Thread by @NeuCare

/thread

This might come out wrong, but here it goes...

Most days, being a primary care physician is really hard--humbling is an understatement. Despite 8 yrs post-HS edu + few yrs post-grad training + decade of private practice, I often feel inadequate...

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...to fix my patients' problems.

Why?

First, our growing body of knowledge on diseases/tests/drugs/procedures is mindboggling. The internet gives me access to info but that takes time. Even w/ a good knowledge base, reviewing guidelines/expert opinion/studies ain't easy.

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Further, applying the "best evidence" or "standard" to Steve often isn't straightforward; confounders are often present when treating an individual as a whole person & all their organs. (after all, I'm not a partialist...I mean, specialist.)

Often, the best I can say is...

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"This is your best treatment option, but it has a 72% chance of success & a 15% chance of causing another problem."

or

"I'm not certain of your diagnosis but let's start with these tests as a first step."

And I must make this recommendation while factoring in...

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a person's psychosocial state & personal preferences. (sometimes Aunt Sally's opinions too!)

Thx to Jeff at the gym & Google, many patients have already formulated strong ideas about what is wrong, what tests, and/or treatment(s) are warranted before they see me.

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Don't get me wrong: I'm far from paternalistic.

I encourage patients to become educated on their known health issues using reputable internet sources--some patients become near experts!

But (a big BUT) there are boatloads of terrible information at the gym & online.

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So, often, the information & suggestions patients bring me (e.g. I'd like to get my reverse T3 checked) would require a 30-minute lecture on pathophysiology lecture to explain why the info is NOT correct or applicable.

Of course, patients deserve explanations, but...

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...that takes precious time.

Correcting misunderstanding(s) is fraught with potential contention. Sometimes, even after sharing my perspective, we do not see eye-to-eye on a matter. (even if we don't say it out loud)

Yet,...

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...my main goal is to develop a trusting, lasting relationship with every patient. That, at times, is exhausting.

Even when I'm 100% on the same page with my patient, doctoring is hard.

Most days...

Bad shit happens that I didn't predict and cannot explain.

9/

I realize I've failed to motivate a patient to do the right
thing.

I deliver bad news.

I have to clean up messes & confusion left by other providers.

I spill coffee on my shirt.

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If I'm being honest with myself, I'm an average doctor at best. But, I also have an irreplaceable superpower....time.

In my family practice, I have 30-60 minutes w/ each patient. This allows me...

the time to sit & truly listen, to understand a patient's story;

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the time to educate patients & allow them to ask questions;

the time to develop long-term, trusting relationships with my patients & staff;

the time to learn and grow in my knowledge and skills; and...

the time to stay (somewhat) sane & happy while doing all of the above.

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Adequate time doesn't assure good outcomes or relationships, but really, without it, the chances are much lesser.

Perhaps I shouldn't be satisfied with being "just an okay family doc". But, for my patients' sake & mine, it's favorable to being a brilliant, rushed doctor.

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