perceived high tolerance to opiates. I remember considering that this pain could be long-term, and I immediately knew that there was no way I could live that way.
Because I am in healthcare I think it was easy for me to pick up on this perception of the nurses. … that they were looking at me as a possible opiate abuser. I haven’t had any prior visits to the hospital or any record of taking opioids. They must have given me a lot of medication. My nurse call button was not working on my bed.. I was repeatedly pushing it and nobody came. I had been laying there screaming in pain and the pain was getting worse. 15 minutes seems like 4 hours. Finally I crawled down on my hands and knees to the nurses station, writhing in pain and crying like an infant, begging them for someone to help me with my pain. They just gave me this strange look like I was completely fabricating my pain. I felt like a complete ass. They also didn’t like to have to change their orders, it was a lot of work to do this they just said. Finally the urologist returned and asked me about intraspinal anesthetic administration which I welcomed. The urologist was a great guy and actually I had met him before because of my friend with kidney cancer (this was the same physician who performed the partial nephrectomy surgery on my friend). Shortly thereafter the pain cycle finally broke. I almost immediately fell asleep, and I slept for a entire day. Two days later when I was released from the hospital I still felt off from all the pain meds they gave me. Unfortunately the pain became a recurrent problem for the next 12 months… getting progressively better over a 12-month period. I never returned for pain meds because they just didn’t do anything for this kind of pain. ( I left the hospital with 30 dilaudid, a month regimen of levoquin which gave me hives and we had to change to tetracycline, something for diarhea because of the antibiotics, and 800mg motrin. ( I didn’t take that either because it tears my tummy up). I did finish my antibiotic regimen.
I survived the ordeal and I have been pain-free for quite some time. Howevrr, I did not like the way I felt when I left that hospital.
The other thing I didn’t like was being stigmatized because I am gay. After the ultrasound didnt conclusively suggest a torsion, they suggested that it must be from a sexually transmitted disease because I am gay and sexually active. The tests were negative for sexually transmitted infection… but the er doc who originally admitted me suggested it was likely due to me being gay and sexually active, but it was not gonorrhea or chlamydia. I thought to myself.. oh yeah because I’m gay… must be something to do with that. Physicians wonder why they don’t always get disclosure in their patient histories. I certainly am not going to offer up that information voluntarily in the future.
I was very disturbed about how I felt when I left the hospital and how I perceived myself being treated. At first I just blew it off thinking I was heavily medicated and I was probably just imagining it. As time has passsed, I realize that I was probably “profiled” as another drug seeking opiod addict. I’m sure they were annoyed at my constant screaming in pain as we’ll. I was a very loud. I remember feeling like everyone in the hospital was looking at my testicles at one point… and normally I’m very private but I really could care less because it hurts so bad.
Urologist said it was epididymitis, that I had a hydrocele, and extreme swelling of my scrotum and hyperemia. Also I have had blood and protein in my ua’s since but they haven’t been able to figure out webt. When I went for a follow-up they decided to do bladder cytoscopy… and I was completely freaked out because of the procedure and the nurse basically told me they do this all day long and to stop being a baby. I told her you’re going to stick that up my penis I’m pretty sure I’m going to be freaked out by that. I didn’t like her and I felt they were just doing a lot of procedures to got their production goals. She was completely and mechanical about the whole thing. I asked her if she had ever had one of those stuck-up her Yang Yang and she said no…. I just said for a guy that’s kind of a big deal. They didn’t find any pathokogy in the imaging. I asked for urologist when I should return and he said only return if your scrotum continues to be swollen or gets bigger. I didnt return after that… but there are plenty more episodes of pain. The urologist I saw for F/u and who decided to perform cytoscopy was not the same urologist I saw in the hospital.
Anyway I think when a doctor becomes a patient, especially a patient who was a pain in the ass like I was, you can learn a lot about the way we deliver health care services, and how doctors and patients interact. I definitely think about that when I am interacting with my patients a lot more than I did before this happened.
By the way… great thing that you’re doing there. Has the rest of medicine has gone totally corporate… I know it’s challenging to do it the way you’re doing it but I’m sure the extra work has been rewards for both you and your lucky patients. J
Sorry for the typos… I forget to proof before I send.
I am interested in getting a doctor that will help with assisted suicide.i would also like to make appt if at all possible
I am so glad to see that someone in the medical field is taking a stance against the mistreatment of mentally ill patients and patients with severe health problems. I have experienced a tremendous amount of discrimination and abuse from many people in my life and I cant tell you how scared I am to go to the doctor now since these acts. We patients need to feel like we are real people with respect and support from the hospitals and the doctors. In order for me to make a difference in this situation I need to work with our health professionals and not against them. Please help me continue to spread this message to my parents and friends that we need to learn to understand and respect each other looking forward
Hey,
You are treating others as you would like to be treated
I wish I could see this dr or 1 like her cause this is the kind of bedside manner I remember.
Dr.s have changed so much but I’m still me except for the fact that I’ve been patient profiled, I suffer from fear of dr.s with dr. Hypertension white coat syndrome. Something I never even had before and I only asked for my meds to be cut down and I’m suffering more health problems than before. I just want a dr who cares about me as a patient again. I never gave a dr any reason to treat me this way and I don’t deserve it. My anxiety was getting better and today is worse than ever and only in just 2 years. Why is this happening and I need a dr I can feel safe and comfortable with again. Where are the drs that used to care about a patient’s health and well being? My story is long and sad so I can’t tell you everything here but I need good care. I suffer from lupus,chronic Anxiety,Disc diseases,hypertension 3 from fear of dr.s. my health wasn’t being taking care of and I’m sick and suffer from pain. Why are the drs hurting us more? Please respond cause I am so lost.