This full-scope family physician worries that compartmentalizing medicine hinders doctors from fully understanding their patients.
Lately I have been getting ads for physician jobs offering me amazing salaries plus bonuses; all with a four-day work week and no call. Some days when I am looking at my double-booked office schedule or reviewing how many patients I am going to see on the inpatient service, these ads tempt me. Who wouldn't want to work less?
As a full-scope family physician, however, I am not a 9-to-5 doctor. Deliveries happen at all hours of the day and night. The relationships I have built with my patients compel me to be at their sides for the birth of their children. Office paperwork and office notes are often completed after hours. Patients get sick on weekends or need hospital admission in the wee hours of the morning. Supervising residents often means being available almost all the time. What I wouldn't give for a just a few more hours in the day!
I understand the pull my graduating residents feel to work in narrower-scope practices to find a better balance of life and work. At the same time, I cannot imagine caring for patients in just my office. When in the hospital, I am able to gain a better understanding of their social support through the visitors that I meet. Home visits allow a broader knowledge of the environments that they live in and how they affect their health. One of my elderly patients struggled with coming to the office. She had no close family and had recently stopped driving. My visit to her home opened my eyes to the services she desperately needed that she had been unable to articulate at any visit. Although visiting nursing services can sometimes be the eyes at home for me, I find that seeing it for myself is sometimes more valuable.
As medicine becomes more compartmentalized with specialists, subspecialists, hospitalists, and urgent care centers, I worry about the continuity of patient care. Changes are made in treatment plans or diagnostic tests are ordered without any documentation of the results sent to me. My patients often have little understanding of what pills they are taking or what a particular doctor told them in the hospital. More often they complain about how many people came in and out of their rooms with minimal introduction or explanation. When my patients are admitted to an outside hospital I am not usually contacted and if I find out at all it may be months later. Some hospitalists are excellent in providing detailed discharge summaries, but hospitals may not be quite as diligent in ensuring I receive it.
My plea to all providers, and a reminder to myself, is to communicate with the other providers who care for your patients. I appreciate every office note that is forwarded to me and every phone call made to update me on my patients. I know we are all busy with boxes to check and quality measures to meet, but I can help take better care of my patients, our patients, when I know that a medication has been discontinued or a new lab finding needs follow up. With more and more providers involved in a patient's care and the practice of medicine becoming more complex, we need to reach out to our colleagues and ensure the plan of care is passed forward and understood. We should not be a barrier in patient compliance. If we don't know what the plan is, how can we fully expect our patients to know?