Sometimes the business plan completely falls apart. I look at my clock; it’s 11 a.m., and I only have two patients remaining for the morning? Something must be wrong. Every fail safe measure to keep the assembly line going must have failed. The initial card with the appointment time to carry in the wallet? Failed. The reminder phone call the day before? Failed. Even the insurance company gift card to keep the follow-up? Failed. Two patients, one hour. Who cares about the loads of charting I have to do? Who cares about the basket full of documents I have to review and sign at the clinic? Who cares about the even bigger basket at the hospital? Who cares about the inbox full of lab results and phone messages I have to answer? The patient at the hospital is stable; I can see her later. For one solid hour, I get to be the physician I dreamed of being when I decided I wanted to go to medical school so many moons ago. First patient: “You’ve been crying often? Tell me more about that.” I put my computer down and listen. The tears flow. “It’s alright.” I have a box of tissues, and guess what — I have thirty minutes (maybe more) to listen and discuss anything you want to. “Turns out, the opiate addiction started as a child when your mom’s friend gave you a handful of pills?” Invaluable information to learn. I cannot imagine a childhood like that. “And your cousin passed away from taking alprazolam and a narcotic pain reliever?” I find myself diagramming GABA receptors and mu receptors, explaining potentiation and the potentially life-threatening respiratory depression that can occur with this deadly combination — the exact reason why I don’t want her drinking alcohol or taking any other pills during her opiate addiction therapy. I know she won’t remember the names of the receptors, but hopefully, she’ll remember the main idea behind the discussion. If she relapses, benzodiazepines and opiods can kill. Next patient: “You took ibuprofen, and you’re pregnant?” Again, the computer gets put to the side. I find myself diagramming fetal cardiopulmonary circulation and discussing the incredible change as the ductus arteriosus and foramen ovale close after the baby’s first breath and the role prostaglandins play in this — the reason why she should avoid ibuprofen at this time in her pregnancy. We even discuss delayed cord clamping, and how that eases this incredible transformation. I know she won’t remember the words prostaglandins and uteroplacental circulation, but hopefully, she’ll remember not to take ibuprofen again during her pregnancy. It’s now noon. Actually, it’s fifteen minutes over. Time to get back to reality. Sadly, those insurance companies that say they care about health don’t really care about those discussions — they only care about the documentation of those discussions. In fact, I’ll probably get a nasty letter about how I’m a terrible doctor from those insurance companies because I didn’t do a depression screening on that first patient (despite the fact that we increased her antidepressant) and because my pregnant patient likely won’t make her 6 week postpartum visit (we also discussed the fact that she doesn’t have a car). And of course – there’s a hospital staff meeting I forgot about that started at noon. The charting will have to take place after dinner, unless call dictates otherwise. But what a great hour. A physician learning about the lives of two patients, and two patients learning about the anatomy and physiology of their own bodies, hopefully with some improved health as a result. Source
