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I know this column is titled "Building the Patient-Centered Medical Home," and a lot of it is about what's wrong with the healthcare system, and thinking deep thoughts about how to make it better.

But despite the fact that the column often feels like a lot of griping about what's going wrong, how so many things are set up to work against us and our patients instead of for us, how all of us are trying really hard and fighting an uphill battle, I still feel an incredible amount of gratitude for getting to do what I do when and where I do it.

My Gratitude List

Every day I'm grateful that I get to come into work and do what I do.

I'm thankful I have a job, and I'm thankful I have a great place to go every day (I've discovered I'm pretty terrible at working from home).

I'm grateful for my partners at work taking care of patients and teaching the next generation the infinite value of outpatient primary care.

I'm grateful for the residents who work so hard under such challenging conditions in both the inpatient and outpatient settings to take care of our patients.

I'm grateful for the nurse practitioners in our practice who serve by our sides.

I'm grateful for the staff that is there to help us take care of patients -- always being asked to do more with less.

I'm grateful for our nurses who educate our patients and vaccinate them. I'm grateful for the medical technicians who weigh our patients, take their vital signs, and get to know them. I'm grateful for our registrars, who answer the phones, listen to patients complain about the system, and help them find solutions.

I'm grateful to our team of administrators and supervisors who help us navigate the craziness of the system and help calm the day-to-day chaos.

I'm grateful for our colleagues in other primary care specialties, as well as those in so many other medical and surgical specialties and subspecialties: surgeons, ophthalmologists, urologists, dermatologists, and on and on.

And I am especially grateful to all the patients who allow us to participate in their care, and who trust us with their health and well-being.

So yeah, a lot to be thankful for.

How Can We Achieve Perfection?

If you've been along for the ride as I've written this column over these past years, we've seen a lot of ideas rise and fall, a lot of suggestions that led nowhere, a lot of little changes that made a big difference, and over 500 columns (and counting), hopefully meant to make us all think about this crazy topsy-turvy healthcare system and how it can be better for us and for our patients.

I have so much to be thankful for -- we all do -- and I am grateful that we get to do this job every single day, but I don't think I'm ever going to stop thinking about how to make every day perfect.

Think of it:

That alarm clock goes off in the morning while it's still dark out, and you roll over in bed (maybe hitting the snooze button once or twice ...) and think to yourself, "I can't wait to get to work."

The full schedule of patients that awaits you has already been pre-screened, with the aid of navigators, mental health team members, and assistants real and virtual, making sure our patients get all their pre-visit screenings done.

The patient registries have all been entered and checked, and orders have been queued up for the day for the things our patients all need: labs, vaccines, mammograms, colonoscopies.

Portal messages have been uploaded, pre-screened by artificial intelligence, and suggestions of responses are right there waiting for the doctor to say, "Looks good to me; send it out."

Care coordinators and navigators are making sure that patients know that their appointment is today, that transportation is arranged, and wait lists have been actively churned and updated to make sure that patients can get in when they need to.

Smart systems will be there waiting to listen in on our visits, generating billable, compliant office notes that are accurate and effective communicators of what went on in the office visit today.

Billing will happen automatically.

Our patients will get smoothly and efficiently scheduled for all the follow-up they need, whether that's mental health care in the community; follow-up televisits and video visits with our nurses, pharmacists, or social workers; or remote patient monitoring to follow blood pressure, hypertension, and other chronic diseases at home.

Relevant patient education materials will be selected based on the patient's visit today, and their medication and medical problems lists sent out to them in the right format that works for them.

All positive screenings will result in actions, with referrals to community health workers and other external resources to help our patients overcome social barriers to health and find ways to help address the critical social determinants of health.

Referrals will be processed with minimal involvement of the providers, with follow-up for ongoing care of chronic conditions auto-managed by the system, so no longer will we be interrupted from our clinical work to be told to enter an emergency referral for Podiatry or Dermatology.

Putting Patient Needs First

I think the more we let these systems grow organically around the needs of patients and the needs of providers, the more we'll be able to return to practicing clinical medicine, to talking to our patients, to exploring their lives, to getting to know them, to making sure that no one feels rushed, to making sure that all of their social determinants of health are addressed and barriers to access and care are overcome, so that we can take the time to manage the conditions that we want to manage, and have the resources to get them into the care they need for those we can't.

When we make the day as perfect as we can, we're more likely to get our patients healthier, happier, and this can only reflect back on us.

So, while I am truly thankful for what we have, there are undoubtedly countless opportunities out there for us to make things better.

To build a perfect day that we'd all be thankful for.

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