Doctoring in 2020: Why is the Patient Here? Whose Visit is it Anyway?


A new decade and a new EMR are making me think about what the best use of my time and medical knowledge really is. The thing that stands out more and more for me is the tension between what my patients are asking me for and what the medical bureaucracy is mandating me to do. This is, to be blunt, an untenable, crazy-making situation to be in.

Many of my patients with chronic diseases don’t, deep down, want better blood sugars, BMIs or blood pressures – nor do they want better diets or exercise habits. People often hope they can feel better without fundamentally changing their comfortable, familiar and ingrained habits – that’s just human nature.

I went to medical school to learn how to heal, treat and guide patients through illness, away from un-health and toward health. I didn’t go to school to become a babysitter or code enforcement officer.

“So, it’s been three months. I can see you haven’t lost any weight, actually, you gained some. Your blood sugars are up a hair and your blood pressure is staying about the same. I think it’s time we add a couple more medications…” I might say as I imagine my quality scores continuing to lag for 2020.

My patient has dutifully showed up for a potential shaming or embarrassment session due to his lack of motivation to give up some of his comforting vices. But if you don’t show up, you might in the end lose your entry point to the primary care system – you may become an “inactive” patient.

What he really wants is some answers, explanations and reassurance about common symptoms he’s been having and maybe some shortcuts to better health without turning his routines upside down too much.

“I work for you”, I often tell my patients. “I’ll help you move toward your own health goals for yourself.”

How crazy is it that Medicare decides the best use for each of my fifteen minute encounters with my patients? That is a dystopian, totalitarian, nightmarish concept that makes me think of clanking iron gates, media censorship and surveillance cameras.

For 2020 I will record more health information videos and find more ways to communicate positive health messages in my clinic and community.

I will automate the way I meet the Medicare mandates as much as I can by mastering my new technology and I will work hard to make sure every patient feels heard and valued during our visits.

I will continue to see myself as an example for my patients. If I don’t take care of myself, how could I possibly help my patients help themselves? Many have seen me lose weight, so I tell them what I eat. They ask about my little farm and I tell them I have no power equipment and do a lot of walking, carrying and shoveling.

I will be on the lookout for natural opportunities to nudge my patients toward making lifestyle changes without preaching or criticizing past behaviors.

But most of all, I will make sure to ask everyone soon after walking through the exam door what they hope to get out of that particular visit.

Darn it, it is my patient’s visit. May I never lose sight of that.

Hans Duvefelt is a Swedish-born rural Family Physician in Maine. This post originally appeared on his blog, A Country Doctor Writes, here.

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