As a doctor, I am always mindful of the relationship with my patients. The continuity of care is important for the patient-centered relationship and far too often it is easy to get caught up in trying to do too many things at once because we are all so busy these days. In my experience, and career, I’ve found that it’s simply not worth sacrificing that one-on-one time with our patients.
When I meet with a new patient about their health concerns, whether they are asking about leg pain and swelling or vein issues in general. I am always patient (pun intended!) with any questions they may have about any aspect of their medical care. Sometimes it is confusing when you consider the different types of medicine, let alone what we do as doctors – especially for those who are paying more attention to symptoms than following a chronology and timeline to find the root cause of an illness.
Ensuring that the patient has the opportunity to ask their questions and be answered in a comforting, calm, and open dialogue is a key factor to overall patient satisfaction and trust.
It is my philosophy to be patient and understanding of the patient’s needs so that we can create a plan together for their future care.
What I was not patient about when I started my training over 30 years ago was the amount of time it took me to see my patients. My office schedule would allow me just enough time to do all the necessary tasks, but left little time to really connect with the patient, their family and answer all of their questions.
I decided early on that I wanted to ensure I spent the time needed with each patient to ensure they felt comfortable, heard and secure in their care.
I share the experience of Mr. Smith, an otherwise healthy gentleman in his mid-70s, who had developed a cough. His family doctor had ordered a chest x-ray which revealed an area of concern in an area of his right upper lung. An initial CT scan was completed which confirmed the presence of a > 2 cm mass within the right upper lobe.
When Mr. Smith was referred to my practice for a thoracic surgical consultation, I had the opportunity to review his chart before our first visit. After reviewing his medical records forwarded by his physician, including the CT scan on my laptop computer, I entered the consult room and I noticed that Mr. Smith was accompanied by his wife and two adult children. Everyone looked worried.
I exchanged the needed pleasantries, thanked them for coming to see us for their care and sat with them to start gathering a full history. I inquired as to his past history, current symptoms and had questions about things that might indicate his ability to tolerate surgery or reveal evidence of more advanced disease. We discussed risk factors that may have contributed to a possible malignancy that included being a heavy smoker. We reviewed whether anyone in his family had a history of lung cancer, which he shared they had not.
I completed my exam with Mr. Smith and then shared the images of his CT scan on my laptop with him and his family, drawing with pictures on a large dry erase board with multicolored markers to educate Mr. Smith and his family about the abnormal findings. Based on his history and x-ray appearances I expressed my concern of the likelihood of a malignancy; cancer. We began to discuss the next steps which included more detailed scans to assess how quickly the area was growing and to search for any other possible sites of spread. Additionally, I asked that he complete some pulmonary function testing to evaluate his respiratory reserve in order to allow for removal of the right upper lobe without limiting his ability to function, and possible cardiac testing to identify any significant cardiovascular risk to surgery.
Many questions were asked and answered regarding the possible details of the operation, length of stay in the hospital, amount of pain to expect, recovery time and so on. After all of Mr. Smith’s and his family’s questions were answered, there was a pause. Then….”and will you be the one who will be doing the surgery?”
I get this question quite a bit, and my response is always “Yes, I will be your surgeon.”
I share that, “I will see again to review your test results and talk more about this problem. I will see you before surgery, perform your operation, be there when you wake up in the recovery room, talk with your family after surgery, call the nurses at night to check on you, see you every day in the hospital, update your primary care physician, call other consultants as needed for you, remove your chest tubes and discharge you home with instructions, pain medication and home health nursing if you need it. I will see you in the office for each and every office visit, personally order and review every chest x-ray and CT scan in your follow up, monitor your progress, watch out for recurrent disease, and hear about your trials and tribulations for the rest of your life.”
This continuity of care is an expectation all of my patients can expect when coming to my practice.