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 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.
This insecurity is the biggest challenge in my practice: getting people to change their behavior. Somehow I have to somehow get people to pay attention to their health when they\’d rather ignore it, to be taking medications when they\’d rather not, to be exercising when they don\’t want to, to lose weight when they love cheeseburgers, and to be checking their blood sugars when they\’d rather not know how high they are. After trying lots of things over the past 20+ years, the one thing I find almost never works is what is usually done: lecturing the patient.
The real question I am asking here is not if this care is good or bad (the answer to that is, yes, it is good and bad), but whether it is patient-centered.
This should be a silly question, like asking if car-repair is car-centered. But it is clear that much of the high cost of care in our country is due to the huge number of unnecessary procedures, medications, hospitalizations, and services given to/done on people. Unnecessary care is, almost always, not patient-centered.
When I say we need more tech, I am not saying we need more computerization so we can produce a higher volume of medically irrelevant word garbage. I am not saying we need to gather more points of data that can measure physicians and \”reward\” them if they input data well enough. The tech I am referring to is like that I used regarding my father. I want technology that does two things: connects and organizes. I want to be able to coordinate care with specialists and to reach out to my patients. I want my patients to be able to reach me when they need my help. Technology can do this; it sure did for my dad.
\”I\’m kind of stumped here,\” I confessed to her, going through my list of possible causes. Together we discussed the possible options of diagnostic testing and treatment. While we talked, she continued showing a glimmer of fear in her eyes. It wasn\’t that she thought she\’d die from this, and I don\’t even believe it was a fear that I couldn\’t help her; it was a fear I would tell her the grass was not green. Maybe her reality isn\’t real. Maybe she is crazy.
Doctor and patient. Insecurity meets insecurity. Weak helping weak.
A local business that does MRI scans is doing a promotion on their Facebook page, asking people to nominate their doctor as the \”Best Doctor\” (in celebration of \”Doctors\’ Day\”, which is Sunday). So yesterday I put this up on my Facebook page: Hephzibah, by the way, is a working-class part of greater Augusta, where …
As an incurable compulsive introspect, I tend to brood, ponder, contemplate, and (of course) muse on \”big ideas,\” such as:
- What makes people choose things which cause themselves harm?
- Are some people better people than others, or are they just more skilled at hiding their problems?
- Is pain really a bad thing, or is our aversion to it a sign of human weakness?
- Do dogs watch Oprah?
- Does God ever wear a hat?
- Why is \”big ideas\” in quotes?
Lately I\’ve been contemplating the nature of human awareness:
- Is self-awareness (the ability to think of ourselves in the first person) a uniquely human trait, and is lack of self-awareness the essence of mental illness?
- Is empathy, or other-awareness the highest of human traits? Is this what the biblical idea of being \”made in the image of God\” really means?
Yeah, that\’s a lot deeper than about dogs watching Oprah.