A Rare Chance to Really Connect

A Rare Chance to Really Connect

— An unexpected hole in my schedule gave me the chance to do something invaluable

by
Fred Pelzman, MD, Contributing Writer, MedPage Today

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    Fred Pelzman is an associate professor of medicine at Weill Cornell, and has been a practicing internist for nearly 30 years. He is medical director of Weill Cornell Internal Medicine Associates.

Every once in a while, we have the time.

Just a few weeks ago, in what had originally looked like an incredibly busy afternoon practice schedule, I suddenly had two back-to-back appointments canceled at the last minute.

As it turned out, on that particular day there were no patients on a waitlist looking for an urgent appointment, or asking to be squeezed in for their annual physicals, and throughout that morning there were no phone calls or portal messages from patients that looked like they needed to be seen that day for an in-person evaluation or a video visit, that ordinarily I would’ve snuck into those small windows of opportunity.

So, I went into my afternoon schedule thinking that that little chunk of time in there would give me a little breather, a chance to hydrate and use the bathroom, to catch up on the messages that would surely come in while I was in with patients, or even, can you believe it, keep up with my notes from the day.

Instead, I got to spend the time.

A patient I’ve taken care of for the past few years with a great many medical conditions, who is followed closely by a large cohort of specialists who do the bulk of the management for these complex issues, came in to see me for their annual wellness visit.

At the start of the visit, I just assumed we were going to run through the items that had been raised on the electronic annual health review that had been completed in advance of their appointment, but things quickly took a turn in a different direction.

Yeah, yeah, they said, we can go through all that, but mostly I just wanted to talk.

They had their hearing aids, they had the eyesight of a hawk, and they were proud of the fact that they were continent of urine and stool, and slept through the night.

We then spent nearly an hour sitting and talking, learning how they felt about the state of their health, their outlook on life, what they missed the most about the life they’d had before growing old, and how the challenges of being at such an advanced age was changing how they dealt with nearly every part of their life.

Their spouse had died many years ago, their family had moved to cities far away and they were estranged from many of them, and most of their peers and lifelong friends had passed away.

Their world had shrunk, and learning to live with this, while a challenge, was clearly something that they were handling quite well.

It turned out that this was a chance for us to really connect, to see the side of the patient that we often don’t get to see, when we’re rushed with our agenda, with their agenda, with the need to screen for so many things, to get all of their forms and questionnaires filled out, to do their physical, to draw their labs, to update their vaccines.

Not that I don’t really love doing all of that stuff, my bread and butter, but when we have to attend to all of that in our 20-minute visit, this particular encounter made me realize how many opportunities we must be missing.

Sure, no one really wants to pay me to sit around and talk to people, to chew the fat, to really get to know them.

The system is designed for billing for services provided, for generating RVUs, the “you-eat-what-you-kill” model of healthcare.

But having the time to really get to know our patients, whether that’s over decades of taking care of them, or a single session where we get to sit and talk without interruption or pressure, can really make a difference, can make us better doctors, can make them better patients.

Perhaps as we move things forward, as we change the healthcare system, as we review what we do now and reorient away from fee-for-service and start looking at quality and the importance of relationships, we can build a system that rewards this connection, this time, this nurturing.

A system that helps us get all of the rest of the getting done, done, while freeing us up to do the doctoring, to listen to our patients, to take the time.

The time has come.

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