Tuesday, August 12, 2008


Under a highly improbable set of circumstances, I briefly became the primary care physician for an elderly relative of a college friend. I tried to limit my exposure to the octogenarians given the breadth of my practice as a Med/Peds physician, but I was honored by the fact that friends thought highly enough of me to want me to take over her care.

Even though I loosely knew the patient from long-ago social contacts, the patient-physician relationship that budded was a comfortable one. Yes, she always tried to turn it into a social call when we truly had a few medical issues to discuss, but fortunately, she was wickedly healthy compared to her age-matched peers. She travelled. She read the paper. She exercised. It also helped that my hospital's productivity whip had not yet started to crack. I had a little time to burn with her at her Q6 month visits.

Then a tragedy hit the family far from home. This actually touched me emotionally as well -- this person was also a friend. Not surprisingly, some somatic complaints on the part of my patient began to manifest. Appropriate work-up was negative.

But almost simultaneous to the tragedy, I escaped primary care. My partner took over graciously. But the transition was not pleasant. Despite 2 visits very generous in time spent with the patient, she would call hours after her visit to complain to our office manager that the physician did not spend enough time with her. She felt rushed. She did not feel that her complaints were being addressed. This, despite the fact that my partner had a 2-page note from each of these "follow-up" visits. The office manager had to talk to her for an hour to calm the anger. The patient was "shocked" that there were "time constraints" on how long she was allowed to carry on her visits.

Obviously, grief plays into this. My departure from the office plays into this. But this is an otherwise rational woman who is pissed off that the current system doesn't allow her the time she feels she is due in her hour of need. She is in counselling, but she sees physician-patient time as a critical piece of that... a piece we're not letting her enjoy bite-by-bite over an hour.

I have mixed feelings about this. On one hand, I wish the healthcare system were such that a physician could spend more (even if not to the degree this woman wants) time providing lending an ear... having the hand-on-the-shoulder. On the other hand, our government and populace at large has made it clear they have no intention of paying for it.

I have a social ability to tell her to chill out... one that I don't with the average elderly patient. But she's not listening to me. I'm now just one of the cold mechanical voices of healthcare to her. And if this is how someone who's a hybrid social contact-patient is reacting to her primary care doctor... can you even imagine what the expectations of the average elderly patient are of their primary care provider? How can we ever win? These are the seeds of litigation.

She served to solidify my belief that for the forseeeable future, primary care is screwed.

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