I walked into the room, with my student in tow behind me. The elderly couple who greeted us were some of my older, longer-standing patients. They were delighted to meet my student and I explained to her about this pair (but were not sure of me calling them “elderly”).
The husband is pretty healthy, but has a few conditions that significantly hurt his quality of life. He likes to complain about things, and sometimes sounds like he’s grumpy, but there is never a harshness or bitterness behind the complaints. He doesn’t mince words when he feels something, but he’s never mean or insensitive. The wife is the sicker of the two, and she’s as sweet as sugar. She doesn’t complain nearly enough about things that matter, making it imperative that I ask lots of questions. They always come to the office together, and always wait patiently while I talk to the other about their problems. He probably wears on her at times with his complaining, but she seldom shows it. They obviously love each other deeply.
At the beginning of my explanation, I say to my student, “Just so you know, Joe here is Mr. Sunshine. He’s always spunky and cheerful, and loves to talk about butterflies and flowers. Sally,” I say, turning to the wife,”is a total grump. She never smiles, is always complaining about something, and never lets you get a word in edgewise.”
Joe and Sally laugh loudly when I finish this introduction. I don’t have to explain my use of irony. I don’t have to worry that they might not appreciate my humor. I don’t have to worry about my explanation about them in front of my student (in fact, they smile as I summarize each person to the student). I don’t have to do any of this because I know them. I know them really well.
One of the best things about being a primary care doctor are the many deep relationships I have with my patients. I started practice here in Augusta in 1994, and I still have some patients from that first year I was here. This couple started with me in 2003. So when I walked into that room with my student, what was new to her was anything but new to me. I knew about their medical histories: the major surgery Sally had, the struggle with chronic disease, and their skeptical view of parts of medicine. I also knew about the family situation with one of their children, their losses, and their utter devotion to each other. I am happy when they are on my schedule, and I can tell they are happy to be there (despite his feelings about getting blood drawn). I like them, and they like me.
The relationship goes both ways. They didn’t hesitate to follow me to my direct care practice when I made the switch in 2013. They knew about the struggles I went through with my old practice, and they know about my divorce and recent engagement. They ask me about my kids, and about how things are going with the business. This isn’t small talk, it’s caring. It’s friendship. It is, to some degree, love.
I am important to my patients. That seems obvious (because I’m their doctor, right???), but the importance is on many levels, not just as a medical aid and decision-maker. I know about their weaknesses, about their bad habits, and about their fears. I keep their secrets. I listen to their complaints, help them with their fears, reduce their pain, and celebrate their victories. I know things about people that nobody else knows.
So when I walk into a room, it’s not just an algorithm of chief complaint, history of present illness, etc. I walk into the room with all the stories, all of the previous interactions, knowing what works and doesn’t work with each person, if they respond to confrontation or gentle words better, if they beg for medications or refuse them. Nobody else has that knowledge.
I am so very lucky. I’m also sad for patients who don’t have this kind of relationship with their doctor, and sad for doctors who don’t get this kind of experience, don’t have the time to sit and chat, don’t have affection toward their patients, don’t have the joy walking into a room and being appreciated, being important.
2 thoughts on “Being Important”
Your relationships with your patients are maybe more important to their physical and emotional (and spiritual) wellbeing than meds and therapies you prescribe. My mom is an active 95, her sister 98, and her brother 92. My grandmother lived to 102, and her grandmother to 103. I’ve seen the life-giving effects of a caring doc in whom they have total confidence (and sometimes the negative impact of a doc who doesn’t make them feel valuable).
You mention second thoughts about using the word elderly. Are you aware that in the last 1-2 years the AMA, APA, AARP, and AGS have published “Guidelines for Age-Inclusive Language?” They agree “older person,” “men over 75,” “women over 70,” etc. are preferred to words like elderly, seniors, the aged, the young old, the old old, etc. As health editor for WebMD, I watch out (along with my colleagues) for ageist language and make sure to choose images that reflect vitality in later life. After all, aging is something happening to all of us.
Thank you for your thoughtful column. It’s clearly from your heart — and healthcare needs more of that.
When we really know our patients well, and they know us, there is harmony and it is easy to. be ironic, or sarcastic. If you really know your patient you do not need to do a long history..If you don’t remember it all thanks to modern EHRs it is all there/. Some times too much