It has been longer than I would like since posting here, but at least let me offer that the time away has been well spent climbing the learning curve. Meanwhile, it almost shocked me to learn that patients are really reading my blog! This is encouraging, because there are so many simple but easily forgotten principles that, when applied, can make a remarkable difference in the journey between “existing” and “thriving”. I have already grown so much in my first few months as a PCP that I certainly couldn’t tell it all in just one entry. I’ll begin with a summary, and plan to dive deeper in weeks to come.
Lesson #1: I stand corrected. As described in an earlier post, I expected the majority of my patients to look significantly different from me. I expected to face a lot of chronic, unrelenting illness like I saw in hospitalized patients. There is some of that of course, but to my surprise, I have seen a host of adults – aged 19 to the 90s – who would easily describe themselves as generally healthy: a little blood pressure, a little cholesterol, a problem shoulder or knee, etc. These people have a fairly clear sense of what makes life meaningful, and are really just coming to me to address any ailments that may get in the way. There is, however, a common thread between many, which I will explain in Lesson #3…
Lesson #2: The pace of Primary Care is extremely different from Hospital Medicine in that many of the problems faced in the office can take weeks to months, sometimes even years to fix, whereas in the hospital the acuity and severity of illness you may face must be turned around in the course of hours or days lest life-changing – potentially even life-ending – consequences ensue. “In the office” – which is really a medical colloquialism for “in day to day life” – the consequences can actually be similar, but the changes occur quite gradually, almost imperceptibly. That phenomenon occurs in both directions in fact: illness develops slowly, and the healing process may also be slow. This requires patience and perseverance, on the part of both patients and providers. But beyond that, it involves having a plan. In a future entry, I’ll talk about some practical plans that can be meaningfully implemented to pursue healing and thrive.
Lesson #3: Illness that comes into a clinic occurs on a scale that is so much lower in severity than it does in the hospital that even experienced clinicians may be inclined to ignore it, or at least assign it a misnomer. By far and away, the most prevalent illness I have encountered in the office is – even during flu season, NOT upper respiratory infections – but anxiety. Anxiety can be a simple feeling, or it can be a complex diagnosis. It manifests on a scale broad enough to include everything from worrying about overly chapped lips to crippling disability through the exacerbation of severe chronic pain. I do not pretend to have the solution to this highly virulent condition, but I have discovered that Step One to addressing it is validation. More to come on this point, too.
I plan to be back soon, and hopefully you will, too. [=-)