Have you ever seen the Norman Rockwell era oil paintings of physicians at work? One in particular has always intrigued me. It shows an older male physician at a desk with his patient across from him in conversation. It’s an image of the true consultation. One where the patient and physician spend a significant amount of time talking about and thinking through the patient’s complaint. I was always baffled by that painting because it was so far from modern medical practice as to be laughable. That is, until I started my DPC practice.
When I completed residency and finished eight grueling years of medical training, I assumed private practice would offer me more control over my daily schedule and workload. I was completely wrong. I entered private practice and immediately realized it is akin to drinking from a fire hydrant. The pace is dizzying and unsustainable. Every second of every working day is spent pushing faster because more and more is expected of you. There is little time for truly thoughtful discussion with your patient and even less time to research a nuanced answer. I found that whenever I let one of my patient’s down it was by failing to deliver on researching some topic outside of the exam room. I found that there just was never any extra time for research. Trinity as a practice fought against this fast paced trend by attempting to schedule more time with each patient and buffering work days with unscheduled, uninterruptible non-clinical days. By community comparison, we are slow and spend too many days not seeing patients. But these were the only safeguards I had at trying to maintain a high level of medical care for my patients who needed complex answers to their complex problems.
During the heat of each day, clinical questions would come rapid fire and pausing to think through a harder situation only allows everyone to assume you’re ‘not doing anything’ and are therefore free to help them with their question. Since 99.9% of my job involves nothing other than firing off a few trillion neurons, if you ever see me standing around looking off into the distance then I’m likely working my hardest.
After nearly 10 years in practice I figured the days of a Normal Rockwell era physician thoughtfully discussing the case with his patient were gone. Thankfully, I’ve seen that turn around since being a DPC physician.
This week for instance, one morning while reviewing my new lab reports I found an unusual and dangerous result on one of my patients. The implications were significant but the therapeutic next steps were not clear. So, without another patient pressing on the schedule, I fired up my modern online medical resources and then sought counsel from some trusted physician sources who have expert knowledge in the area. In the following hour I digested all I found on this disorder, developed a protocol for helping future patients discover their risk, and formulated a treatment plan based on the best medical evidence. I grew as a physician. I have more understanding into this poorly known disorder than I did last week.
After my time of study I called my patient and spent another 15-20 minutes talking about the result and explaining what we need to do next. We discussed the implications it has on their family. As I care for many of their family members I was able to step back and look comprehensively as to how it affects everyone’s health. With permission from my patient, I contacted another family member who the result would also directly impact. We had another thoughtful discussion and developed a plan of action.
It’s in these moments that I realize the art of continually learning and honing my craft as a physician was being pushed to the wayside by the modern business approach. I understand now what it means to work with your patient and not simply be present in the exam room with them. Most all of us went into medical training with the hopes that we would spend our hours with our patients and not on their paperwork. Don’t get me wrong, there are many exceptional physicians working in the standard medical business model, but most assuredly, they are a dying breed. I, however, have found a place of deep professional satisfaction in being able to care for the whole of my patient, to grow along with their needs, to develop intricate, nuanced therapeutic plans, to provide comprehensive, family wide care, and to walk with them over the years as we face these challenges together. Direct Primary Care allows me to be the physician I always knew I was meant to be.