I adore my friend Rita, but I think I was avoiding her for the past two weeks. She's a friend whom I met when I was attending the Tacoma Filmmakers meetings regularly. However, since I moved up to Anacortes, I rarely get to see her. At least, until the lockdown. Then a lot of my old writing groups went to Zoom. So I started attending them again. And, I started meeting up with Rita regularly again. I was writing prolifically when we met weekly.

But the last time we met, we lingered after discussing our writing. And we got onto the subject of why I am no longer in medicine.

She gave me a litany of reasons why she thinks I can open my own practice.

It's frustrating talking with non-physicians, because people assume a lot of things:

1. They assume all doctors are rich.

2. They assume we really don't do much.

I still remember the time my Uncle Danny came over to my parents' house for dinner, and my dad got a call from the E.R. in the middle of our meal. My uncle yelled from the dinner table, "Just order another MRI, Doc!" My dad was angry, but he only complained once my aunt and uncle had left the house. "What does he think I do all day? Just order MRIs?"

All my life, my dad has gotten phone calls in the middle of the night where he had to leave my mom and me. He would spend the night working in the hospital instead of being with us. My Uncle Danny at that time was unemployed and living off his wife's income as a nurse. I could see why my dad was angry. Doctors and nurse practitioners give up a lot of their family time to save other people's families. It's the "Cobber's kids have no shoes, phenomenon."

3. They assume all you have to do to make money is hang a sign on your door, and people will pay you.

This is where I almost got into an argument with Rita. She thinks I can just open up a clinic and have people come in. People don't understand the overhead costs of running a clinic. There's the medical license, which in Washington state costs $876 a year now. I know, because I just had to renew it. And there's malpractice insurance, which God only knows how much it costs, because the last two places I worked, the "company" carried the costs for me. As a hospital or group clinic, they get reduced rates. Self-employed, I don't. But they don't teach doctors this. I found it out the hard way. Because as a doctor, I wasn't trained in running a business. It's almost as if they willfully keep us ignorant about it.

When I was a doctor in a small town, I couldn't even afford health insurance for my husband. Self-employed people get to see their health insurance costs in a way that salaried people never do. So when the government demanded we all purchase health insurance, I was happy I had stopped being self-employed, because there was no way I could afford health insurance for both of us. It's ridiculous how much people pay for health insurance, with a deductible even. Health insurance is NOT the same thing as health CARE.

When I was self-employed but contracted, I was getting paid $35 per patient. AND I had to pay for my own health insurance, which was $10,000+ per year.

Yeah, so Rita saying I can just "hang out my shingle" as a doctor, is not practical. She acted like I had never thought about the idea in all my forty-eight years of life. Babe, I have thought and thought and thought about it FOREVER. I'm still thinking about it. And it's STILL not feasible. Not right now, anyway. I'd have to find a SECOND JOB to fund my own clinic. And that's what I'm currently doing.

4. They assume we don't know much.

Specifically here in Washington state, I've had more patients tell me I don't know anything than in the two other states I've practiced. Women and men say they know more about medicine from reading shit online than I do, with my four and half years of college at U.C. Berkeley where I studied biochemistry, chemistry, classical physics, quantum mechanics, linear algebra and differential equations, in addition to being forced to take humanities classes (English literature, drama, Asian music history, geology, and anthropology), two years of working with G. Steven Martin in signal transduction, almost a year of working with Nilabh Shastri in immunology, sequencing DNA, learning how to create monoclonal antibodies, cell culture, protein sequencing, and gel columns, six years as a graduate student in biochemistry harvesting and plating neurons and myotubes, working with Dr. David Shapiro on the estrogen receptor, Cheng Ming Chiang on transcription factors, getting paid as a teaching assistant in everything from undergraduate chemistry to biochemistry and molecular biology, and then finishing medical school (an American medical school, mind you, as I saw once a textbook for UK pediatricians, and I was a little shocked at how lacking it was compared to Nelson's Pediatrics), three years of pediatric residency, and practicing as a solo pediatrician for six years, in a physician-owned clinic for three years, and a government subsidied hospital-clinic system for three years.

It's just a little bit insulting to have some twenty-year-old mom with maybe not even a high school degree tell me she learned about PANDAS online and that I don't know how to diagnose all four of her kids with it.

Now that I'm past menopause, I realize, I really don't have to take their shit anymore.

It's a John Galt phenomenon, you know.

I went to college and trained for.... for.... I can't even count how long anymore. Since 1990, when I started college to 2004 when I finished pediatric residency.... however long that is.... to "help people." And to have people insult me and tell me that they're going to sue me if I don't get immunotherapy for a condition that they do not have. Immunotherapy that could kill her kids, by the way. Because, sister, I actually know what that immunotherapy is that you learned about on Google.

Even my friends are constantly telling me they found some "new" information about herbs or other things that help cure cancer, or diabetes, or God knows what else. I forgive them, because I know they mean well. As my husband told me, "Sometimes people talk about things they really know nothing about, because it's hard to suppress the urge to help out."

And this is where I get into the topic of my essay -- problem solvers. My friends and I are all "problem solvers."

The one thing that the people I like to hang out with -- my husband included -- have in common is we are problem solvers. People who like to figure out how to make things work.

That's why a lot of my friends identify with Sherlock Holmes. Sherlock wasn't all that different from his rival and arch enemy Moriarty. Both were problem solvers. Only difference is Sherlock chose to solve problems that serve justice. Moriarity chose to figure out ways to help only himself. Otherwise, the two men were the same.

Problem solvers are not happy unless they are using their brains to figure things out.

Sherlock Holmes liked a good puzzle. He liked to use his brain to find ways to make things work. He also liked to find out why things are they way they are. You would think this is an evolutionarily favorable trait, right? But not everyone has this trait.

I didn't know this. I assumed EVERYONE questioned things, and wanted to know the truth behind it. But no. Problem solvers are a rare type of person. I've learned that 90% of people go along in life and never ever question things. They're not curious how their stove works. They're not experimenting with their sourdough starter to see how to make their bread fluffier. They're not saying, "Hey! I can grind peanuts down into a paste, and sell it as 'peanut butter.'" (That's a Washington Carver reference.)

It's come to a point in medicine where the bean counters and administrators are not letting me solve problems. Figuring out diseases and finding ways to treat them. So I am not going back to medicine. Not at this point in time. No, these days, the way they are forcing us to practice medicine only creates problems. And then they silence us with HIPAA, so we cannot explain what is happening.

Silencing me makes it so that I cannot help to solve the problems that I see.

And, as I mentioned, when you stifle a problem-solver, she or he becomes extremely unhappy.

So when I listened to a student of the Northwest School of Boatbuilding say, "I'm a problem solver," and he described how his former job was becoming "death by Powerpoint," it resonated with me.

In 2019, hospital staff meetings were always some business school grad standing up there, pointing to a Powerpoint presentation, and spouting bullshit acronyms that have nothing to do with patient care. And then, after listing the new acronyms for the month, he would chastise us for not seeing enough patients and not putting the correct number on the bill so they could charge a patient $500 for dick all.

There is no reason a doctor's visit should cost more than $20. None.

All those secretaries up there at the front? Not needed. All those computers? Not needed. It's bullshit. But now, we are required to have EMR. That high school grad that shows patients to their room and tells them to "take your clothes off" and shit? Not needed. That's another $16/hour, folks. Sure, it creates jobs, but it simply is not needed. And wastes time. And it's stupid to have sick people linger in a clinic for longer than they have to.

Common sense.

Where was I?

Oh yeah. Problem solvers. Medicine these days in the United States leaves no room for problem solvers.

Marine electricians on the other hand. Diesel mechanics. Fleet captains. I found my home after I quit medicine, and began working on the water. Problem solving. They paid me to diagnose a problem and solve it. Wow, what a concept.

My friends now are no longer doctors. They are sailors, filmmakers, writers, musicians, mechanics, delivery captains, and I could go on and on.

They are all problem solvers. Even Rita. So I will meet with her tonight for the first time in many weeks, because problem solvers are my tribe.