I recently went hiking in a beautiful national park outside of Columbia, SC. This park was in a swampy area and contained all sorts of wildlife (called “critters” down here) and plant life (called “trees and those other things” down here). When I was young, my dad would take us kids on hikes through the Adirondack Park in New York, and so being on hikes in nature hits my soul in a very deep spot. It’s emotional, it’s physical, it’s a treat to my senses, and it’s a spiritual experience for me.
Being a doctor involves hearing a person's narrative and working to direct it in the best direction possible. There are some people for whom I have become a significant part of their narrative, and others whose narrative I know better than anyone else. It's a bond that doesn't happen anywhere else.
I hate dealing with opioid pain medications. They are one of the worst parts of being a primary care doctor. Many patients come to my practice on chronic opioids, expecting me to continue these medications. Other patients have the expectation that any pain should be treated with a narcotic. Some people sell the stuff, others continue in current pain despite being on daily medication. There are contracts to be signed, urine to be tested, and pain management doctors to consult, most of whom don’t prescribe narcotics.
Nobody is happy. It is absolutely miserable.
One of the questions people ask is whether or not I see patients in the hospital. I assume they aren’t are asking about my eyesight in the inpatient clinic. I can see quite well in the hospital, thank you. But what people are really asking is if my care extends to the hospital, or most importantly, will I still be their doctor if they are hospitalized? The answer is yes, but not in the way people are asking.
Go to a typical primary care practice (like the one I was in for 18 years) and try to find out the cost of anything and you will only get shrugs and obfuscation. It’s not only that they don’t know what things cost, but the design of the system on which care is built goes out of its way to hide those costs. Why? Because it would be infuriating to people to see that their insurance pays 100% more than someone else’s plan and it would be equally mortifying to some physicians to realize just how bad their pay is compared to the docs down the hall.
We live in a world where patience is a diminishing commodity. We want each day to wrap up neatly like an episode of a TV show. We want to end all arguments by having the perfectly worded Facebook post. We want to figure out the solution to our problems, meet our soul-mate, elect the perfect candidate, and live the rest of our lives happy and contented. But every story has many pages, every timeline has many data points, and every life is made up of many days, many decisions.
One of the big unfortunate things about the medical system is that it turns listening into a rarity. "You are the only doctor who has ever listened to me," I often get told. Really? That's like being told that I am the only chef who has ever cooked food for someone. Isn't listening the essence of care? How could so many people go through our system feeling like they never get listened to? Yet they do. It is incredibly sad. It causes a huge amount of pain. It probably kills a fair number of people.
But if we are rewarding doctors for spending less time with people, what do we expect? If we are making computer time more profitable than patient time, ICD more important than bowel sounds, Medicare compliance more important than the emotional state of the person in the room with you, then it's hard to blame clinicians for ignoring patients. They are just doing what they are told.
But in our practice we live on this little island of sanity in a world where that is scarce. We work in an place where "you're welcome" is said far more than "I'm sorry." Patient wait times only go up when people have the nerve to show up early -- otherwise, we still have an average of around 30 seconds. I still spend an hour with new patients, for them to get to know me and me to get to know them; and they still generally walk away with an amazed expression on their face, having never experienced a good experience at a doctor's office. We still have a steady stream of new patients without doing much at all in the way of marketing. So all's well in Robsville.