I spent 20 minutes listening to Michelle and asking her questions to understand why she was not taking her insulin as recommended. The appointment was for 15 minutes, 5 of which were used by the medical assistant who had to check the vitals and “do an A1c.”
I did not ask Michelle whether her feet were tingling or numb. I did not ask her whether she had her eyes checked this year. Instead, I felt the need to stop the generic factory madness, and actually focus what the primary issue was … instead of typing “noncompliant” in my note, and having all the aspects of diabetic care addressed to justify the high complexity of the encounter.
I did not force a checklist on her. I could not.
Michelle was also due for a reminder to schedule her mammogram, but that box remained unchecked. I also “forgot” to listen to her chest, which is part of a routine for almost every doctor visit.
The chest auscultation ceremony is where I linger sometimes, just to regroup my thoughts. It is many times the only time I have a patient quiet. But I actually needed Michelle to talk, and I needed to listen.
Yes, I “only” listened for the most part.
On paper, that did not meet the standards of diabetic care for that day. Still, the encounter lasted for a total of 30 minutes, since we had to come up with an action plan.
What we are often taught time is what I call “generic regurgitation.” A one-size-fits-all approach with little room for outliers or actual patient priorities. Something we have to do or say, otherwise we would be providing substandard care to the eyes of a third party.
Michelle had to come back, so I could catch up on checking boxes, and also assess her progress.
“DrizzleMD” is an internal medicine physician who blogs at his self-titled site, Drizzle MD.
Image credit: DrizzleMD