Retirement: The Other Side of Life
Retire! Doctors don't retire. We are like priests. Once you are ordained a priest, you are a priest for life. Oh, you can drop out of religion, get married, have kids and work a regular job, but you are still a priest to the end.

Doctors are the same. We tell everyone we are retired, but caddies, friends and relatives are always right there asking us for complex diagnoses. These same people expect the diagnosis to come with the guarantee that no real, hands-on medical attention from their primary care physician is required. None! Of course, sticking your head in sand saves a lot of money.

Remedy: Feign Alzheimer's. Stand there silently and patiently wait for the armchair patients' messages to get through the amyloid plaques. Remember to maintain a blank stare. To see if they are paying attention, simply look at them without making eye contact and refer to them by your dog's name. But don't laugh. This rattles them somewhat, but not enough to seek medical attention.

What's with you people? Retired doctors don't do hip replacements in the garage anymore, especially if we're retired from family practice, not orthopedic surgery.

Since my days as president of the Los Angeles County Medical Association, when I had an active, lively private practice to the days as medical director of an HMO and later medical director of Cedars-Sinai Health Associates, I enjoyed medicine from a variety of viewpoints. Now retired, I've taken to assisting with the legal defense of physicians. Attorneys call me to consult on the medical aspects of malpractice cases.

I play golf at least seven days each week. (E-mail me immediately if there are more than seven days in a week!) For years, my golf score (high 70s) qualified me for tournament play. But now, like some soap opera (nah, I don't watch those--YET), it follows the ups and downs that flow through all physicians' careers.

My television of choice: car chases on the 11 o'clock news. I watch with the fascination of a kid who knows the math, but wants to see some moron who doesn't think the car will need gas, the tires will burn out and he will need medical attention after the cops wrestle him to the ground prior to hauling him away! I think people use car chases as a fast track to pursuing lawsuits. (I don't get THOSE calls.)

My wife, Sarah, a psychotherapist, and I married in January 2005. I met Sarah in the late 1970s at an AMA House of Delegates meeting and again in the late 1980s when she interviewed me for an article in the predecessor to this magazine, LACMA Physician. The subject was physicians with progressive and catastrophic illnesses. At the time, I was back on track from my 1984 bypass surgery and restarting my career. We still have the tapes of the interview. We followed each other's careers until we emerged as a couple, reinventing ourselves.

And that is the essence of retirement: You reinvent yourself every day. Good luck when your turn comes. It's really a lot of fun.

William Weil, MD
Family Practice (Retired)
Los Angeles

Opening Eyes to Home Healthcare
Most physicians think of home healthcare as the next step after hospitalization, but they may not know about the internal workings of home health agencies (HHAs) unless they have had patients with complicated HHA issues.

Here are some things I've learned through experience with this fast growing area of medicine.

Medicare and most insurance companies require the HHA patient to be homebound. Exceptions to the homebound rule usually include appointments with the doctor, wound care center or dialysis, and religious services once weekly.

Home healthcare can be ordered directly from a physician's office, whether or not the patient has been hospitalized. In the case of a hospitalized patient, the home health process usually starts when the attending physician or hospitalist writes an order. Then, the agency's intake department gets the order and obtains detailed information from the discharge planner reviewing the chart.

The more detailed the referral, the more the HHA can prepare the various disciplines to treat the patient. Allergies, weight-bearing restrictions (if it is an orthopedic case), information on wounds and cognitive defects are all necessary facts. The agencies need quick responses from physicians to approve orders and create comprehensive treatment plans. This is particularly true of nurses who call to confirm or change orders. No home healthcare can be rendered without a physician order. It is a problem if paperwork from an HHA is put at the bottom of the physician's in-basket, because the patient being seen by the HHA is often acutely ill.

Many home health patients will receive nursing, rehabilitation and/or pharmacy services. Some HHAs have their own pharmacy that provides infusion supplies, medications and medication advice to the field staff. HHAs might also serve a medically complex pediatric population. This includes infants with serious medical problems who are home with a breathing apparatus, feeding tube, drain and/or a stoma.

HHAs provide intermittent care only. A typical home health visit is rarely more than an hour and usually a discipline does not visit more than three times a week. Therefore, instructions given directly to the patient or to a caregiver in the home are an essential part of home health.

Nurses review the complete list of medications, outline the wound care, look for medical complications, govern the management of infusion therapy, and perform other nursing functions. Physical therapists offer total body strength training, gait training and energy conservation. Occupational therapists help with activities of daily living, kitchen activities, energy conservation and upper-extremity strengthening. Speech therapists assist with speech, cognitive functioning, feeding and swallowing.

To avoid patient frustration, physicians and discharge planners should be careful about promising the patient a certain number of visits per week or a certain number of weeks of treatment. Upon assessment by the home health field staff, the HHA will collaborate with the physician to plan an appropriate frequency and duration of treatment.

Leonard Shulman, MD, FAAFP, FAAP
Pediatrics and Family Practice
Anaheim