“Mommy, mommy, mommy”, Claire kept saying.  Claire is a chubby cheeked 3 year old patient of mine.  While her mom and I were discussing a sibling’s illness, Claire wanted to color on a picture but needed permission.  Claire’s mom was quite skilled at redirection and instruction even as she initially refused to let Claire interrupt.  It was a good example of a calm, multitasking parent.  However, Claire persisted until we paused our conversation and her mom gave her the go ahead to color.  Her mom and I picked up our discussion without missing a beat and completed our visit.

I can’t tell you the number of conversations I’ve had with this family over the years.  I’ve seen them for well visits, adult physicals, sudden sicknesses, and even visits counseling them through tough medical decisions.  They are some of my favorite all time patients and I look forward to each encounter.  I’ve had the privilege to care for their whole family and many extended family members too.

Each time I see them and we discuss their concerns, I feel the weight of responsibility rest heavier on my shoulders.  I know that as we review the pertinent symptoms and develop our diagnosis that they are looking to me for guidance on what treatment plan to undertake.  Obviously, some decisions are harder than others.  Deciding on surgery is harder than deciding on therapy for a positive strep test.  Regardless, each time I feel afresh the desire to give them my best.  I strive for the right answer every time; not the easy answer or the common answer or the profitable answer, but the right answer.  Some days it feels like trying to thread a needle from across the room.  The answer that is best for the patient in front of me is precise and nuanced.  It exactly solves the medical dilemma while minimizing any risk of therapy.

As modern medical care continues to confuse evidenced based medicine for the unbreakable standard of care, our communities experience less and less of this personal care.  We experience less interaction and less conversation because ultimately it doesn’t matter.  The patient’s story is becoming irrelevant.  All that matters is finding those key words or data points that dictate the next decision point of the algorithm.  Practitioners are being trained, often unintentionally, to use specific lingo and jargon in order to satisfy the requirements imposed by government meaningful use, pay for performance, and insurance reimbursement.

Before long this steady transition away from a narrative story to a check box list of data points will render the clinician as the last weak point in the chain of healthcare delivery.  At that point we, as clinicians, could, and arguably should, be replaced by automated systems.  Mechanized processes are more reliable and less biased than any human counterpart.  I can imagine one day that healthcare delivery will take place in front of a glorified vending machine.  Patients will approach the monolith, punch in a few keyword complaints, and out will pop the only approved form of treatment.

Direct Primary Care allows me to push back against that trend.  It allows me to preserve the nuanced narrative of a patient’s story.  It allows for me to develop a conversation with my patients and their families that lasts sometimes for decades.  When children ask me what I’m typing at their visit (I’m fortunate to have learned to touch type so I can look at my patient without having to look at my keyboard), I tell them that I’m writing a story about them.  Each time they come see me I write a new chapter.   Their story never stops.  My conversation with their parents shouldn’t stop either.

The story of a child’s life cannot unfold in disconnected episodes lacking context.  Have you ever had to retell the same set of events over and over again?  It is a frustrating experience.  You find yourself shortening the details just to save time.  Through Direct Primary Care I seek to maintain a relationship with my patients that allows us to meander among their concerns.  Their story remains unique and my counsel remains specific.

I encourage you to consider a Direct Primary Care membership and see what a difference it can make.  Pediatric memberships are $30 per month and cover the whole range of office visits from well visits to ear infections.  Membership include communication by phone and email during the business week.  For the month of February we are waiving the enrollment fee for new pediatric members.  This way new patients can experience the difference for less than most co-pays.

Under her mother’s guidance Claire will continue to mature into a respectful young adult learning how to remain patient during the conversations of others.  I hope she never stops worrying about interrupting her mother’s conversations at the doctor’s office though, because one can’t have a conversation with a vending machine.

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