I made my 10:20 a.m. patient wait while I told my support staff about my day off. “I was getting an ice cream when I saw a car accident. By the time I got there, it was clear that there were no serious injuries and all I did was to distract the passenger so she wouldn’t panic while we waited for EMS. Her husband hit a tree with their van, and she was lying on her back, on the floor between the two front seats. She told me her seatbelt on had been on. This didn’t make any sense, so I asked her more questions. It turned out she had her seatbelt on, but not buckled. In what universe would that keep her safe?” We all laughed. Eventually, my MA said, “Maybe she thought it instantly clicked if she was in an accident — you know like how an airbag deploys really fast.” This is why I love working with this MA. She can make connections I do not. I went to see my patient and realized he was not taking some of the meds on his med list even though the MA’s note said, “The patient confirms that the medication list is complete and accurate.” The way the MAs confirm the med list is to ask the patient if there are any changes to their meds. When the MA asks this, she means, “Are you taking all the meds we have prescribed in the way we’ve prescribed them and has any other doctor added other meds since we last updated your medication list?” When the patient says, “Nope, no changes,” he means, “I’m still not taking that blood pressure medicine I can’t afford that you prescribed a while ago. I’m still taking my cholesterol medicine in the morning because I can’t remember to take it at night, and I’m taking it every other day because I read on the internet that it’s bad for you, but you tell me it’s good for me, so I’ve compromised at taking it every other day. I’ve been doing it that way for months, so that hasn’t changed either.” They both think they understand the exchange that just happened. My assistant clicks, “The patient confirms that the medication list is complete and accurate.” Then in three months, when I check the patient’s cholesterol and find the statin is not nearly as effective as I thought it would be, I question them. They say, “I thought you knew I was taking it every other morning,” and a conclusion of “patients lie” would be understandable, but not helpful. Or maybe I might think, “MAs are lazy.” I think neither. Patients have their seatbelt on, but not buckled. They are no better at understanding the inside of my mind than I am at understanding the inside of theirs. They have no real way of guessing what is important to me. If I asked the right question, they’d give me an answer I could use. I have to really think about what might be going on in another’s mind so that I can ask the right question. I must pay attention to which questions have given me useful answers in the past and which ones produce confusion. I must be sure my patients understand that my goal is to keep them off the floor of the van, not to hear the seatbelt click. Mary Braun is a family physician. Source
