After almost eight years of practice in primary care, urgent care and a hybrid practice of both, I have learned that 90% of my patients need me for knowledge, encouragement, a sounding board, empowerment, and some guidance more than they need me for drugs. I’ve worked in rural areas of Texas, inner cities and underserved communities my entire life and patients no longer need an ‘expert’ who orders labs and unnecessary imaging, who tells them what to take, how often to take it and return in three months to make sure the numbers we are chasing fall in range. Most chronic disease is pretty darn easy to treat.
Yes, I said it. Most chronic disease can be looked at in an algorithm and for me it’s easy to simplify, synthesize and share with my patients. Chronic disease includes diabetes, high blood pressure, high cholesterol, obesity, hypothyroidism. If your patient is diagnosed with one or more of these diseases, the internet is replete with accurate information about the disease process, symptoms, signs, organs involved and how they’re damaged throughout the disease, the pharmacokinetics and side effects of each drug, what lifestyle change could help treat, manage and reverse the disease (s). They don’t really need us except to write for the proper drug or refer to a specialist for their eyes or feet. Or if they are emergent and way down the line and show up with a full blown heart attack or stroke or HHS, then we are definitely necessary.
Again, acute, life or limb-threatening, emergent cases, this is not easy. Treatment and management of most acute cases requires years of education and experience and to you experts, specialists, life-savers I bow to you, I applaud you, I thank you for all your hard work. Though I had a friend who had a few weeks of wilderness first response training and knew how to stabilize a pneumothorax better than I did and I just read about a doctor in Alaska who called a pediatric cardiologist to get advice on treating a patient who couldn’t be shipped out immediately, so there is that. But I digress, this is meant for the primary care setting.
If you are anything like me a few years ago, you’re thinking “this lady is crazy, medicine is hard and I worked my butt off to get where I am today and patients could never know more about their disease when they come into see me”. I would roll my eyes when my patients would try to give me information about a new drug or changing their diet and pretend to listen while thinking to myself that I had all the answers.
Sweet little Erica, no way. Yes, I was one of those ego-heads.
Not only is this way of thinking arrogant, but it is also wrong. We are ‘experts’ in populations of people with certain diseases, we’re not ‘experts’ of individual patients. We’ve studied evidence-based medicine, research and memorized the complex HPA-axis and the Na+/K+/Cl- action that happens in the loop of Henle and regurgitated them for tests, so of course we know everything. Wrong. We don’t. This is where you have to release some of that ego in order to provide the best service and care for your patient.
Our patients need guidance and time, a open ear and a compassionate heart. They need someone to listen to their worries about working three jobs to feed their kids or panic about leaving an abusive relationship or their fear of losing their depressed and suicidal 13 year old. They need us to help them find the easiest and most affordable way to get more veggies into their diet and stop depending on convenient fast foods. Or a hero who is willing to stay after clinic and walk with patients for thirty minutes, break a sweat and build a community. They want someone who looks at them as a human being and not just a label with a disease who’s only value is in their blood and numbers on a piece of paper.
They need us to advocate for their needs and time. To empower ourselves and silence the higher-ups who demand more numbers and more revenue. Patients need a strong, confident source of unbiased medical knowledge who helps them find what is best for their unique biology, physiology, chemistry and neurology. Someone who curates a treatment plan that allows them to take baby steps towards big victories and motivates and encourages them to find their own individual way to heal. A provider who teaches self-care as healthcare and helps provide an easy first step to feeling good and optimistic about taking control of their own health.
Patients want and need a provider who assists, educates and empowers them to find the healer within. Can you do that?
photo credit by akeeris at http://www.freedigitalphotos.net/images/Healthcare_g355-Lady_Doctor_Teaching_p77330.html