Mommy Doc Madness

What a week of motherhood, medicine and mayhem! It’s inspired me to write my first blog entry. And, what a week it has been . . .

Last Sunday, I attended a class about making the middle school years better with your teenage daughter. It was a great time of giggling and laughing with my daughter and her friends. And, there were some great pearls to remember. I think my favorite is the idea of the “Botox Brow.” The concept is simple. No matter what your teenager tells you, you need to listen without judgment and without a furrowed brow, so that she will continue to come back and tell you more. I thought about how I try to practice that in my patient care experiences. Somehow it seems easier with patients than it does at home with family. When a married patient comes and spills her soul that she’s lost interest in her marriage and has been having an affair with her boss, I have no problem listening with a compassionate ear and a calm face. I have to explain to her that she now has an STD and we need to work through treating her and testing her partner. But, when my tween tells me she forgot to charge her phone for the 3rd time and cannot find it (since the Find My iPhone app won’t work when the phone is dead), my face crinkles in utter frustration. Somehow, the consequences of the choices made by my patient and my daughter don’t match the consternation of my brow!

I resolved to do a better job of flattening my brow at home and at work. When I opened my emails Monday morning, I was hit with two articles about medicine that challenged my brow resolve. The first was an Annals of Internal Medicine article talking about how little time physicians are spending in face-to-face interaction with patients: only 27% of a physician’s time is spent in face-to-face contact. This is in a peer reviewed journal article. I felt affirmed, as my sense is that the same thing is happening in my practice and my colleagues’ practices.

The second article, written by Jay Parkinson, suggested that the role of a primary care physician in today's world is obsolete because patients don’t value the doctor-patient relationship. It also affirmed that physicians have very little time to spend with patients, and suggested that most folks today just want convenient care at the time that works for them. They would rather have easy access and quick care in lieu of having a relationship with a primary care provider. The article suggested that the limited time that physicians have to spend with patients precludes building a meaningful relationship: “All relationships, both personal and professional, are built over time. Does it qualify as a relationship if you’ve seen a doctor three times over three years?”

Then the barrage of emails started flowing into my inbox concerning all the changes we are trying to implement in primary care, attempting to restore that time to spend with patients. My organization has wholeheartedly supported efforts in trying to redesign how we deliver care in order to restore the quality time we spend with patients. I know we still have work to do. For example, in an email from one of my colleagues, he said that morale is low in his practice and group. Ironically, it's the season of teammate engagement (provider satisfaction surveys) and I have to send emails reminding my colleagues to complete their surveys. It will be interesting to see what these surveys reveal.

After sorting through the inbox, it was finally time for me pursue my passion and care for my patients. And, God showed up in power and in truth. I had a patient that came in for a routine follow to check labs and get some refills on medications. Out of the blue, she says to me: “You know, you changed my life.” I was baffled; I had no idea to what she was referring, although I did notice she had lost weight. She explained that in a conversation over a year ago, that I don't even remember, I referred her to a specific weight loss program that seemed appropriate to her needs and lifestyle. It was a referral program from which only a select group patients would've benefited. She told me that she'd lost 100 pounds since the day she delivered her last child. She said she feels like she has her life back. Because I knew that patient, and had a relationship with her, I knew the program would be right for her. And, it was!

Then, a few days later, I had a patient come in to see me that I've known for many years. I have walked beside her through the death of her mother, the birth of her children, and several complicated medical issues with her family. She came in to see my partner earlier in the week for an acute health need. Yet, she had called back multiple times during the week, pressing to get an appointment with me. I walked in the room and she said she just needed to hear my voice and get my opinion. My partner had met her physical needs earlier in the week, but she just wanted the assurance of her primary care physician. Wow! So, we prayed together and asked for God to give us both wisdom to get through a difficult season for the patient.

Is my time limited with my patients? Yes. But, is it any less valuable to them or to me? I emphatically say, NO. The same is true with my kids. One got off the bus this week with a fever of 102.5. The nanny gave him Tylenol to get his fever down, but he wanted to curl up on my lap when I got home. The tween with whom I took the class last week talked my ears off this weekend . . . and it was awesome! I kept my brow as flat as a pancake.

I have hope that my messy life as a mom and a doctor do matter and I can continue to make a difference in the lives of people around me. I may not always understand what’s happening in all my roles, but, I know the plans God has for me are full of hope and a great future:

“For I know the plans I have for you,” declares the LORD, “plans to prosper you and not to harm you, plans to give you hope and a future.” (Jeremiah 29:11, NIV)

Footnotes

Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties Allocation of Physician Time in Ambulatory Practice ONLINE FIRST

Christine Sinsky, MD; Lacey Colligan, MD; Ling Li, PhD; Mirela Prgomet, PhD; Sam Reynolds, MBA; Lindsey Goeders, MBA; Johanna Westbrook, PhD; Michael Tutty, PhD; and George Blike, MD

Ann Intern Med. Published online 6 September 2016 doi:10.7326/M16-0961 © 2016 American College of Physicians

http://qz.com/781485/do-i-really-need-a-primary-care-doctor/

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