As a partner in an independent practice, my pay is determined by my billing. The more patients I see, the more labs that I order, the more surgery that I perform increases my monetary reward at the end of each month. The paradox is that is not how I practice medicine. My billing for labs is often at the bottom quartile of our group, and I often give patients non-surgical options to try first before proceeding with the more expensive surgery. I see the Annual Physical Exam as a prime example of what I am trying to achieve with my patients.
Most of Americans have bought into the false belief that the more supplements you take, the healthier you will be. They substitue a pill for what truly makes you healthy; exercise, a diet high in fiber, adequate sleep, and no smoking. As I troll thru their list of supplements, I inquire as to what they are trying to achieve with each pill and explain that fish oil tablets do no replicate eating oily fish when it comes to cardiovascular disease, vitamin C does not prevent colds and a multi-vitamin has no beneficial effects in the vast majority of people. The money spent on these supplements can be significant over the course of a year and would be much better spent on a good pair of walking shoes or at the grocery store.
It is much easier to agree to multiple labs, particularly a yearly lipid profile and glucose, than to explain how numbers do not equate with overall health. If the lipid profile or glucose last year was borderline high and the patient has made no lifestyle change, a slightly lower number this time does not indicate that the patient is healthier but does give them a false sense of relief.
As women are often the drivers of medical care for the rest of their family, I often discuss the importance of vaccines, not only for the patient in front of me but also for her partner and children. I have been accused by some patients of getting a kick-back from "Big Pharma" for recommending vaccines such as Gardasil, flu, and a Dtap booster. This is another discussion that while improving overal patient health does not equate with an increase in the paycheck.
The most common complaints on the review of systems list that patients fill out are fatigue, joint pain, depression and anxiety. Drawing a TSH and prescribing an antidepressant is often what the patient may desire, but their long-term health will be improved if they realize that many of their complaints are part of a pattern due to lifestyle. Asking open-ended questions and making suggestions about lifestyle change is often not a short conversation and one where the patient may often be defensive. I am rewarded by the occasional patient who follows up a few months later to inform me that multiple problems were improved with a daily walk outside and a 5 lb weight loss.
It has been shown that we age much better when we feel connected to the community and people around us. Making sure my patients remain active with friends and family in addition to offering suggestions for volunteer activities, lets them know that I care not only about their yearly mammogram but also about their long-term mental health. Patients sharing photos of recent trips, children and grandchildren, and discussions about interesting books help to keep me engaged in my job as I am allowed to share in their lives.
At the end of the day, I feel that my patients are better served when they realize there may not be a quick fix to their problem, but I am more than willing to walk with them on a journey to improve their health. That journey takes time for both of us; me in the schedule and the patient in lifestyle changes.
Dr. Leslee Jaeger is an ob/gyn and a 2018–2019 Doximity Author. She is also a mom to 3 bio and 2 adopted children, an advocate for women’s health domestically and internationally, and she loves good food and good books. She currently blogs about her family and work at jaegerleslee.wordpress.com.