“You’re the third doctor I’ve seen today who I’ve told I feel weepy, and everyone says my labs look perfect and sends me on my way,” said my last patient of the day, exasperated. I follow her for cholesterol and thyroid. I had checked my boxes on providing her care, but clearly had not even come close to checking hers.
I tried to brush off the experience and criticism, but after two weeks of recounting the visit daily, I knew I had to work through it.
Why is my agenda so different from my patients? Is my agenda the right one? Is their agenda more important? How do we get on the same page to create a fulfilling experience for both parties while providing excellent medical care?
Being a physician can be confusing. What makes you great to your colleagues and your academic self oftentimes conflicts with what makes you great to your patients and what simply feels right. This experience made me re-examine my practice and forced me to look at who I am, who I have become, and who I want to be. I feel that being a doctor is a unique career where your work is not just a job but a calling wrought with ethical dilemmas and constant introspection.
With this in mind, I decided to do an experiment. After greeting my patients, I start our visits by asking them what they would like to talk about. Most have something very specific they want to discuss. They usually start with recent events or emotions that seemingly have nothing to do with their diabetes, thyroid, or anything else I had on my problem list. But somehow, the conversation finds its way back to the medical problems I am treating.
I am reminded that finding out where my patient is emotionally and physically, helps me guide treatment they can actually implement. Isn’t this the whole point of coming to the doctor? Treating the patient not the problem is unfortunately so easily lost in a busy clinic.
I try to cover my patients’ most pressing medical issues, reminding myself that they will be back in a few months. Looking at objective data while listening to what is most important to them at the time helps me diagnose the most pertinent problem. I try to remember that for most patients, especially those with diabetes, management is a process, not a one-visit solution.
We know that people absorb less than a third of what we tell them, so why should I try to force more information than they can swallow into one visit, leaving both of us stressed and unfulfilled?
It has not been perfect, but I think this method is better and certainly more gratifying. In training, I was encouraged to try to solve every medical problem at each visit, terrified that my attending would ask a question I did not ask the patient. An hour spent on one patient was accepted, if not encouraged. Long discussions were commonplace.
Practice is different. We are no longer afforded the same luxury of time, but this is offset by the opportunity to help many more patients. Finding a good balance is a challenge, but a challenge I accept to perfect my ever-evolving craft.
I have seen that the application of guidelines and evidence-based medicine requires an emotional toolbox to truly impact a patient.
The office visit is as much about building a bond as it is about medical treatment. Chronic medical problems require trust and engagement as much as medication. This frameshift in thinking has helped me refocus on the patient and has relieved some of my stress in trying to solve all the patient’s problems in a 15-minute office visit.
Arti Thangudu, MD is an endocrinologist and a 2018–2019 Doximity Author. She specializes in Endocrinology, Diabetes, and Metabolism and is a mom of two beautiful kiddos under three! She writes a blog for other working mamas,www.riverwalkdoc.com. She has also contributed to Medscape, Doximity and KevinMD. Outside of work, Dr. Thangudu enjoys traveling, cooking, and spending time with her husband and two children.