How to set a realistic bar in family medicine

My fourth grade teacher labeled me “most inquisitive,” and I’d like to believe that superlative still rings true.  But I challenge you to stop and think about it for a second – how do you set the “bar” of expectations in your own life? With your patients? With your family? With your commitments?

Are you the kind of person to place the bar nice and low and manageable, allowing you to gracefully step over?  Perhaps you have your own sort of personal limbo bar, and are flexible enough to test it out at various heights?  But my guess is that you, like most high achieving and hard working doctors and students I know, have a bar that is set so high that you couldn’t even jump to reach for a pull-up.  That’s just the problem with expectations – we often experience disappointment when we fail to meet them.

So what happens to our patients, then, who have been raised with an admiration for the miracle of medicine; who are ever more present members of a society that glorifies instant gratification; and who are now emboldened by the political momentum guaranteeing health care as a natural right? Expectations are high, indeed.  And we stand with a perfect opportunity to disappoint our patients if we fail to set the bar to that perfect height.

Have you ever had the kind of day in which you expected you’d be working until 8pm, but when you got off at 6pm it felt like you won the lottery?  Conversely, we have all experienced the opposite – planning and looking forward to getting off by 4pm, only to be waylaid and stuck until 6pm.  In reality both sorts of days end at the same time, but it is our expectations at the outset that ultimately dictate our emotional response.

Translating this, how do we create that “I expected to get off at 8, but was home by 6” feeling within our patients?  I believe that we can set realistic expectations at the forefront of our practice of medicine, rather than offer graceful apologies as we wave goodbye.

I have a few thoughts on how we can set these realistic bars in family medicine:

1. Be willing and forthcoming in surrendering the role of omniscient provider. Let’s get real for a second.  Each and every one of our patients now carries a device that contains more information with the stroke of a few keys, than all the textbooks we read in training.  We are no longer purveyors of information, but rather intuitive and experienced interpreters for our patients.  I think that we already do a pretty good job of acknowledging this in family medicine, where we are often willing to defer and consult to our specialist colleagues.  I suggest we be transparent and upfront about our role, from the point of our first patient encounter. We need to be clear that we are supportive guides for our patients in their health as they move through the stages of life and the intricacies of health systems.

2. Create an office environment that thrives in its consistency. Provide an experience such that, when patients walk in the door, they know what to expect from front to back.  By this I am referring not to the exam room door, but the front door.  The second they walk in, they should feel at home and have a good sense of what will be happening.  This is the reason that so many people choose to shop at Target or buy Apple products – the reliability, consistency, and comfort.  This is the best way to prevent that “I thought I’d be home by 4pm, but got stuck working till 6pm” feeling as they leave a clinic appointment.

3. Be willing to respond to change and move the bar. When was the last time that you “moved your bar”? In concert with what has been written about all good being the enemy of great, many bars are set in concrete.  Conversely, as previously mentioned, some bars are set far too high with no hope of finding accomplishment.  As family physicians, we need to be adaptable in our goals and transparent in our abilities.  When we reach that figurative double aim, then our patients can realistically expect accountable and consistent action.

Doing this, we will never let them down.

Aaron George is a family practice resident who blogs at Future of Family Medicine.

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