
Physician & Advocate. Husband 2 @netrix_sky. @USArmy #SoldierForLife 40+ years and counting. #FamilyMedicine/#meded/#TEDx geek. #FMRevolution #InRecovery
The Pacific Northwest
Joined November 2007
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"I’m sorry that I have no words of wisdom or inspiration. I get sad and scared too. I think maybe it’s part of the natural price of wanting to do this kind of work."
~David Foster Wallace
mcsweeneys.net/pages/memorie…
LinkedIn just routed one of my Substack posts back to me in my notification feed as “suggested for you”
I guess I have finally nailed my audience.
Mike Moore, DO FAAFP retweeted
Chef opens a restaurant. People really like it. He books out reservations for 3 months.
But now people are upset there’s a 3 month wait to go to the restaurant.
Then, the government decides to put price caps at how much he can charge customers. He still needs to pay overhead and staff and ingredients, though.
So he decides he needs to serve more customers to cover his costs. So he shortens the allowable time for meals. Of course, now the customers aren’t happy about having to rush through their meals. Many of them insist on eating at a leisurely pace, or they send their food back because they didn’t like it, or they show up late for their reservation and insist on being seated anyway.
Meanwhile, the chef is trying to keep up. He feels bad he can’t put the same attention into each meal he did before. But if he doesn’t serve enough people in a day, he will have to close down (or sell to the large restaurant conglomerate down the street).
Oh, and the government also decides that he now needs to do two hours of computer work for every hour he spends cooking. They force him to use a terrible, but expensive, computer system, too, not the one he wanted. So he needs to serve even more customers to cover those costs as well.
The customers are rightly upset. They’re waiting longer and getting less personalized service. The chef is also upset that he’s spending more on overhead but delivering worse meals.
Nobody is happy here.
Mike Moore, DO FAAFP retweeted
We've been getting a lot of questions lately about how the Internet Archive digitizes books.
The short answer: page by page, by hand.
You may remember our viral 2021 video of Eliza Zhang scanning a book. That's still how we do it.
Meet Eliza, and learn how we scan books: blog.archive.org/2021/02/09/…
Mike Moore, DO FAAFP retweeted
I entered UCLA as a freshman at 46 and graduated with a computer science and digital media management degree at 50. In the ten years since, I’ve made three feature films, two film shorts, established a film festival, written for numerous publications, and published two books (third one on the way). You’re either alive or dead. Those are the only two ages.
Mike Moore, DO FAAFP retweeted
Family doctors build a caring relationship with you and your family. They listen, document your health history and help you make informed decisions about your health.
Learn more about how to find the right family doctor: bit.ly/4j9TqnZ
Mike Moore, DO FAAFP retweeted
EHRs are a tax on physician time. Countless hours of our lives are lost waiting on screens to load, or the clicks to process.
Many hospitals host remotely, making work happen through a remote desktop, so every single action has a quarter second delay.
It all adds up.
There is a tax on American medicine that appears in no budget. It is one second long.
Click delay.
The pause between a physician’s action and the EHR’s response. Order entry that takes two seconds to open. Pull-down fields that hesitate. And worse: one major EHR I work in daily freezes for five to ten seconds, sometimes longer, when I expand a diagnosis list. Not occasionally. Routinely. No exaggeration.
Do the arithmetic with me, because nobody ever does.
The classic time-motion study of community ED physicians counted roughly 4,000 clicks per 10-hour shift. Now assign a delay to some fraction of those interactions. Suppose only a quarter of them carry a one-second lag, a conservative figure for anyone who has used these systems. That is 1,000 seconds. Seventeen minutes per shift, per physician, spent watching a screen think. Across a five-physician ED, an hour and a half of clinical attention daily. Across a thousand US emergency departments, thousands of physician-hours every day. Millions annually. Paid to no one, for nothing.
And the seconds are the smaller cost. Every freeze is an interruption, and emergency medicine has an entire literature on what interruptions do to clinical reasoning. The delay does not just steal the second. It breaks the thought that was in progress at 2 AM on patient seventeen.
Here is the analogy I keep returning to. Imagine McDonalds ran its kitchens this way: food cooked only after each customer arrives, never prepared for the lunch rush everyone knows is coming. Asked why, they explain that anticipating demand would require both technical skill and an understanding of their customers. We would call that organization broken. Every EHR that generates a summary only when clicked, loads a screen only when opened, and computes nothing in advance is running exactly that kitchen. Anticipation is not exotic. Consumer software has prefetched and prepopulated for decades. Your phone does it a hundred times a day.
The reason this persists is not technical difficulty. A one-second interaction delay is an afternoon of engineering. It persists because the physician’s time is the one resource in the transaction that the vendor does not pay for. Latency is free to everyone except the person practicing medicine and the patient waiting behind them.
Speed is not a convenience feature. In clinical software, speed is respect. And the bill for its absence arrives every single shift, unitemized.
Mike Moore, DO FAAFP retweeted
Our perspective on decision authority in health AI was just published at @Nature Health, w/ Aiden Gu
free access rdcu.be/fwDdv
nature.com/articles/s44360-0…
Mike Moore, DO FAAFP retweeted
Happy Independence Day!
There’s a story from the end of the Revolutionary War I want to tell as we celebrate America’s 250th Birthday, and it’s one everyone in the world can learn from.
George Washington, at that moment, after commanding the American forces to victory, was the most powerful man in the new country. Many people talked about making him King of America.
Across the ocean, King George was sitting with an American painter, and asked what he thought Washington would do now that the war was ending. The painter said he believed he would go back to his farm.
The King said, “If he does that, he will be the greatest man in the world.”
As the war officially ended, Washington came to speak to Congress and said, “Having now finished the work assigned me, I retire from the great theater of Action.” He returned his commission they’d given him in 1775 - after more than 8 years of leading the Americans to victory without pay, and he was home at Mount Vernon for Christmas.
Of course, he was elected as our first President a few years later, and after two terms, showed the same selflessness again when he willingly gave up his power and went back to Mount Vernon again.
That’s true greatness. He had all the power in the world. But power, alone, does not make you great.
Washington’s greatness came from being a true servant - to a cause much bigger than himself. His greatness was his complete lack of selfishness.
The whole story of American Independence is a story of selflessness. It’s a story of people who set their self-interest aside and worked for each other.
We’ve all heard the line about “We must all hang together, or, most assuredly, we shall all hang separately.”
Apparently, Ben Franklin might have actually never said that.
But that’s fine, because the same mentality is right there in the last line of the Declaration of Independence, published on this day 250 years ago:
“And for the support of this Declaration, with a firm reliance on the protection of divine Providence, we mutually pledge to each other our Lives, our Fortunes and our sacred Honor.”
We mutually pledge to each other.
No one was in this alone. No one was in it for themselves. This was a group of people with different backgrounds who were in it for each other.
Today is a reminder: greatness comes from what we do for each other, never what we do for ourselves.
That’s a lesson that applies no matter what country you call home.
It’s a lesson that doesn’t require any law passed by a politician, because, let’s be honest, if you’re waiting for selfless politicians, I really hope you are not holding your breath.
All of us have the power to be there for the people around us. For our families and friends. For our neighbors. For everyone.
All of us can reach for greatness.
It’s as simple as looking beyond yourself, seeing past the mirror, picking your eyes up from your phone, and pledging to be there for each other.
Happy Fourth. May you all find your own version of greatness today by lifting each other up.
Lift up your neighborhood. Lift up America. Lift up the World.
Mike Moore, DO FAAFP retweeted
bets still on the table America, yet.
Matthew McConaughey - Howdy America 250
America 250
Mike Moore, DO FAAFP retweeted
Join me to support:
The Ben to Shore Bike Tour
Benefits fallen police 👮 families
#BenToShoreTour @NickKayal @GREGSTOCKER @DawnMendte @1210wpht @healthis1show @RoadWarriorJohn
bikesignup.com/drcraigwax
Mike Moore, DO FAAFP retweeted
Dr. Mike Moore (@MikeMooreDO) shares how family physicians are uniquely positioned to provide medical context and advice because of their continuity of care, supporting you through every life stage. 🫶
Mike Moore, DO FAAFP retweeted
When I applied to medical school in 1996, lots of people (attendings, residents, some family members) told me the profession was doomed because of HMOs, longer hours, and lower pay. It's been 30 years, and medicine is still in demand, with excellent job security. Don't let the current fatalists get you down. The world will always need doctors.
Mike Moore, DO FAAFP retweeted
Every year, I share this video of French caretakers who take sand from Omaha Beach in Normandy, and scrub them into the letters to give them the gold coloring.
They do this for all 9,386 US soldiers who died.
France also gave us this land as American soil. #MemorialDayWeekend
Mike Moore, DO FAAFP retweeted
This is one of the most out of touch takes I’ve ever heard from a fellow physician.
Read the room, Congressman.
Physicians are burning out because we are being crushed by administrative burden, loss of autonomy, declining reimbursement, corporate consolidation, insurance interference, and a system that treats doctors like disposable labor while demanding endless sacrifice.
Stop blaming physicians for refusing to tolerate an increasingly dysfunctional system. The problem is not that young doctors lack commitment. The problem is that medicine has become unsustainable.




























