6 ms·

Primary care is so much about forming a lifelong relationship between doctor and patient, finding a way for the patient to inject their own hopes, worries, drea

Primary care is so much about forming a lifelong relationship between doctor and patient, finding a way for the patient to inject their own hopes, worries, dreams feels so important, and beyond the proscribed tick boxes.

rmah 7y ago
I think primary care should be more about the doctor using his knowledge of the patient's lifestyle, gained over time, as context for proper diagnosis and treatment. Empathy without competence is sort of pointless from a medical professional. IMO, of course.
nradov 7y ago
What you're looking for is a therapist. My primary doctor is a nice person but she's a busy professional and I'm not going to waste her time talking about my hopes and dreams. That stuff is almost entirely irrelevant for most medical issues.
- asdfman123 7y ago
  My problem is when doctors are rushed, I can't really communicate with them effectively. Probably 90% of what I feel like telling a doctor is useless to them, but that last 10% could be vital. We have a cult of "busy-ness" in our culture, where if you're busy, you must be important. But "busy" is not the same as effective. Maybe they could more effectively treat patients if they slowed down a beat with them.
  - nradov 7y ago
    If you're wealthy enough you can sign up for a concierge medicine service and get exactly that. But it's simply impossible to deliver that level of service to the general population. There wouldn't be enough primary care doctors to go around (we already have shortages in many areas) and there's no realistic way to fund drastically expanding the number of doctors any time soon.
    - asdfman123 7y ago
      I'm not asking for anything extreme. Just patience and a few more pauses in the conversation.
- sp332 7y ago
  If a doctor doesn't know what outcome the patient is looking for, how are they going to recommend a course of action? 1. What is your understanding of where you are and of your illness? 2. Your fears or worries for the future 3. Your goals and priorities 4. What outcomes are unacceptable to you? What are you willing to sacrifice and not? And later, 5. What would a good day look like? https://www.nextavenue.org/atul-gawandes-5-questions-ask-lifes-end/ https://www.nextavenue.org/atul-gawandes-5-questions-ask-lif... (Just for an example)
  - specialist 7y ago
    There's a story about a marathon runner and a cardiologist. Determines dude has some risk factor. "Can I still run?" "I determine the condition, you determine the benefit."
  - sl1ck731 7y ago
    Unless your goals are physical in nature(I want to be able to check the mail again or otherwise return to a level of mobility, become a body builder...etc) I see very little benefit. "I want to not die, and if I must, preferably at a later date." About sums it up.
MrTonyD 7y ago
If I remember correctly Steinbeck's doctor was a friend from his days at Stanford. So we aren't talking about traditional doctor/patient relationships.
specialist 7y ago
This is the Correct Answer. I have multiple chronic life threatening illnesses. I dread switching care providers. Continuity of care is key to my survival. My primary recently switched to a concierge model, $50/mo and consults are open ended, which has been fantastic for me. The sweet spot for choosing a new primary doctor is late 30s. Recent schooling means more up to date knowledge. And you can age well together. Some exceptions, of course. My proctologist and neurosurgeon are the best in my city. I've had terrible luck with dermatologists.
marssaxman 7y ago
I wonder what kind of life you lead in which it could be meaningful to imagine having a "lifelong relationship" with any given medical practicioner. That just isn't... I mean, my health insurance situation changes often enough that it's a new network almost as often as I ever have to go see a doctor.

rmah 7y ago

I think primary care should be more about the doctor using his knowledge of the patient's lifestyle, gained over time, as context for proper diagnosis and treatment. Empathy without competence is sort of pointless from a medical professional. IMO, of course.

nradov 7y ago

What you're looking for is a therapist. My primary doctor is a nice person but she's a busy professional and I'm not going to waste her time talking about my hopes and dreams. That stuff is almost entirely irrelevant for most medical issues.

asdfman123 7y ago
My problem is when doctors are rushed, I can't really communicate with them effectively. Probably 90% of what I feel like telling a doctor is useless to them, but that last 10% could be vital. We have a cult of "busy-ness" in our culture, where if you're busy, you must be important. But "busy" is not the same as effective. Maybe they could more effectively treat patients if they slowed down a beat with them.
- nradov 7y ago
  If you're wealthy enough you can sign up for a concierge medicine service and get exactly that. But it's simply impossible to deliver that level of service to the general population. There wouldn't be enough primary care doctors to go around (we already have shortages in many areas) and there's no realistic way to fund drastically expanding the number of doctors any time soon.
  - asdfman123 7y ago
    I'm not asking for anything extreme. Just patience and a few more pauses in the conversation.
sp332 7y ago
If a doctor doesn't know what outcome the patient is looking for, how are they going to recommend a course of action? 1. What is your understanding of where you are and of your illness? 2. Your fears or worries for the future 3. Your goals and priorities 4. What outcomes are unacceptable to you? What are you willing to sacrifice and not? And later, 5. What would a good day look like? https://www.nextavenue.org/atul-gawandes-5-questions-ask-lifes-end/ https://www.nextavenue.org/atul-gawandes-5-questions-ask-lif... (Just for an example)
- specialist 7y ago
  There's a story about a marathon runner and a cardiologist. Determines dude has some risk factor. "Can I still run?" "I determine the condition, you determine the benefit."
- sl1ck731 7y ago
  Unless your goals are physical in nature(I want to be able to check the mail again or otherwise return to a level of mobility, become a body builder...etc) I see very little benefit. "I want to not die, and if I must, preferably at a later date." About sums it up.

MrTonyD 7y ago

If I remember correctly Steinbeck's doctor was a friend from his days at Stanford. So we aren't talking about traditional doctor/patient relationships.

specialist 7y ago

This is the Correct Answer. I have multiple chronic life threatening illnesses. I dread switching care providers. Continuity of care is key to my survival. My primary recently switched to a concierge model, $50/mo and consults are open ended, which has been fantastic for me. The sweet spot for choosing a new primary doctor is late 30s. Recent schooling means more up to date knowledge. And you can age well together. Some exceptions, of course. My proctologist and neurosurgeon are the best in my city. I've had terrible luck with dermatologists.

marssaxman 7y ago

I wonder what kind of life you lead in which it could be meaningful to imagine having a "lifelong relationship" with any given medical practicioner. That just isn't... I mean, my health insurance situation changes often enough that it's a new network almost as often as I ever have to go see a doctor.