I wish my patients could see what I see

I wish my patients could see what I see.  I see through a lens sharpened over 30 years of experience.  I see the present and often the future.  Yes, I’m a fortune teller!  Many times, the picture of the future I see is bleak.

It’s my job to predict the future and then try to change it.  A friend once told me that he believed life was a movie playing on a VCR tape.  It was his belief that each of us had a library filled with thousands of tapes and at any time, we could hit the eject button, remove the current and put in a new tape that would play to a different ending.

So, what is it that I see?  I see a 30-year old diabetic who is overweight and out of shape.  His blood pressure is high, his cholesterol is high and he is high on life with his family and work.  He has no time to take care of himself.  He does not respect diabetes.  He doesn’t fear it.  He will take care of it “one day.”  I know what’s coming.  I can see his future.  How?

When I walk into the next room, I see a 60-year old diabetic who started with me 28 years ago.  He has kidney disease and sees a kidney specialist.  He can’t feel his feet (nerve damage from uncontrolled diabetes).  He is here due to an infection in his toe.  His infection won’t heal.  He goes for wound management therapy to the local hospital and is seeing a surgeon.  He will lose his toe and maybe, his foot.

My 60-year old patient is my 30-year old’s future.  Neither have time for themselves.  One is working on building a bright future, the other built a future that should have been bright but now is bleak.

I see a 48-year old woman who has uncontrolled hypertension.  She is busy being a parent, spouse, and is soon to be a grandma.  Her Christmas shopping is done.  She ran out of her medication 2 weeks ago.  She did not have time to pick it up.  Her blood pressure is through the roof.  I know her future.  In the next room is a 71-year old female in a wheelchair.  The Medi-van brought her to the office from the nursing home.  She had a stroke.  She can’t walk, has trouble eating and communicating.  She was a CFO of a large local company.  She used to run through the airport, rushing to her next meeting.  She did not have time to be hypertensive.  She, too, did not take her medication as prescribed.

I see the future.  Sometimes, I see dead people, walking.  I wish my patients could see what I see.

Stewart Segal is a family physician who blogs at Livewellthy.org.

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  • http://makethislookawesome.blogspot.com/ PamC

    There was a very interesting TED talk where they discussed how difficult it is to see out future selves and make decisions for that future self. This isn’t just your patients. This is human nature. Thinking in terms of the future is *difficult*, especially when the present is so pressing. 
    http://www.ted.com/talks/daniel_goldstein_the_battle_between_your_present_and_future_self.html 

  • http://pulse.yahoo.com/_XVD6GI7PQMMR5KUA7GSFHKZC5I LisaR

    That was a really great piece, Dr Segal. Succinct, simple enough, yet powerful. I’m in my 30s and have an issue I’m dealing with and all of the professionals tell me that it is important I make time for myself every day to work on it, which can be difficult. Your article gave me pause and I’m scheduling some time right now for tomorrow

  • Alaska Turner

    Thank you.

  • Anonymous

    Dr. Segal,

    there is such wisdom in your perspective and I wish that patients with late stage preventable disease would make themselves available for just this educational purpose–to awaken those who have not made the effort to take care of things before they worsen.  Maybe all we physicians need to do is ask.

    Emily Gibson M.D.

  • Anonymous

    You just scared me.

  • http://pulse.yahoo.com/_3CY2U67646G7UIAHBQVTT2UP4Y Kristy S

    Not only did I find this article very good to read, but an excellent reminder of what happens when patients don’t take care of themselves.  It sent shivers down my spine.  Thank you for the reminder Dr. Segal.

  • Anonymous

    Gee, sounds like you are overwhelmed! Maybe you should consider partnering with the hundreds of independent one-doc and two-doc practices in your area and begin to collaborate and coordinate your efforts. There’s nothing more inefficient that having a huge number of one-doc and two-doc offices in a geographical area that don’t work together and never talk to each other. A typical diabetic patient has a primary care doc, a foot doc, an eye doc, a dentist and maybe am endocrine doc. Do any of them talk to each other? Never! My docs don’t! That’s why we need Accountable Care Organizations (ACOs). Under the Affordable Care Act, ACOs are the “one-stop-shopping” model where patients have a much better chance to get coordinated care. Everything under one roof! Big-box health care! The story above is clear evidence of a lack of coordination and cooperation in today’s broken fee-for-service (FFS) health care delivery model. Critics can poo-poo the ACO model all they want. Fact is, the current FFS delivery model is clearly broken and consumers are the victims. The only people getting rich in today’s failed FFS model are providers. Until we make the consumer the clear winner, our health care system will remain broken. ACOs may or may not work, who knows, but if we don’t give them a try, nobody will never know. ACOs toss out FFS medicine. That, in and of itself, is a fantastic beginning! 

  • Isabel C.

    A patient’s version of this would go:

    I wish my doctors could see what I see. I work a job that can barely make ends meet in a small company that does not offer insurance, forcing me to choose between purchasing a plan independently or going without certain necessities. I can’t afford a gym membership, and my neighborhood isn’t designed for jogging. In fact, my neighborhood is lined with fast food restaurants at every other corner. The cheapest food in the grocery store are the ones that are processed. I prefer making sure my family has a full stomach on processed foods than hungry because I spent half the food budget on fruits and vegetables. You prescribe me medicine I can’t afford, so I either don’t buy it or use it sparingly to avoid buying it regularly. I don’t want to be sick because who wants that, but how am I supposed to afford a healthy lifestyle in this economy?

    • Anonymous

      How can anyone possibly say that America has the best health care in the world when 1/4th of its population is excluded from participating. Over 50 million Americans are uninsured and 25 million more are underinsured. Yet, as a nation, we spend 18 percent of GDP for health care. Best health care in the world? Yeah, for the very wealthy 1 percent!