I love juggling. I started doing it when I was a little kid. My brother learned how to do it from reading a book. I wasn’t going to let that go unchallenged, so I taught myself!

I started with one ball, which I tossed back and forth from hand to hand. I did this for weeks until I felt that I had mastered that much — and could do it with my eyes closed!

Then I added a second ball. Two balls are a little trickier. Although the process is similar — throw the ball up with one hand and catch with the other — the juggler’s concentration is now split. Plus both hands are now engaged at the same time.

It wasn’t until months later that I was ready to add a third ball, and then a fourth.

The trick to juggling is to be able to give the appropriate amount of attention to each ball at exactly the right time and then move on, while always staying aware of all the other balls. It is a dance performed by the hands, but mastered by the eyes. The more balls in play, the more precise and intense that focus must be. Once concentration falters, even for a moment, everything tumbles to the ground.  

Medicine is a lot like juggling. The doctor must focus with razor sharpness on the patient before him/her, without losing awareness of thousands of others also in his/her care in the background. It’s a juggling act, and for the lowly generalist, the struggle to keep all the balls in the air without dropping any is becoming more and more difficult.

The number of distractions pulling physician attention away from where it should be — on patients — has increased. Five years ago, such distractions — such as paperwork and other hassles — were even less. There were no face-to-face encounter forms to fill out, nor medical reconciliation forms.

Pre-authorization was not nearly so rampant. Nor did doctors spend so much time dutifully filling out electronic medical records. While all of these “advances” may have some beneficial value — emphasis on “may” — they also have consequences.

Since they’re so obviously struggling, one could argue that maybe physicians should not try to “keep so many balls in the air.” But, with decreasing reimbursements and increasing community need, that’s just not likely to happen.

So, the question should not be whether physicians are “dropping the ball” — it’s why does this happen?

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