An Uncloudy Day
Oh, they tell me of a home far beyond the skies
Oh, they tell me of a home far away
Oh, they tell me of a home where no storm clouds rise
Oh, they tell me of an unclouded day
Being a Doctor
Being Important
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 …
Context
“Doc, I didn’t take the medication you gave me. I read something that said it would destroy my liver.” Sigh. These conversations are far too common…and they make me wonder: what are they thinking? Do they really think I prescribed the drug with the evil intent of destroying their liver? Do they think I …
Good in the Balance
I am normal.
OK, aside from that llama thing.
I have good days and bad. Some days I am content, connected, focused, and motivated. On those days I enjoy my job, I enjoy the people I’m with, I am willing to be inconvenienced by interruptions.
On other days…not so much. I wake up grumpy and (despite multiple cups of coffee) continue it through the day. I keep score of all the ways in which life has conspired to make the day difficult. Too many red lights. Too windy. Clearly terrible things going on. I am not patient with people, and am distracted by little things.
Like I said: I am normal. I do my best to not let these things stand in the way of the care I give, and I try to hide my emotions from my patients. It’s a necessary part of the job. But there are still days I’m better at it than others.
There Will be Patients Like This
Being a doctor involves hearing a person\’s narrative and working to direct it in the best direction possible. There are some people for whom I have become a significant part of their narrative, and others whose narrative I know better than anyone else. It\’s a bond that doesn\’t happen anywhere else.
A Point on the Timeline
We live in a world where patience is a diminishing commodity. We want each day to wrap up neatly like an episode of a TV show. We want to end all arguments by having the perfectly worded Facebook post. We want to figure out the solution to our problems, meet our soul-mate, elect the perfect candidate, and live the rest of our lives happy and contented. But every story has many pages, every timeline has many data points, and every life is made up of many days, many decisions.
Entering The Narrative
My hope is that somehow we are able to return to care that is patient-centered. People want their narrative to be a good one, and doctors need to be able to enter that narrative and become a positive influence. Our goal needs to push people out of the medical realm and back to living the rest of their narratives with as little contact with the healthcare system as possible. That\’s what patient-centered care really is.
Of PCP\’s and THC
The drug test came back abnormal. There was THC present. I walked back to Mrs. Johnson and raised my eyebrows.
\”What\’s wrong?\” she asked, not used to whatever kind of look I was giving her.
\”Uh, you forgot to mention to me that you smoke weed.\”
She blushed and then smirked. \”Well, yes, I guess I forgot to put that down on the sheet. I don\’t do it real often, but sometimes it takes mind off of things. I just get real anxious about my kids, my husband…and my heart problems. I only smoke one or two a night\”
She\’s not your usual picture of a pot-head. She\’s in her sixties, has coronary heart disease, irritable bowel, hypertension, is on Medicaid, and is the essential caricature of the the poor white folk who live in the deep south. And she smokes weed.
Simply Difficult
\”I want to tell you my story now,\” a patient recently told me, a woman who suffers from many physical and emotional ailments. She had the diagnosis of PTSD on her problem list, along with hospitalizations for \”stress,\” but I never asked beyond that.
\”OK,\” I answered, not knowing what to expect. \”Tell me your story.\”
She paused for about 30 seconds, but I knew not to interrupt the silence. \”I killed my husband,\” she finally said.
OK. Unexpected.
How to Avoid Being a Dumb-Ass Doctor
It\’s been two years since I first started my new practice. I have successfully avoided driving my business into the ground because I am a dumb-ass doctor. Don\’t get me wrong: I am not a dumb-ass when it comes to being a doctor. I am pretty comfortable on that, but the future will hold many opportunities to change that verdict. No, I am talking about being a dumb-ass running the business because I am a doctor.