After 38 years of practicing family medicine in the same community and after 45 years of working as a physician, I have retired from direct patient care.
Here is a very lightly edited version of the speech that I gave at my office during the lovely retirement party they the medical group arranged for me:
I have always proudly defined myself as a board-certified family doctor. For over 40 years now.
Maybe sometimes to too great an extent, missing time with family and friends with late nights at the hospital or weekends in the clinic.
Do not say that that I am GP, a general practitioner- Family docs may be generalists, but we are trained as experts in recognizing the primacy of the family in understanding the disease process.
Whether inside or out of the clinic, I always introduced myself as a family doctor.
When I was running a Code Blue in the ER or giving general anesthetics in the OR, or delivering babies in the birthing suite or setting a fracture in the cast room, or consulting at a psych hospital or teaching medical students, interns and residents or giving expert forensic testimony in court defending sexually abused little children or counselling at a student health clinic or speaking at a hematology conference, I proudly said that I was a family doctor, not a shrink or an ob/gyn or an orthopedic or a hematologist.
Family physicians don’t have a limited scope of practice – unlike the orthopedic surgeons who won’t look at the patient’s ankle if she was referred for knee pain. There is no problem where we can’t at least start to do a work-up.
Like the point man on a hockey powerplay, we may not always score the cure, but we organize the team and keep the puck in play and give the team the chance to get reach the goal.
Family physicians know that to be successful we need to take a wholistic view of our patients.
Family physicians know that we need a team for many of the problems we are trying to solve. And family physicians never forget that the patient needs to the captain of the team.
I am extremely grateful to my patients for sharing their lives with me. I have learned so much from them. And am so grateful for the nurses and medical assistants and imaging team and the front office and administration. I have learned so much from all of you. And of course, I will be forever in debt to my colleagues and partners. Dr. Starr and Dr. Rhodes have shared so many joys and more than our share of sadness over nearly 4 decades. I have learned so much from them sharing not only how to care for our patients, but also how to care for our growing practice and to care for each other.
I have essentially spent my whole professional career offering continuing comprehensive care for my patients in Diamond Bar.
I will miss it all.
I am deeply grateful to my family, my wife and children who put up with my long hours and frequent distractions. They are the ones that were always there for me.
What I won’t miss is the electronic medical records, essentially a computerized cash register with just enough medical information to justify the billing code. What I won’t miss is the transition from a community-based practice to a big corporate business that despite all the talk to the contrary, too often puts margin ahead of mission and is increasingly dismissive of the family doctors that helped build the modern medical system in favor of the big dollar producing specialties. And of course, I won’t miss the multi-million-dollar salaries of the administrators in their executive offices that all supported by those of us who work on the frontlines of patient care.
I am leaving family medicine, but too few are willing to take my place. I get it. Medicine as a career is not what it used to be, and family medicine has fallen the furthest from its vision of lifelong comprehensive family-based care. We have increasingly become border guards who must make quick decisions about who gets access to the specialist citadel. Increasingly graded on throughput, rewarded for cost saving and fake informatics that are so far removed from what really matters: excellence and compassion. As Cameron said: Not everything that counts can be counted, and not everything that can be counted counts.
Still I love the work and miss it badly. It’s been a rougher transition that I expected.
When my dad retired, his family physician said one needs to retire to something, not from something.
And that I have done and what my dad did too decades before me.
My wife, Patty and I founded the nonprofit 501c3 CLL Society dedicated to addressing the unmet needs of the chronic lymphocytic leukemia (CLL) community.
In 4 short years, we have produced and published the largest survey ever of leukemia patients, presented abstracts at ASH, ASCO and EHA, seen our research published in peer reviewed journals, run a dozen educational forums annually partnering with the NIH, Mayo, Harvard, Moffitt, Duke, OSU and UCSD and so many others. We are the preferred partner for LLS, LRF, Cancer Care, Cancer Support Community, and so many others when they want to reach the CLL community. Our website is visited between 40,000 and 50,000 times a month. We have established, support and train 33 peer to peer support groups across the USA and Canada. Our innovative program offers free access to hundreds of CLL patients across the country using a HIPAA compliant online SKYPE platform who otherwise would not have the benefit of such expert care. We have helped a new CLL charity launch in Ireland and shared our best practices with over 50 mostly 3rd world countries. We have received international press coverage and won two international awards for our work.
But mostly we are saving lives through our education, support, advocacy and research.
I love this new work, but despite its fall from glory, I still miss being a family doctor.
And when I introduce myself to my fellow leukemia patients or the hematologists that I work with now, I still will always proudly identify myself as a family doctor.
At my retirement party, where all my family attended, I received the most incredible gift. When we designed the “new” office in Diamond Bar decades ago, I and my fellow doctors insisted that we have a room for patient teaching, a room that generates no income, but allows patients to learn how to care for themselves. At my retirement bash, I learned that the Board of Directors had named that education room in my honor.
It was the best possible gift.
We are all in this together.
Brian Koffman MDCM DCFP, DABFM, MS Ed
Co-Founder, Executive VP and Chief Medical Officer
CLL Society, Inc.
Retired Family Doctor