At conferences
they keep saying
what a bad job I'm doing

Only half of hypertension
is controlled
in primary care
(I note that I don't really
control anything)
even less of high cholesterol
They've changed who should
be on aspirin

We don't diagnose peripheral vascular disease enough
Vitamin E is out
and maybe we should
use hormones after all

The management
says see more people
faster faster
My clinic time dropped
from 30 to 20 minute visits
In Seattle doctors have it worse
Six people per hour

Mrs. Smith is here
My nurse puts a pop up
that her blood pressure is too high
Otherwise I might miss it
I quickly scan my last note
Did she stop taking her medicine
or is it not enough
We should talk about colon cancer screening
And when were her last labs?

She is here for foot pain

But then she tells me
her daughter is back on drugs
left rehab
She is caring for her three year old
She's tired
She's in tears

We have ten minutes left

I wonder
where exactly
I should start?

first draft: 6/17/07, revised for Iron Noder 2014
musical accompaniment: Joni Mitchell