How squeaky brakes reminded this doctor of the joys of primary care

Our local media, in an effort to raise awareness and increase vaccination rates, devoted a lot of time to the unusually harsh flu outbreak this winter. While well intended, the stories about children getting morbidly ill inadvertently led to a flood of families coming to our emergency room and urgent care centers fearful that their child would be next to get very ill or die.

On one of my recent Friday night shifts at our main campus urgent care I had spoken to 6 or 7 families about their child’s flu diagnosis, discussing what the flu is, the expected course of the illness, and red flags that the families should be monitoring for. I tried to answer their particular questions and concerns, which though similar, differed family to family. The response was uniformly relief on the parents’ part.

As I was coming out of our last patient’s room (who of course had the flu) during this shift, a student who was working with us that night stated: “How can you do this for a living? It’s the same stuff and same questions over and over again.” While these statements caught me off guard, they did get me thinking.

We also have had a stretch of cold and snowy weather, leading to the roads being covered with a mixture of salt, grime, snow and frozen gristle for about six weeks. Heading home late after the shift I noticed that my brakes were squeaking badly. They still seemed to work fine on the salt covered roads but sounded awful. I did what any reasonable non-auto mechanic person would do; I freaked out.

For the next few days, I was fearful to drive my car though it acted fine, except for the brakes squeaking. I finally went to our local auto dealer and was expecting the worse, because, well, I’m not an auto mechanic. After about an hour one of the senior mechanics came out. “Mr. Rakowsky please …” I heard and sheepishly walked towards him.

“Your brakes are fine. The ice and salt and grime just built up in your brakes. The noise will clear with time once it gets warmer.”

He then took the time to explain this in detail, answer my questions and reassure me that my car was the 6th or 7th that week with the same issue. I felt relieved and shook his hand with happy vigor.

As I was going to my urgent care shift the following Friday, I realized that one of the main joys of primary care is to help patients and parents understand a problem and answer their questions. I still love the tougher cases, and cool rashes will always be fascinating, but as a more experienced (a.k.a. “older”) doctor now I find most of these cases fairly easy to think through and figure out. What I find more challenging is to take my experience and accumulated knowledge and translate it to a specific patient and family in a way that they can not only understand but in a way that is meaningful to them. For me, there is a lot of joy in this momentary human bonding where perfect strangers can trust and understand one another.

I remember the adage that the squeaky wheel gets the oil, but in this case, the squeaky brakes reinforced my desire to be much better at communicating with my patients and families.

Alexander Rakowsky is a pediatrician.

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