How I Will Work Smarter in 2019

Last year I put down ten things I intended to do better in my role as a doctor, and as I look back at that post, I think I made headway in most of those areas.

This year, I don’t really feel up to making a long, detailed list. I’m more thinking about “the big picture”.

There are two kinds of philosophies, two diametrically opposed ways of looking at the world, expansive and reductive.

We move back and forth along that spectrum. Many forces are at work to push us to one of the extremes: Touch as many aspects of a patient’s medical situation as possible. This is manifested in our mandated and self imposed checklists. We screen for depression, smoking, alcohol use, cancers and a host of preventive care gaps every time we see a patient.

The expansive approach has been viewed as desirable while “reductive” has become something negative, even described as “crude” by several dictionaries.

I think, and I will cultivate this in the coming year, that medicine has brought us too far in the expansive direction and that we aren’t seeing the forest for all the trees.

We aren’t seeing the patient behind the multitude of measurements; we aren’t seeing the connection between their various ailments; we aren’t seeing the connection between their emotions and their bodies.

I believe that whatever success I have had in filling my appointment schedule through four decades with loyal patients who travel great distances or wait longer than I’d like to see me isn’t from me covering a million things in each visit. I believe, and many tell me, that it is because I dig deep into their concern of the day, and because I zero in on who they really are.

In order to get to know somebody, do you step back for some kind of “birds eye view” and ask many wide ranging questions, or do you lean in, look them in the eyes, lower your own voice and invite them to speak freely?

Ours is a vocation founded in relationship. I aim to strengthen my patient relationships, and I aim to use my available technology and my team members to help with the laundry lists of today’s health care duties so that I can know my patients even better and be the glue that connects my patients to the clinics I work for.

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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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