Why is the Patient Here?

Looking at my EMR patient schedule in its usual display, I can’t see quickly if I have appointment slots open. I would have to think 8:00, 8:30, 9:30 – so 9:00 must be open. There is a grid display, too, which lets me quickly see the unfilled slots. But the grid view gives no indication of why the patient is coming to see me. The standard version prominently displays 15 minute or 30 minute “visit type” but I am at the mercy of the scheduler as to whether there is a freetexted comment about the purpose of the visit.

For a busy clinician, it is crucially important to know why the patient is coming in. A wound check is not like a “doesn’t feel well” visit. When you’re always asked “where can we squeeze somebody in”, you need to know “why” in order to guess “how much time”.

I actually have no tolerance for “not feeling well” visits. Come on, use some common sense: Does the person have the sniffles or are they desperately ill with shortness of breath, chest pain or something equally dramatic? In my opinion, even offices that don’t have an automated phone system that says “if this is a life threatening emergency, please hang up and call 911” should have that triage step first and foremost in the mind of whoever answers the phone.

“Why” is also crucial when it comes to planning what needs to happen. If someone is coming in to have a wart frozen, the cryo equipment from down the hall needs to be available. A “3 month diabetes” visit needs a glycosylated hemoglobin, either a result from the lab or a fingerstick done in the office, whereas “followup blood sugars” is an interim visit to just review the blood sugar log.

Even the word followup means something. For me, a “followup blood pressure” visit is a predictable visit at my request, not something urgent. Theoretically such a visit could be “bumped” in a pinch to make room for an urgent hospital followup or something similar. But a patient’s own request to be seen because their blood pressure is skyrocketing must be labeled as “BP high”. Such a visit should obviously not be bumped and should not be labeled the same as a routine visit.

This may seem picky, but think of hailing a ride or making a dinner reservation. The driver might benefit from knowing how far and how many passengers, just like the restaurant might want to know how many guests and a regular meal or a birthday party and so on.

Another scheduling issue in my opinion is the “physical”. I hear family members worry about someone being ill and saying “he needs a complete physical”. First of all, there is no such thing as a complete anything in medicine. Second, billing for a physical implies that you did a lot of preventative things that would be inappropriate when somebody is very ill. I sometimes actually say “you are too sick to have a random physical, tell me what’s going on instead”.

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

The Healing Power of Even Virtual Human Connection

Almost two years into this new age of varying degrees of self quarantine, I am registering that my own social interactions through technology have been an important part of my life.

I text with my son, 175 miles away, morning and night and often in between. I talk and text with my daughter and watch the videos she and my grandchildren create.

I not only treat patients via Zoom; I also participate, as one of the facilitators, in a virtual support group for family members of patients in recovery.

I have reconnected with cousins in Sweden I used to go years without seeing; now I get likes and comments almost daily on things that I post. I have also video chatted with some of them and with my brother from my exchange student year in Massachusetts 50 years ago.

I have stayed in touch with people who moved away. And I have made new friends through the same powerful little eye on the world I use for all these things, my 2016 iPhone SE.

Members of my addiction recovery group stay in touch with each other via phone or text between clinics. They constantly point out the value of the social network they have formed, even though they only meet, many of them via Zoom, once a week. The literature has supported this notion for many years and is very robust: Social isolation is a driver of addiction.

It is also a driver of cardiovascular risk and is thought to be a risk factor of the same magnitude as smoking.

But, do new, online friendships mean as much for our health? This is probably a question that is too new to be answered. How many of these relationships can transition and deepen over time and through different stages of life? Suzanne Degges-White, PhD, writes cautiously about this in Psychology Today.

In 2017, pre-pandemic, Frontiers in Psychology reported that people who spent a lot of time on the Internet were more lonely than people who used the Internet less. But that was in a different era, when in-person relationships were a more practical and safe option than they are today. Back then, the heavy users of the Internet were possibly a self selected group for entirely different reasons than today’s high utilization demographic.

But with the fragile state of affairs, exemplified by the revolving door of new coronavirus mutations – of which Omicron is unlikely the last one – we probably need to make the most of whatever means we have to stay in touch with family and friends. Not so much that we neglect the necessary solitude we all need for introspection and self care, but enough to feel connected in some way to the human race.


Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.

BOOKS BY HANS DUVEFELT, MD

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