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

A new decade and a new EMR are making me think about what the best use of my time and medical knowledge really is. The thing that stands out more and more for me is the tension between what my patients are asking me for and what the medical bureaucracy is mandating me to do. This is, to be blunt, an untenable, crazy-making situation to be in.

Many of my patients with chronic diseases don’t, deep down, want better blood sugars, BMIs or blood pressures – nor do they want better diets or exercise habits. People often hope they can feel better without fundamentally changing their comfortable, familiar and ingrained habits – that’s just human nature.

I went to medical school to learn how to heal, treat and guide patients through illness, away from un-health and toward health. I didn’t go to school to become a babysitter or code enforcement officer.

“So, it’s been three months. I can see you haven’t lost any weight, actually, you gained some. Your blood sugars are up a hair and your blood pressure is staying about the same. I think it’s time we add a couple more medications…” I might say as I imagine my quality scores continuing to lag for 2020.

My patient has dutifully showed up for a potential shaming or embarrassment session due to his lack of motivation to give up some of his comforting vices. But if you don’t show up, you might in the end lose your entry point to the primary care system – you may become an “inactive” patient.

What he really wants is some answers, explanations and reassurance about common symptoms he’s been having and maybe some shortcuts to better health without turning his routines upside down too much.

“I work for you”, I often tell my patients. “I’ll help you move toward your own health goals for yourself.”

How crazy is it that Medicare decides the best use for each of my fifteen minute encounters with my patients? That is a dystopian, totalitarian, nightmarish concept that makes me think of clanking iron gates, media censorship and surveillance cameras.

For 2020 I will record more health information videos and find more ways to communicate positive health messages in my clinic and community.

I will automate the way I meet the Medicare mandates as much as I can by mastering my new technology and I will work hard to make sure every patient feels heard and valued during our visits.

I will continue to see myself as an example for my patients. If I don’t take care of myself, how could I possibly help my patients help themselves? Many have seen me lose weight, so I tell them what I eat. They ask about my little farm and I tell them I have no power equipment and do a lot of walking, carrying and shoveling.

I will be on the lookout for natural opportunities to nudge my patients toward making lifestyle changes without preaching or criticizing past behaviors.

But most of all, I will make sure to ask everyone soon after walking through the exam door what they hope to get out of that particular visit.

Darn it, it is my patient’s visit. May I never lose sight of that.

9 Responses to “Doctoring in 2020: Why is the Patient Here? Whose Visit is it Anyway?”


  1. 1 David Welsh January 6, 2020 at 5:33 am

    Great! And read Sinclair’s “Lifespan”. I’m inspired that it is possible to get them to lose weight and reverse ageing….I can’t recommend the book highly enough to doctors.

  2. 2 Marguerite joyce January 8, 2020 at 9:39 pm

    We had a country drs in 50s had the best doctors. Last 15 years the ones i go to haven’t the tiniest idea on what conditions and diseases i have since age 5 they don’t look at your medical records they have no idea the what the body looks like they they don’t go by the Oath which i have in print they don’t care they refuse to listen the one I’ve seen 3 times when i see him he’s making another appointment with behavior health going by schizophrenia that was told to be put on my record but no Dr name or test or diagnoses ever on my medical history then last summery they sent me said same old thing then he puts in his words i told him i know my body more them.him


  1. 1 Doctoring in 2020: Why is the Patient Here? Whose Visit is it Anyway? | Health Advice and more Trackback on January 9, 2020 at 9:05 am
  2. 2 Doctoring in 2020: Why is the Patient Here? Whose Visit is it Anyway? – Health Econ Bot Trackback on January 9, 2020 at 9:33 am
  3. 3 Doctoring in 2020: Why is the Patient Here? Whose Visit is it Anyway? – Health Facts & Tips Trackback on January 9, 2020 at 9:34 am
  4. 4 Doctoring in 2020: Why is the Patient Here? Whose Visit is it Anyway? – Health Benefits Trackback on January 9, 2020 at 11:57 am
  5. 5 Doctoring in 2020: Why is the Patient Here? Whose Visit is it Anyway? – BrighterLife Trackback on January 9, 2020 at 12:14 pm
  6. 6 Doctoring in 2020: Why is the Patient Here? Whose Visit is it Anyway? – Health News Trackback on January 9, 2020 at 12:25 pm
  7. 7 Doctoring in 2020: Why is the Patient Here? Whose Visit is it Anyway? – Techno Hub Trackback on January 9, 2020 at 1:27 pm

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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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