* * Anonymous Doc

Wednesday, September 22, 2010

Working at clinic is starting to get interesting.

The goal, as we progress through residency, is that we'll end up with a bunch of patients we follow for the three years, as their primary doctor. The appointments don't always work out-- if they have urgent needs, it's likely I won't be the one who sees them, because I only do an afternoon or two per week in each clinic I'm assigned to. But for ongoing checkups and maintenance appointments, they try to schedule the patients to see me if they can. So now there are about a dozen people I've seen two or three times, and they think of me as their real doctor.

And I'm starting to realize why being someone's doctor can be completely frustrating.

"You said last time you wanted to quit smoking, we put together a plan, and-- you haven't even taken the first step."

"Have you been watching what you eat? Because we came up with some ways to modify your diet, and it doesn't seem like you've taken any action--"

"Did you ever even fill the prescription I gave you last month?"

"You've canceled four appointments in a row. Why has it been so difficult for you to come see me?"

and so on.

I understand the practical difficulties-- people have to miss work to come see the doctor, transportation can be an issue, etc-- but it's hard to feel like you're making a difference if nothing gets acted upon, nothing gets followed up. You spend an hour counseling a patient on how to reduce her cholesterol, she writes down a plan... and then comes back two months later and acts as if the conversation never happened. We're not hall monitors. There's a limit to what we can make someone do.

There's a patient who I usually use the translator phone with, but the Wolof translator (have you ever heard of this language? I hadn't.) seemed to be out to lunch, because the phone just kept ringing and ringing. So we tried to muddle through in English. All I know is that there's something wrong with something in the general area of his stomach. Maybe.


  1. I don't think it's really your job to motivate the person, so don't get too down on yourself. That's what personal trainers and nutritionists are for. Sure they're expensive, and the patients you're seeing probably can't afford them, but you can't be there with them every day to motivate them, which is what it takes to make a serious change.

    This is what I expect from my primary care doctor:

    Tell me what's wrong (although I realize sometimes this isn't possible)

    Write a prescription if absolutely necessary

    Refer me to services that could help me reach my goals

    If he does those things and I didn't change, hey, he shouldn't stress over it. He did everything he could.

  2. I like clinic duty too. Patients are not so sick, and if they are, sometimes you get to see them getting better. It's true most of them don't do what you tell them to do, for various reasons, but it's basically inevitable. Everything you can do is keep insisting on it.
    In my med school they tell us it is in fact part of our work to motivate patients a bit, though, and I agree with them; I believe that being positive and making a stress in their accomplishments works better than telling them they suck at it. But I haven't done a lot of clinic duty, so I suppose you eventually must get tired of it. Just don't beat yourself up for it. Try to enjoy the good things it has.

  3. I like your approach to phrasing the questions -- starting with the facts, but raising the real issue.

    I'm afraid eventually doctors must start realizing people aren't going to listen to their advice and they start taking it less seriously themselves. I had a doctor tell me I should never lift more than thirty pounds again four years ago, which is a pretty big restriction, but he didn't bother arguing with me when I asked, "Is that true even if plain sitting seems to aggravate it and lifting doesn't?" He probably figured I'd do what I want and no point explaining.

  4. Lots of people who speak Wolof also speak French. fwiw

  5. some day along is going to come that one patient whom what you say will make a whole lot of difference, and what you feel inside will make up for every patient that never listened or seemed to hear what you said. My former doctor, gave me a new lease on life, because in reverse the doctor I had before her, did not hear anything I was saying and was ignoring some pretty serious concerns, perhaps, just because no one listened to him(I dont Know), but for having been given this new lease on life, for her having discovered what was wrong all those years..(undiagnoised mixed type sleep apnea)that landed me in icu near dead) I started rebuilding my life, it took me 4 years, to put myself back togethor, bit by bit making the changes I needed for a healthy lifestyle and I did it so that I could show her, how much I appreciated, that she listened to me and how sick I was. walk side by side with your patients, and never above them,and you will be surprised at the results you will get..there is always that one, whom you will make a difference, and that one, will make you shine inside your heart..my old doctor has moved on, but we became friends after she moved and she always remembers me and the things she learned from me and things of me as her major success story, which I am, because she never gave up..have a nice day