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A few weeks ago a patient asked me with a hint of irritation in his voice, why I always typed during our visits together.
At morning work rounds the attending suggested we start with a patient I had seen and admitted through the Emergency Room the night before.
During a recent Quality Initiative meeting at our medical center, concern was voiced that non-compliant patients make it hard for our individual providers and the institution as a whole to achieve our QI goals.
Tim Jackson has written a fascinating piece about the economic limits of productivity. Aside from the economic considerations, I increasingly believe that the philosophy underlying medical care is incompatible with the concept of productivity.
This imaginary letter, penned after attending a Quality Initiative meeting, is fictional today, but I suspect something like it will appear in the near future and be sadly common within five years.
This imaginary letter, penned after attending a Quality Initiative meeting, is fictional today, but I suspect something like it will appear in the near future and be sadly common within five years. I hope I have retired by that time, because it would be truly shameful to actually sign and send such a letter.
Dear (computer generated patient name),
I am writing to express my deepest regret that I can no longer serve as your PCP. I will continue to provide you with all appropriate care during the next sixty days while you arrange an alternative provider.
This folk wisdom is variously attributed to Sun Tzu (The Art of War), Carl von Clausewitz, Mae Zedong, and the heavyweight prizefighter Jack Dempsey. Regardless of origin, it deserves its place in the pantheon of behavioral truths.
During a recent conversation with a patient about her irritable bowel syndrome, I asked about possible stressors:
“So, tell me, I know it’s hard to manage both full time school and a part time job, but I wonder if there are any other things going on for you that you wish you could change?”
Every physician has a few stories of things that are funny or amazing, in retrospect, but were less so at the time. Many of these are of questionable taste. This is one of those stories. Read on at your own risk – you were warned.
Which approach seems right to you? How do you maintain a balance?
The model of the expert physician making decisions for a compliant patient and giving orders to obedient nurses and technicians is thankfully disappearing, being replaced by a patient-centered team approach.