I remember a time I looked down at my schedule for the day and it was a whopping 23 patients. You may say that’s not very many, particularly if you’re in deep with the assembly-line medicine world. 23 is cake. In fact, my Ob/Gyn friend he said he had 60 on his 8-hour Monday and there is a legendary NP in East El Paso who sees 80 patients in a 12-hour day. But for me 23 was a ton, especially in a rural internal medicine practice with highly complex and vulnerable patients. That meant that I had 18 minutes with each patient with an hour lunch.
18 minutes to:
- review their chart, their meds, their labs, if they had been in the hospital, what they were there for
- to get their history (after not seeing them for 3, 6, 9 or 12 months), document their acute and chronic concerns
- examine them thoroughly based on their chief complaint or if they’re there for a physical
- titrate, change, discontinue, add medications
- order labs, imaging, home health, screening tests
- sign disability papers, prior authorizations, work/school notes
- educate them on a myriad of lifestyle changes, their medications and side effects or their newest chronic disease diagnosis
- answer any questions they may have about their health and disease or their overall life and wellbeing
- get to know them, understand them, listen to their worries, stressors, concerns
- finish up chart, get them set for their next steps, say goodbye
Oh, that’s why we don’t educate instead of medicate. It makes perfect sense. There is no time in the big bad world of the business of assembly-line medicine.
Screw that. This has to change. It is changing. When we go into medicine, we’re in it to help others heal. Doctor comes from the word in latin for “to teach”. That’s what we’re supposed to do as clinicians, TEACH!
You ask me how to do it, you just do. I was the same as you not too long ago. I worked in Urgent Care in a rural clinic. During the flu season we would see anywhere from 40-60 patients between two PA’s. It was brutal. In my first year there, there was no lunch, no bathroom breaks, no time to breathe.
And now I work at a community urgent care with the same patient load, sometimes more with two advanced practice providers and a doctor. But instead of running around like a chicken without a head dealing drugs in a pill mill, I sit and educate. I have a five step program I follow and quickly assess where my patients are in the stages of change. If they just want a script, it’s theres. If they’re hungry for something more, I provide that too. If they’re somewhere in the middle, we work with them at that point. You have to meet your patients where they are. Change doesn’t come from your directions, authority, expertise, it originates from them.
So I can tell you with full confidence that it is possible to educate instead of medicate. I can also tell you that patients are now changing and craving this type of interaction. In my clinic, about 70% of my patients ask me about healthy food choices, apple cider vinegar, essential oils and breathing techniques. They talk about their sister or neighbors who use home remedies over medications. Things like cinnamon for blood sugar, chamomile tea bags for eye swelling, turmeric raw honey salve for abscesses. I encourage them to take control of their health by trying these tools, but if something goes awry then check in with us.
You also have to be an advocate for your patient. Take the time to be present with them and watch how time expands. That’s how I made my change, I just took it. I thought about my desired end result, happier, healthier patients and I began to just take the time to educate them and listen to their stories.
I understand I operate in a different realm. I’ve paid off my loans, I have some credit card debt and all I really have is my mortgage. I don’t live in constant fear of being fired. I’ve had enough jobs to know that clinics need PAs and I’ll always have opportunities as one. Once you start to work from this perspective, fear dissipates and you begin to do what’s best for you and your patient.
But until then, help your patient take those baby steps. The educational changes are small and simple, but significant. Adding vegetables into their diet 4-5 times a week vs. never, is one tiny step to success. Drinking more water, the forgotten nutrient, is another way to give their body and mind a little boost. Checking in with their breath, another favorite. Adding in 1 tablespoon of apple cider vinegar in a cup of water twice a day, yet another.
I wish you the best on your journey towards practicing real medicine again. It’s possible, you just have to set the intention and go for it.