Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Article Comments

The “Big Picture” Benefit Of Primary Care

Her eyes were bloodshot. She responded to my casual greeting of “How are you?” with a sigh. “How am I? I’m alive, I can tell you that much for sure.” She went on to describe a situation with her adult son who’s in a bad marriage and has struggled with addiction. She sighed again: “I feel weak. I don’t know if I can deal with this one. I’ve had so many hard things in my life already. When will it stop?”

“Many hard things” — yes, I agree with that assessment. She’s been my patient for more than a decade, and I’ve had a front row seat to her life. Her husband died a few years ago (while in his 40′s) of a longstanding chronic disease. Her daughter also has this disease, and has been slowly declining over time. I’ve watched her bear that burden, and have actually shared some in that load, being the doctor for the whole family.

I’ve also taken care of her parents, who had their own psychological problems. They were difficult patients for me to manage, and they had died long enough ago that I had forgotten that difficult chapter of her life. I’ve helped her with her emotional struggle from all of this. It was hard, but she hung on as best as she could. I know. I was there when it was happening.

To me, this is the biggest benefit of primary care. Yes, it’s nice to have a doctor who knows what’s going on with all of your other doctors. It’s good to have a doctor you are comfortable talking with about anything. It’s good to have someone without a financial stake in doing surgery, performing procedures, or ordering tests. But the unique benefit a long-term relationship with a primary care physician (PCP) is the amazing big picture view they have.

I had a man come into my office with his daughter, who was struggling with emotional problems. We discussed the situation for a while, and the subject of extended family came up. When he reminded me who the girl’s grandparents were, I laughed out loud. They saw my moment of insight as to how the grandparents might be influencing this problem, and they both started laughing with me. Nobody had to explain anything. Nobody even said anything about the grandparents. He just reminded me who they were, and I already knew more than enough.

I have now been practicing for more than 15 years, and have a longstanding relationship with a lot of people. When they come in to see me, it isn’t just for my expertise, knowledge, or to listen to my jokes; they come for my perspective. They come because they know that I know them like no one else. I have spent years gathering information from this visit. I saw them when they were depressed. I took care of their dying child. I broke the news of their spouse’s cancer. My care for them is not just an office visit — it is a legacy.

When she stopped explaining her present situation to me, she let out another sigh, deeper than the rest. ”Can you help me?” she asked.

“Sure, I can help you,” I responded. ”But let me reassure you that you are not weak. I’ve seen you weather the storms in your life and have been impressed by your strength. Sometimes when you are being crushed by a weight, it isn’t that you are weak, it’s that the weight is too heavy. I’ve seen you carry heavier weights than most people could carry. I’ll do what I can to help you, but don’t get discouraged with yourself. You aren’t weak.”

She paused in thought, thinking about all I have seen of her life and my qualification to make this pronouncement. She sighed, then nodded. She knew that I knew.

[As always, I have changed details about both of these situations to protect the identity of these patients.]

*This blog post was originally published at Musings of a Distractible Mind*


You may also like these posts

Read comments »


Comments are closed.

Return to article »

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »