It has been so long since I last posted that I felt inclined to use the above title. Then in doing so it dawned on me that this principle can be applied in the lives of my patients, so let me see if I can bring this full circle.
The six-month mark has come and gone since I began my journey as a primary care physician. In this time I have managed to discover that primary care is the second hardest thing I have ever done, and the second most rewarding thing I have ever done. Of course, the single most difficult and most rewarding thing I have ever done would be parenthood. On that scale, if you happen to be a parent, you can appreciate just how highly primary care ranks!
Reflecting on that analogy, I remember when my children were much smaller, and it seemed as though we would never get them to heed certain instructions or guidelines or standards that we were trying to uphold as parents. It was a helpless and sometimes almost hopeless feeling that in certain situations stayed stable for years.
When I first began primary care several months ago, I admittedly felt quite nervous about the prospect of being able to help many of my patients who would come in with very challenging issues that simply do not respond with any semblance of a quick turnaround time… whatsoever. This anxiety stemmed in no small part from my history of caring for patients admitted to the hospital, where problems were severe and rapid in onset, and frequently responded in a timely fashion to the treatments we would administer at the bedside. Uncontrolled atrial fibrillation? A few IV doses of diltiazem would typically do the trick. Acute agitation and no intravenous access? Intramuscular Haldol. Patient isn’t breathing? Intubate and ventilate. And so forth. By the next day — sometimes within the next few minutes — you had a sense of whether things were going to get better or worse, and you took your next step accordingly.
Not so in the office. Here, you have a limited time allotment with the patient within which you must gather all of your information and make a decision. At the end of your 20 minutes, you need to have a reasonable answer. And you don’t get feedback about the success or failure of your decision right away. In this setting it usually takes weeks to months. So as you can imagine, the first few months can be challenging as you start new plans on patient after patient and never seem to find out whether or not things have worked.
Back on the home front, I don’t know how many thousands of times my husband and I felt like we have gently –and then not so gently– reminded our sons to say “please” and “thank you”, how long those months of potty training lasted when we were sure our first child was going to go to college in diapers… In fact, as a late talker, he even had us convinced that meaningful conversation with our children was a lost cause. You can only imagine the relief and pride we felt when in the middle of his kindergarten year he out of the blue started reading books out loud at close to the second grade level. I wish I could say that I’ll never forget how much he impresses me by responding eons better to being led with compassion and confidence than being pushed with criticism and consequences. But I forget regularly. No one can trigger emotions in you like your children can. And emotions are oh so much stronger than the most logical of rationales.
A huge benefit of primary care, I’ve discovered, is that as much as I care about my patients, I don’t love them nearly as much as I love my children, so I am not as hurt by their shortcomings — their inadequacies don’t feel as much like a personal failure. Which gives me enough breathing room to stay in the “confidence and compassion” camp. I guess that’s what, in spite of the busy pace and high demands involved with assuming responsibility for a person’s total health and well-being, makes this only the second hardest thing I’ve ever done.
Now that I have had enough time to see a few patients for routine follow-up of diabetes that had been wildly out of control when we met, or battle through entire problems from presenting symptom to procedural solution, or –most challenging of all– become fully entrenched in the management of unrelenting chronic pain, the outcome in terms of my investment as a professional is above and beyond anything I could have ever expected. Because now I can say to newer patients with a bit more faith from experience what I had somewhat blindly assured people when I just began: “It may get worse before it gets better… But stick with me and I will stick with you until it gets better, because it will.”
The reality is that it often can get worse. But the magic is in sticking with it until there is a victory. In many cases, the victory is internal: the disease does not go away, but physical health can be replaced by inner strength. Nothing is more rewarding than walking the path to that victory with someone. It is an achievement that no one can give you, but also that no one can take away once it is yours.
It’s a slightly different take on making a comeback, I guess. To use a different cliché, I might instead call it flipping the script. All I can say is when a patient leaves the room with a sense of confidence and determination about taking control of their health and well-being after having started the visit dripping with uncertainty, frustration or fear, for me that’s pretty close to the best thing ever.
But I have to confess: when my kids are playing in the house and one of then suddenly screams out in pain or anger, then before I can even look up from the dishes in the sink the other has already run over to wrap his arms around him and whisper words of comfort, that pretty much takes the cake for me. So… the truth is that working with patients is still second tier for me, in the grand scheme of life. But as far as career goes, it’s about as good as it gets.
Sorry for the absence, but I’m back. Still growing and learning. Planning to keep sharing. So stay tuned.