Every year I write a letter to my patients. I have been doing it for more than 20 years. I usually send a letter out in December because I have a party for my patients every year. Over the past two years, because of COVID, we have not been able to have this party.
Unfortunately, we won’t be able to this year either.
This letter comes late, or early, depending on how you look at it.
I write the letter for several reasons; one of them is to let people know what is going on in the practice, to talk a little bit about my life and some things going on in medicine.
One reason why I was late writing this letter is that we had mold in our house. It is a common problem in Florida and being a native I am used to seeing it but unfortunately, we had to move out for quite a long period of time. Not being near my computer at home where I usually write and edit these letters also contributed to my tardiness.
For that I am sorry.
But first things first, I am happy to report that my family is fine. I have been married for almost 16 years. Now and every year, every day, I love my wife more. We have two children, a daughter and a son. Our daughter’s nickname is CC. She’s doing well in school and has started taking jujitsu. It’s been a great thing for her and her confidence. I’m not so happy when she tries the chokeholds she’s learned on Dad, but she has to practice somewhere, I guess.
Our son George is now nine. I have mentioned before that he is autistic and for a long time he was nonverbal. He is just putting together sentences now and we could not be more proud of him. He loves swimming and the ocean, and is making great progress in school.
I want to talk a little more about my son. Many people come to me and offer advice regarding other autistic kids and the situations that they have known. And they recommend treatments, etc. I know people’s intentions are the best, but we have a plan for our son and he seems to be progressing.
When people ask me to call other doctors or invest time, energy and money into other treatments, I initially was more accommodating.
I appreciate people asking about my kids and my family but my wife and I, after much thought and discussion, have chosen a specific course and we are going to stick by it. We are not closed minded, and this is not to denigrate anyone else’s chosen course for their family.
This is just the way we have chosen. Thank you for respecting our wishes on this.
And, I think most of us would agree that the world is changing rapidly.
Not all these changes are good, but things like formal education, four years in college, and things like this I believe will become less important.
There are a wide variety of things that can be learned easily and quickly through apprenticeships, online courses, etc.
We don’t know which path our kids are going to choose but at this point I won’t try to confine them to a typical formal education.
This is a 180 degree change from how I use to feel. But as I said, the world is changing and my family and I are going to prepare for what’s best for my children and their happiness.
These changing times affect our practice of medicine, too. The past few years have been incredibly challenging. We have had a number of shut downs and even now it is difficult to get supplies.
Many of you know that most of my staff has been with me for more than a decade, I think the average length of time my employees have worked for me is about 15 years. I always make the joke that no one else would hire them, but I am incredibly lucky and blessed to be surrounded by such supportive, kind and hard-working people.
At this point we are akin to a family and I very much appreciate these relationships with them and their families. We feel the same way about many of our patients.
I talked about change above. Medicine is changing too. Every year, and in fact just last week, I get offers to buy my practice.
There are large groups of practices forming that join even larger groups.
I think the corporate structure might work for some doctors, but it won’t work for me. As I said my employees are my family. The first thing that happens when one sells one’s practice is the new owners cut salaries, benefits, etc. Of course, I would get a nice check, and especially in these times, a cushion is nice. But I wouldn’t be able to take care of people the way I want to.
My wife and I are savers and of course we have had some setbacks. I am lucky I do not need that big check to help my family move along in these difficult times.
I spoke about change, but for the foreseeable future Treasure Coast Dermatology will not become part of any of the large groups, but will be guided by me. Selling this practice and the relationships I have with my employees and patients is not a change I am willing to make.
When I first went into practice, I worked for a plastic surgeon.
My practice while working with him was almost exclusively cosmetics. The money was great. One did not have to deal with insurance companies, and people always paid up front. There were certainly many financial benefits.
When I left his practice and opened my own practice, I decided not to do cosmetics.
Though the money was great, as an individual, I felt emptied by trying to sell stuff to people. Many times, this would prey on their insecurities.
At least I felt it was that way. And this is not to criticize others, they may feel differently, and that’s ok. As patients we should have the choice to go to the doctors whose philosophy fits ours. As Doctors, we should have that type of choice too.
Many dermatologists now use what they call physician extenders. Often my patients come to me from other practices and say they have never seen a doctor.
I have made the choice to not use physician extenders.
As many of you know I have a very busy practice, and moving some of the work to others, physician assistants, etc. would certainly lighten the load and of course bring in more money.
But I just can’t bring myself to doing this. I think in many ways doctors have relationships with their patients and having someone else who is not nearly as well trained, loses both a practical and spiritual connection.
I do not blame some of the younger practices for doing the two things I mentioned above. Many of them are struggling. It is much more difficult to start a practice now than when I started more than 20 years ago.
Reimbursements are less, expenses are much higher, and the whole practice of medicine has changed.
In many ways this has not been for the better. In some ways I am a dinosaur. Up until this year we have used paper charts.
Medicare has said that they will dramatically cut reimbursements for any doctors not using electronic medical records. I have a bunch of problems with that as I believe this type of thing should not be mandated and I guess it isn’t, they’ll still pay you but they will not pay you enough to keep your practice open if you do use paper charts. There’s a huge penalty for not being electronic.
I think ultimately what is being enforced is a complete consolidation of medical information. While on one hand this might seem to be a good thing, however, how many times have you been to your doctor’s office and he or she has not even looked up at you because they are typing on the computer.
This depersonalization of the relationship between patients and their doctors is profound.
The example I gave above about selling my practice, if I did do that, technically my patients would not be my patients anymore, they would be the patients of the corporation. This corporation could and they do dictate how to treat patients.
For me, and this is a very personal statement, this is just wrong.
I know many colleagues and good friends have sold their practices. Like many decisions, this is an individual one. I would like to think my patients chose to come to me because of my standing firm on these two principles.
And lastly, I want to talk about my own health situation. I have a rare genetic cardiomyopathy. I have the same gene in my heart that kids with progeria have. Kids with progeria are the kids who age very rapidly.
That same gene is present in the muscle cells of my heart (It’s called an LMNA defect if you want to google it). So, I have the heart of someone much older.
Seven or eight years ago I was told by this time in my life I would probably need a heart transplant.
Four years ago, I had a health scare and went into cardiac arrest. Fortunately, I had some good doctors treating me and things turned out okay.
I now have a pacemaker and defibrillator. Maybe in another letter I will tell the story about the cardiac arrest. It was very dramatic and just because you are the patient, being a doctor and the patient at the same time was an incredibly surreal experience. And not in a good way.
I was lucky to find some doctors who would accommodate my treatment and it seems at the very least my heart is not getting worse. I am on an experimental protocol. It seems that my heart condition has stabilized and might even be getting better.
There was no heart disease history in my family. It seems my genetic problem is a new mutation. We haven’t tested my kids for it yet, because the problem doesn’t usually show up until the late twenties or thirties.
After the diagnosis I spent several months in a funk. My wife has done a lot of things for me including supporting me 100% with this and every other problem we have had. She is always by my side.
And not to get preachy, but she has also brought me closer to God. We do not know what His plan is.
So I have decided I will live my life as fully as I can despite the heart failure and its associated problems.
I actually feel pretty good; better than I did two or three years ago. The protocol I am on seems to be working.
I am grateful for the things that I have been given.
Working in my practice and being with my family are things I enjoy, and I am going to continue to work and do the things that I enjoy for as long as I can.
I hope you will stay on this journey with me.
We are going to try to have a party next year but with the cost of food and everything else, the menu might be a lot more limited, but we will try to get it done.
Thanks for taking the time to read this letter and trusting me to take care of you.
I am grateful for and honored by this trust.
TIM IOANNIDES, MD