A Country Doctor Writes:

The last few days have been really busy, but they still felt controlled, almost leisurely and smooth. Patients have been seen on time, my office notes have been completed in real time and my superbills have been submitted before each patient reached the check-out station. Things were really humming.

The new nurse, who is orienting with Autumn, noticed that I was humming each time I dashed back to my desk to grab a printout, my tuning fork or something else. I, too, realized I was doing it again and again – humming the theme song of Jeopardy, the television quiz show.

I haven’t watched Jeopardy since TV went digital a decade ago and we refused to upgrade. But I still find myself humming its theme now and then through the day. In fact, I’ve been doing it ever since, in a gesture of generosity and solidarity, I volunteered to try fifteen minute visits during a lean spell in the clinic about twelve years ago.

Primary care is a lot like Jeopardy. You have to quickly think of the right answer, which is often disguised as a question, and then press the buzzer as fast as you can before you are presented with the next challenge:

Is it the thyroid? What will the EKG show? Have you traveled to West Africa? Am I meeting my Meaningful Use targets?

Every day I walk the fine line between well oiled efficiency and letting patients take the time they need to tell their stories. Again and again throughout my day, I switch from nudging things along to slowing them down as my experience and clinical intuition guides me in my work.

The patients who were squeezed in for acute problems appreciate my efficiency in getting them in and out. Those with complex medical problems or maladies of the soul expect me to give them the time it takes to grasp what’s important to them. When I can’t tell the two types of appointments apart I fail miserably in carrying out the visit, and kick myself for my misjudgment.

I guess what I do is like like many other things in life that I personally have never experienced much of first hand, like sailing – you’ve got to consider the elements and never try to go completely against the wind or the current, but find the correct angle, know how to rig your sails and be prepared to zigzag a little to get to your destination.

The challenge in what I do as a primary care physician is to accept the changing winds of each clinic visit, to see time as something more fluid than a Swiss watch, and to remain a little bit above it all – just enough so I don’t feel completely stuck in the muddy waters of our modern healthcare bureaucracy.

I do have to stop humming Jeopardy, though. It completely sets the wrong mood.