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Care Package

least two counties in southern Vermont. It would have been a huge undertaking—thrilling and scary and much more interesting than trying to figure out how to implement HIPAA. I purchased a power suit from the local thrift shop and wore it to a few meetings. It just didn't fit.

I didn't want to be a health-care administrator, nor did Tim and I see how we could support ourselves through another bureaucratic transition. So I made one more attempt to understand HIPAA. I'm trained to read closely, to see both text and subtext. What I saw in the language of this law was an Orwellian corruption ofmeaning. The Privacy Rule presents itself as a means of protecting sensitive health information, but what it really does is grant government, law enforcement, and insurance companies access to patients' personal health records. This was not a game I wanted to play.

Instead of putting HIPAA in place, we entered negotiations with Grace Cottage to take over our practice. At the end of the day on June 30, 2003, we closed up shop. The next day, Tim was there as usual, but as an employee of the hospital.

It was hardest on our staff. Even though the hospital matched their wages, offered them more and better benefits, and transferred their years of service, they were used to working for us, and that changed. "It was like a family," one former employee recently told me. "Our patients were like family. Our coworkers were like family. I really miss it." Over the years, this woman had served as a receptionist, bookkeeper, substitute office nurse, insurance coder, and bill collector—sometimes all in the same day. Now she's a certified medical billing specialist and that's all she does, in an isolated cubicle, every working day.

Shafer and Luskin today with their bee hives—one of the many pleasures of living in a rural area.

To my surprise, I sometimes miss it, too. I don't miss my Wednesday night pillow talk with Tim, which was always about whether or not we'd make Thursday's payroll. I don't miss the cost reports; I prefer not knowing who owes money for care. But I do miss our former staff and our teamwork—the way we all pulled together to provide excellent, personalized care for our patients and for each other. I've moved on, however, to a growing career as a freelance teacher, researcher, and writer (often writing about physicians and medicine).

For Tim, what has changed is that he now has a regular paycheck and the freedom to practice medicine without the headaches of running a business as well. Otherwise, much remains the same. He has paid personal days and sick days but has yet to use one. He is still on call too

With the bees back in the hive and the kids back in school, I faced the task of trying to understand the health insurance portability and accountability act.

often, is late for dinner more often than not, and invariably works several hours on his days off. Since signing on with Grace Cottage, he has been named Medical Director and so spends countless hours in meetings as well.

But what has not changed is that Tim is still there, doing what he does best: giving patients his whole attention and providing them with the kind of primary care that takes good listening skills, sharp powers of observation, deep knowledge of a patient's medical as well as social history, and time to give comprehensive care.

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Luskin is a freelance writer and frequent commentator on Vermont Public Radio. And as a visiting scholar for the Vermont Humanities Council since 1986, she also teaches lifelong learners in libraries, hospitals, and prisons throughout the state. She holds a Ph.D. in English literature from Columbia University and is married to Dr. Timothy Shafer, who earned his M.D. from Dartmouth Medical School in 1981. The black-and-white photos on odd-numbered pages of this article were taken in 1994 by Max Aguilera-Hellweg for a feature in Hippocrates magazine (and colorized for Dartmouth Medicine by Jennifer Durgin); they are used here with permission. The color photos on the even-numbered pages are the work of Flying Squirrel Graphics' John Douglas.

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