One reason I’m excited about this new venture into direct primary/patient care is finally having the focus and time to foster best communications and relationships with my patients.
Said communication goes both ways: it need be an intricate, complicated “give and take.”
Yet in some instances, unfortunately, in my years at the bedside, I have noted amongst my peers (and I confess, with me, too), a dynamic that has increasingly evolved into a wholly paternalistic: “I [doctor] will give you [patient] what you need and you will just accept that.” Time constraints, external pressures, insurance companies and government, quality measures, practice guidelines, meaningful use, blah blah blah, can further work to add to a more domineering, less interactive, “take it or leave it” approach in the care of our patients. Though I do believe that my evaluations and resulting plans are sound, I still must earn the confidence of my patients in these decisions impacting their health. Indeed, as I have advanced in my career, dare I say I’ve even learned a thing or two from my patients? From actual medical knowledge, to how to adjust the f-stop and shutter speed for a narrow depth of field, all the way to how to engage another hurting soul right where they are. I’ve been humbled a few times, for sure. Ask my colleagues who know me. Ask my family.
Concomitantly, the advent of Google, Twitter and the like—along with changes in societal norms and expectations—upon the backdrop of an oft difficult to navigate healthcare system, have in some cases, led to more unrealistic patient expectations, increased challenging of our assessments and plans, and sometimes overt frustration from patients and their families. It is true that a little knowledge can be dangerous, and that a seeming new patient empowerment (not a bad thing itself) can fuel contentious interactions. It can seem like a mine field. In this environment, I grew skilled at handling the “difficult” patients. In fact, I was often requested by staff to be the doctor for particular patients because I could set them straight. I was revved up for the battle, all under the guise of tough love.
None of this makes doctoring sound appealing.
In addition, I longed for the day when we would stop thinking of patients as commodities, so that at least while I’m at the bedside, I’m not reminded to focus on the business side of the interactions, the quality metrics, and the satisfaction scores. A time that the primary goal is not in making a patient happy, but that doing so is the natural result of my loving them, serving them, and providing them the best care I can. A time when my unique skill sets and knowledge are used in partnering with my patients to guide them in their health and well-being. A time when patients have a sense of belonging because they know they are being seen as an individual being and not as a number to push through. In that environment, the doctor patient relationship flourishes.
ENTER DIRECT PATIENT CARE. Let’s do this.
May I continue to grow into that physician who just sees himself as person with some knowledge and abilities with which God has given me to serve, not just my patients, but those around me.
All this being said, I may just have to keep this mug a patient gifted me:
It is a process, after all.