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Everyone is Not Going to Like You

It’s the first day of spring break.  My wife scheduled our vacation to start on a Tuesday since she was coming off a week of call and wanted an extra day to wrap things up. I’m home with the kids. To pass the time we went to a germ-infested indoor jungle gym.  There are an unusual number of grandmothers here today, likely helping with childcare since working adults don't get a spring break. Amongst the crowd is a familiar face. A patient of mine.


As I sat and thought about it, I wasn’t so sure. It's been some time since she came in for a visit. She is at an age that warrants at least an annual visit. So why has it been so long? I decide to look her up. Low and behold, I’m no longer her PCP.  Not only am I not her PCP, but she’s seeing someone else.


I’ve been in practice for 9 years.  Seven at my current practice. This still gets me. What did I do? Was it something I said? Social convention keeps me approaching her to say, “Hey! Remember me? Your doctor for the past 5 years? What gives?” Even if this type of behavior was socially agreeable, I probably wouldn’t like any reason, valid or invalid, for the rejection.


On my busy days I do 20 office visits, back-to-back, 20 minutes apart, with a 40-minute lunch. It’s similar to a speed dating experience, if you’ve ever done something like that.  The difference is the other participant is doing most of the talking, there is a list of issues to solve, and the clock is ticking. Always ticking. It’s exhausting. Believe me, I’d much rather swing a hammer, or mow lawns for 8 hours. Knowledge work (doctors, finance, lawyers, teachers) is not physically exhausting, its cognitively exhausting. There's a difference.  You’re hungry, but you don’t know why, you just sat all day. Your brain is way over stimulated. When I get home from work, I’d be completely content if I don’t hear another sound the rest of the day.  All you want is carbs. Give me all the carbs. Your brain craves sugar. So you’re irritable, looking around for a sensory deprivation tank.


The health system I work for survey’s hundreds of my patients each year. The focus is on soft skills. Did you trust me? Did I listen to you? Would you recommend me to a friend? These are surrogates for, did I greet you nicely? Did I give you ample time to discuss your physical ailments? Did the visit conclude with some hope that your future self will be in better shape than it is today?  There isn’t much along the lines of, did I recommend the most impactful intervention? Did I prolong your life? Did I prevent some horrific cancer through prevention? There’s no current resource light method to evaluate those things. So, we are stuck with the soft skills.


At the end of each month, I get a rating of my performance.  My score is good. Usually around 4.5/5.  But my practice still suffers quite a bit of attrition, even before I pivoted to academia. It’s difficult to be “On” all day, which is what the survey measures. You should try it. Find a nice restaurant hosting a speed dating event (if they still exist). You don’t have to be single. You can fib a little. Take a piece of paper and write down how you feel when suitor #15 sits down.  Does it take more energy to smile and chat, than to just stand up and walk away?


Which brings me back to my former patient. Please don’t feel sorry for me. I have a great job, and a great career. I really try to make the experience enjoyable. More of an effort than the cognitive energy I put into your health. At this point in my career, the medicine is the easy part. So, why do I get dumped? 


I assume it’s several factors. There are patients that don’t jive with my general approach to health. I’m not surprised they leave. When it is a surprise, I assume it’s personal.  Most likely something I said.  I get asked all kinds of questions in these visits. A big topic lately has been politics. Some patients will bring it up discretely, others ask me flat out.  Did you vote for Trump!?! I tell them I keep politics out of my practice. Which is true! I don’t want to talk about it, nor do I care what your political views are. I barely care about my own political views. My former patients may not feel the same.  I’ve had 30-year-old man ask me about abortion. If you’re a male, don’t ask me about my stance on abortion, it’s a waste of both our time.


Alternative medicine is a common topic. Some patients assume, since I'm a D.O., that I practice alternative or naturopathic medicine.  I don’t. I don’t know what ashwagandha does or how it will interact with your heart medication, you’re probably taking too much turmeric, and its not healthy to take enough zinc to galvanize a piece of steel.  I can’t tell you the exact amount of water you should drink each day. I don’t analyze sleep charts on your fitbit and relate it to your diabetes. I just assume in that 90-minute awake window you walked down to the fridge and had a snack. Probably of the unhealthy variety, and your fasting a.m. glucose isn’t really fasting. As you can imagine, there are times I say the wrong thing (just ask my wife). I'm getting better. The angry professor in me just blurts it out. Understand that I have no ability to see the world through your lens. Despite how hard I try. The lens provided to me through my education and experience is what I rely on. That doesn't always jive with how you see things. But I will keep trying.


As I’ve matured, these break-ups have stung less and less. Deep down I know it probably has nothing to do with me. Maybe the location of the office sucks. Maybe you preferred a woman. Maybe an office opened near your home. Maybe I’ve had to reschedule your visit and that was the last straw (my schedule is set month’s in advance, but life happens in real time, rescheduling is not malicious, and I try to avoid it as much as possible). All good, and plausible reasons.


Even though some I my patients don’t like me anymore, I’ll find a way to move on. I hope they know I gave them what I had in the tank that day, and unlike most ex’s I’ll always take them back.

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