I don’t think many of my patients have noticed it. It’s been insidious to most, falling under my radar until recently: The gentle urging and nudging to see your doctor…for anything; to ask your doctor for the answer…to everything; to seek a medication…for every untoward feeling; to rely on your own wisdom regarding medical concerns…never. This pattern hasn’t served any of us well and deserves much more exploration than this post alone can provide, but let’s start with a superficial look here.
4 family physicians work out of my office. We are a busy and bustling and thriving and popular office. Our schedules are full or over-full most days with a multitude of phone calls and email messages to respond to in betweeen patients and after hours.
As Covid has swept our nation and my office has mostly shut down, I’ve noticed something peculiar.
We now have bare bones staffing in our office: 1 physician, one front desk staff, one nurse (RN), two medical assistants (MA). We’re rotating through, taking a week at a time. The doctor in the office last week saw 11 patients total for the week. This is seeing his own patients AND covering for us three other doctors. For reference, he’d typically see 17-21 patients per day, covering for only himself.
Meanwhile, the rest of the doctors and staff are working from home fielding phone calls and email messages, of which there are minimal. Fewer than there were pre-covid.
Where did all the patients go?
Is everyone healthy all of a sudden?
Are we in some twilight zone in which covid is the only malady on the planet right now? Of course not.
Let me tell you what I think is going on. Well, in part, anyway. Rarely (if ever?) does one story explain a whole phenomenon.
Over the past decade or so we doctors have created patients that rely on us too heavily, and covid has forced a much needed and healthy gap, or perhaps boundary, between us.
I certainly don’t think us doctors are all to blame; we’ve only been molding and shifting our identities (consciously or not) to fit into the larger framework of our current business model, money hungry, lawsuit-threatened healthcare system.
In a fee for service healthcare system, in a system in which we feel lawyers breathing down our neck ready to pounce on any perceived misstep, if you don’t see patients you don’t get paid, and if you don’t cover your ass, you might get sued. So then, what else did we expect to happen but the following scenarios?:
My patient goes to the urgent care for a sore throat. She is diagnosed with strep throat, put on appropriate antibiotic, and told to see me in follow-up 3 days later.
My patient goes to the ER for a small arm laceration. It is appropriately cleaned, sutured and bandaged. He is told to follow-up with me in the office in 2 days.
What is the purpose of such follow-up visits? When did we stop trusting our patients to be able to tell if their throat felt worse or if their thermometer still registered a fever after 3 days of antibiotic? When did we stop trusting our patients to be able to look at their arm and see if there are the telltale signs of infection we gave them written instructions to look for?
My healthy patients call looking for medicine or a million dollar workup after 24 hours of a stuffy nose; 1 hour of ear pressure; 5 hours of a fever with no other symptoms; a small laceration doesn’t stop bleeding in 30 seconds; one small bruise doesn’t go away in 5 days; feeling stressed 2 days after losing their job; feeling sad 1 day after a miscarriage.
Listen, I think a doctor’s office should be a safe place for people to come with any question. We try to foster that environment in our office. But the overall trend I see is us humans losing touch with our own wisdom, forgetting what is a normal part of the human experience, wanting to medicate away parts of the normal human experience and diagnose pathology where none is to be found.
Patients, I am sorry I have contributed to this. I am sorry I have brought you into the office without clear necessity just so I can get a paycheck. I am sorry I ordered more tests than probably needed and referred you to a specialist perhaps sooner than required to cover my butt. I am sorry I have allowed myself to be shaped by the current healthcare system run by insurance companies, politicians, pharmacy benefit managers, lawyers, businessmen and women and no doubt others because I don’t really understand nor know the depths of how the healthcare system evolved to what we see now.
I am sorry I have contributed to separating you from your wisdom. I am sorry I have contributed to making you think you need me more than you do.
I didn’t know. I couldn’t see how I had changed. I couldn’t see how you had changed. But now I am seeing, and as evidenced by post-covid correspondence with my patients, you are seeing as well.
You are thanking me for being here for you but assuring me you won’t “bother me” unless really needed (don’t worry, you can’t bother me, but I appreciate the sentiment), and we come to an agreement on the terms, or symptoms, for which health care is needed.
You message me asking if immunizations are up to date (hallelujah people are caring about immunizations again!).
You call saying you don’t want an antibiotic if it’s not needed, here are my symptoms, please let me know what you think (no one has called “demanding” an antibiotic for viral symptoms in over a month!).
You sent pictures of a small laceration for which you would’ve gone to the urgent care before, but you are now managing very well (and appropriately) at home with neosporin with pain relief and a bandaid.
I am proud of you all.
I fear that comes across condescending, it is not. You’ve been indoctrinated. I’ve been indoctrinated. Indoctrination can be brutal to overcome. Covid is forcing un-indoctrination on us.
I need you, patients; and patients, you need me. But not if we’re going to use each other at the expense of our better judgement, common sense and highest version of humanity.
To beat an over-used phrase: the world is never going to be the same. The healthcare system is never going to be the same, or so I hope. Really, it must change, but for that to happen we must keep seeing what we see now.
We must not forget.