Don’t Do Chronic Care in December

I am beginning to think that we should not see chronic care patients between Thanksgiving and New Year’s Day. It just makes us look bad.

Our quality metrics make the last blood pressure and the last diabetic lab test of the year for each of our patients our final report card. We should quit while we’re ahead, in mid November.

So here we are: The office has Christmas decorations up. There are trays of Christmas treats on desks and in break rooms. Patient after patient now declares that diet and exercise are on hold until after the holidays. The phrase of the month is “Next Year, I’ll Eat Better”.

I thought of this when I saw Jerry Rigg the other day.

His chest pain was a bit atypical, the stress test slightly equivocal. His belly was quite a bit bigger than last year, but the indigestion medicine seemed to work and the cardiologist was quite reassuring. He had also spoken of diet and exercise, just as I had done many times before.

This man with all the risk factors didn’t take this episode as a warning, but as a green light for stalling a little bit longer before doing something to change his trajectory.

So, instead of beating on people who really don’t want to feast less during Thanksgiving and Christmas, what is a Country Doctor to do?

It didn’t take me long to know:

My Suboxone patients, who can’t have Tuesday group on Christmas Day or New Year’s Day, had fretted about Thanksgiving, which in many families can be emotionally charged or awkward. Major holidays also often expose them to relatives who are not in recovery, who may bring drugs to the periphery of the festivities. Every single one did okay, though. But after realizing their degree of concern, we are holding groups on Christmas and New Year’s Eves and halfway between.

I also have seen a couple of patients already in tears because they can’t afford presents for their children, because they miss loved ones that won’t be there this year or because they weren’t invited to something others in their family did.

I can’t really postpone or cancel my remaining hypertension and diabetes visits on such short notice, but maybe in the future, we need to be more focused on those patients who find the holidays hard.

If by doing that our quality metrics should happen to improve, is that so bad?

1 Response to “Don’t Do Chronic Care in December”


  1. 1 Rich Harvey December 26, 2018 at 1:23 pm

    I like and respect your thought processes. Before I went to PA school (1987-89) , I was first a Special Forces Medic… I carried a “Jerry Rigg” from the evac helicopter to the morgue after he’d been blasted by a booby trap on patrol LZ English Thanksgiving time in Vietnam … one of my good friends ~ it was an honor I cherish to this day, and helps me keep things in perspective that things can go ‘down hill’ and we must be there, keeping our eyes, ears, and hearts attuned, as we rerpresent our patients humanity when theirs has eluded them… We have to be with them and assist them through tough times and try to develop copy skills/mettle for viable longterm outcomes.


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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”.

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