I keep thinking about the dichotomy between covering a lot of ground and getting to the point.
The other day I saw my bosses at one of my clinics stop in their tracks when I suggested that a lot of the things we are measured on as physicians could be turned into standing orders and simply get shifted off my plate. I have just created a letter that anybody can send on my behalf to any patient of mine who hasn’t been screened for colon cancer; it’ll look like I sent it, which is fine, because I support it, but I shouldn’t have to crowd my glorious 15 minutes with that too, in addition to the diabetes and depression and whatever else I need to address.
I sincerely believe that doctors have somehow been excluded from the theory of working to the top of their license. And that’s a shame. I’ll gladly lend my name to colon cancer screening, immunizations, diet and exercise, and other public health programs.
But, and I’ll probably insult some folks (again): You don’t need a medical degree and decades of experience to carry out no-brainers like that.
I want my training and experience put to a different use: Seeing what matters in a tangled mess of symptoms or data, making interconnected value and probability judgments and disregarding a patient’s formal response if their demeanor or body language suggests that their answers are incongruent. (What percentage of suicidal patients answer that question truthfully?)
I often find myself abdicating from deciding if a late patient can still be seen or if one person needs to go ahead of another: I’m too focused on something else.
It is my ability to hyperfocus that lets me deal with a diagnostic dilemma in short order. Don’t ask me to also direct traffic or upsell with unrelated health maintenance gaps in care.
When my patients say, “He really listens,” it means “he focuses” and “he’s not all over the place.”
I don’t think you can have it both ways.
Pay me to focus and pay somebody else to do the housekeeping.
I’m an artist and a problem solver, not an accountant.
Hans Duvefelt, MD, is a family physician who blogs at acountrydoctorwrites.com. This post also appeared on KevinMD.