When it comes to the way patients flow,
You could call this gig a bit slow.
But the patients expressed
They’ve been pretty impressed
At the warmth that I can show.
Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with a return to traveling and adventures in temporary positions in Alaska, rural Iowa, suburban Pennsylvania, western Nebraska and Canada. I have now returned to southern Alaska. Any identifiable patient information has been used with permission.
I currently deal with low patient flow on a daily basis. Yesterday I had, for the second time, 5 patients in one day; all the other days have gone more slowly. Yet with 5 patients, each scheduled for ½ hour appointments, I kept busy. My electronic inbox never gets to empty. I review lab work and incoming consultation results. In fact, my in box would keep me busy for about 2 hours a day whether or not I saw patients. Thus the electronic version of paperwork flows so fast that it has acquired a life of its own.
Still I have a good amount of time to spend with each patient. I impressed each one so far with my patience. I nod, I listen, I take notes. I get to ask the patient their agenda. The vast majority have been over the age of 70; the youngest so far this week was 48.
But I interrupted one patient. Within 2 minutes, I knew my trouble following his story came from his shifting focus. The numbers in his narrative didn’t add up. After a while I asked if he were having trouble focusing, which he was. Eventually, that one piece of information, more than any data from the telling, gave me the diagnosis.
One patient, who gave me permission to write this, has ankylosing spondylitis, a disease I myself have struggled with since 1967 (or maybe 1963). The best I could do during that visit came down to running a chronic pain support group with two people. We turned out to have a lot in common.
Addicts lie. This truth comes so consistently that, when I find a liar, I look for an addiction. However fun and charming the addict, their words cannot be trusted, especially when it comes to what drugs they use. I have not yet found a way to figure out when an addict stops lying.
But I listen to the addicts and alcoholics as patiently as I listen to the overeaters and the smokers. Perfect people do not come to see me. Everyone who brings illness through the front door comes with a back story of drama and irony, and I have the time here to dig for the patient’s agenda.
The patient’s agenda always wins. Asking what they want in 5 or 10 years uncovers that agenda better than anything else, but does not do so perfectly. Some people don’t know what they want. But asking what they want makes them think.