I thought that my minister used grief for a memorial recently, but he didn't. He sent me a copy and it was grounded that he used. Which I agree is the better choice. I thought about lying down in a furrow and just becoming part of the dirt and ground and earth when I wrote that one, and never getting up. But then, eventually tears slow and one gets up.

A friend called at lunch yesterday, asked me to stitch her up, so I added her on at 2 pm. Her daughter took a photo and put it up on Facebook. Thus not a HIPAA violation. In theory I am on "3/4" time, but even though I usually see my last patient at 1 pm, I then work from 2 to 4 or 5 doing the referral letters, labs, reading specialist letters, xray reports, MRIs.... and I really need to read medicare's rules for 2017 because I have to make some sort of choice and revamp again to conform to the new rules. Square peg here. I signed for two years of clinic lease rather than five because it is a big question how long I can follow medicare's rules. If they become more impossible I will flee to somewhere else....and probably not in the US. I am trying to hold my hours including the paperwork to 40 per week. No, it would not "help" to hire more people because I still have to write the letters to the specialists and read all the ER, lab, radiology, old records and specialty reports that come in. I am doing Slow Medicine so as not to burn out. And an hour visit with a complex new patient yesterday STILL feels short, though by the end I suspect I have a handle on the part that providers have not had time for.....we'll see.

The Surgeon General is worried about medical provider burnout. I want to mail him my Slow Medicine essay. It will probably be ignored. I grieve whenever one of the primary care doctors that I think is good, leaves or quits medicine. Another one bites the dust.