One Crazy Afternoon

In affirmation of the Universe's sense of humor, the first patient into my grand plan to create a brighter medical experience promptly passed out while trying to leave her appointment. She was taken to the ER in a stretcher and I can safely say that neither she nor myself had a spiritually fulfilling encounter.

There are many issues that could be addressed related to this case including the cost that is going to be charged the system for this (rough guess $15 thousand dollars by the time the patient is observed overnight and released) or how we deal with our increasing numbers of very ill patients that modern medicine has allowed to remain living in the community (a great success to be sure but a management nightmare).

Instead, I'd like to keep to topic and explore the visits for the rest of the afternoon. I saw a fairly typical mix of respiratory infections, medical follow ups, new patients seeing me because of insurance changes, and mental health. Though my "project" spurred me a bit to try to make the best of these visits, I certainly didn't feel great satisfaction at any point. One patient was, in fact, quite happy because we had finally found the right medication after months or even years of never quite hitting the mark. But there were none of the "Aha" moments that remind you why you went into medicine.

I felt that I had done my job adequately or even well in every case, and I think every patient went away at least satisfied. But my sense of presence and intensity of attention were not going to be at their peak. Which leads me to the simple idea that the key to the best encounters follow rules that have little to do with exam rooms, payers, personnel, or the tea party. The best encounters are simply when people give their real attention and their true energy in those moments to the relationship.

I feel these moments most often early in the process of treating mental health issues, but that's my personal interest, my niche in my local healthcare system. It occurs to me that optimizing health care may be, in part, the process of simply allowing these genuinely present human interactions to take place. And part of my job is to figure out how I can bring presence and not allow my frustrations with medicine as a whole ruin the one thing I truly do have some power over.

But given the fact that this is only the third patient in six years that I've had to call EMS for, I'll give myself a little break. A few points to ponder for the evening.