Tuesday, November 17, 2009

Case history- I'm listening.

In the New York Times this morning, I came across an editorial on the care of patients- something that's relevant for anyone in the healthcare field and also probably in many fields where we're being measured for our productivity and care by computer programs:
"Checking the right boxes, but failing the patient"

While I was learning to be an optometrist at Kaiser, I discovered that patients come in with all the answers. You just have to ask a few questions and take time to listen. Medicine is less objective than we're taught it is. Patients usually don't lie. People don't go to the doctor unless they have a problem. And they usually do have a problem when they think they do, however minor it is.

I used to have anxiety when a patient arrived with a convoluted history, when I could see their anxiety, when I felt like they needed reassurance and too much from me. Who was I? A counselor? Maybe they had hypochondria or something without explanation. Especially if they were a fifty year old female. It was implied in school that patients had a tendency to over exaggerate things and come in with too much anxiety. I should poo-poo them and send them on their way. Another dumb subconjunctival heme? That's nothing but a bruise in the eye. It will go away by itself.

But is it nothing?

Is it nothing if it's something that's causing my patient to sit at home and worry all weekend that they might be going blind? Is it worth a fifteen minute consult to discuss the dumb little thing that really doesn't need to be worried about? I think so. I figure if I can make someone's life easier, I will. And sometimes it's not a nothing, sometimes it's a big thing that we diagnose.

That is the part of medicine I like. The people. The story. The humanity. Listening.

I've come to feel that my patient's history tells the story and it truly is the most intruiguing part of the exam. If we as providers think of it as the patient's story and listen with human interest, I think it makes medicine feel very different. We're not going to get away from the checks and balances of the insurance industry. Or the productivity ratings of our employers. I still want to know if my patient's wife is having a baby this afternoon, if they are scared about their vision, and that they are human like me.

"Our lives begin to end the day we become silent about the things that matter."
-Martin Luther King

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