I used to be a stickler for time. One of my first blog posts was about how it felt to go to work without my wristwatch.
I also used to be very particular about knowing the purpose of each visit, partly to help me manage my time, and partly to help me feel prepared and in control of the visit.
I often questioned why my colleagues’ patients would sometimes end up in my schedule for issues that seemed to me safe to wait until the patient’s own provider was available.
Over the last five years I have relaxed about these peeves of mine. I have become more accepting of the fact that patients don’t think in terms of how many minutes they have assigned to them as well as the fact that many patients can’t or choose not to tell the front desk staff why they want to see me on a given day.
Thinking about the way I used to be, I was more efficient than my employer expected me to be, but I don’t believe I quite lived up to my full potential as a healer. There were already then systems in place that made sure the housekeeping aspects of health care weren’t missed for very long if I were to digress in the visit – we had our chronic disease registries and recall systems for pap smears, mammograms and immunizations.
Lately, I have come to think more and more about the physician’s duty to ease suffering. So much of modern medicine is about population and disease management, and there are so many pressures on our time and attention that physicians seem to have little left to offer patients who are suffering, physically or emotionally.
But the systems to manage the measurable aspects of medicine are there, backed up by even more computer power, and we physicians may just need to step back from the numbers long enough in every encounter with each fellow human being to allow us to be open and see our patients as individuals. We need to listen actively to hear their unique agendas. We have teams behind us now to help manage the housekeeping details; we have health coaches and case managers and more nurses than we used to. But since only we have the title “Doctor”, we need to have our senses open to those things only we get to hear.
My wife, reflecting on her years delivering primary health care, always says: “I never had just a diabetes visit. There was always something else.”
The sad truth is that the health of a nation is more dependent on public health, socioeconomics and the prevailing attitude among the majority of the population. The quality of medical care matters very little. For example, a healthy diet together with an active lifestyle is at least as good a weapon against heart disease as all the cholesterol pills and interventional cardiology that money can buy. It doesn’t take a medical degree to change the attitude of a nation, and trying to do it on a case-by-case basis with each patient at $7 a minute is not effective population management – not that I don’t try every single day.
So, what is the role of the physician in today’s health care system? I believe we are the ones who can best help patients make sense of their symptoms and also understand what the health care system can and cannot do for them.
With common human experiences given names that make them seem like diseases, and with our nation’s increasing confusion about even common ailments and preventive measures in spite of the glut of information out there, physicians can bring wisdom and empathy to a system that provides neither. Since we are closer to the mysteries of birth, disease and death than most people, we need to be there for our patients to turn to when the angst of life afflicts them.
I believe the new systems we have all been required to put in place to meet all the public mandates are actually blessings in disguise. If we are wise, we can meet our quality and productivity metrics through the use of the technology at our disposal and at the same time rediscover and cultivate the ancient art of doctoring. Because the phones at my clinic as well as every other doctor’s office keep ringing, not with patients asking to have diabetes follow-ups, but with patients who have a new concern, a new fear, or the courage – just today, or they will lose their momentum – to finally tell someone their deepest fear.
Pausing, as I do every time before knocking on the exam room door, I clear my mind and I am ready:
“Hi, I am D—. What can I do for you today?”
“A Country Doctor” is a family physician who blogs at A Country Doctor Writes:.