For over three decades, I practiced adult primary care medicine in various settings in California. I worked in a U.S. Public Health Service clinic, an Emergency Department, two different medicine departments in Kaiser Permanente, and a community clinic in Vallejo, California. I retired from clinical practice in 2016.
Practicing medicine was never quite what I expected when I went to medical school. During tens of thousands of patient interactions, I often found myself surprised — surprised by what patients were saying and experiencing, surprised by what my colleagues were doing, and surprised by my own reactions to patient encounters.
As I was going through this process, I decided to write about some of my experiences. Many of my reflections were published in the professional staff newsletter of The Permanente Medical Group in Vallejo. I recently re-read these pieces, and in doing so I recaptured the surprise and the evolution of my understanding of the doctor-patient relationship.
This website contains many, though not all, of the articles I wrote over a 15 year period. The intended audience at the time I wrote them was my fellow clinicians, but I think my reflections may also help others understand a little better what is going through the mind of their personal physician. All of the stories are true. In every case, I have changed the name to protect the privacy of the patients I am discussing.
Some of the articles obviously reflect a different time than the present, such as references to economic crises, watching DVDs, and other phenomena. To place each piece in context, I have included the date it was written at the end of each one. But the observations made during these earlier years still reverberate today.
I hope you enjoy reading these, whether you’re a clinician, or a patient, and I welcome any comments or feedback. Thank you.
Richard Fleming, M.D.
Benicia, California