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Being a primary-care doctor often means “minding the gap” for patients and serving as therapeutic reassurance for patients unsure of specialists’ plan of care.
Some days I don’t feel like a physician. In primary care, I often play the role of social worker, therapist, insurance broker, and pharmacist. Recently, one of my patients came into see me at the end of her rope after a long battle with a perplexing and troublesome set of symptoms. I almost called her to tell her not to come in, because I had nothing else to offer -she was already being evaluated by a few specialists. I didn’t want to waste her time and money if there was nothing else I could do. I’m glad I didn’t discourage her from coming in.
The cause of her symptoms remains a mystery to me and the specialists with whom she has consulted. However, I was able to address a number of different issues including her inability to afford one of the prescribed medications, side effects from a different medication, and an important medication she is supposed to be on that was never prescribed. I also mediated the he said-she said between different specialists to determine the next part of her care plan. Most importantly, I have the honor of having this patient’s trust and respect, so I am able to offer therapeutic presence.
After I clarified exactly what she needed to do next, worked out the medication issues, and communicated this all back to her, I felt tremendous satisfaction in what I was able to do for my patient, even though I had not alleviated any of her physical suffering. While I often bemoan the many hats I am forced to wear, patients like her remind me of the increasing need for some part of the healthcare system to “mind the gap” between all the specialists, tests, and medications.
I’ve been surprised to have patients come back for an appointment with me solely to discuss whether they should do what the specialist recommended. It was perplexing why a patient who I saw, evaluated, and determined needed additional expertise did not trust the specialist that I referred enough to agree to the proposed plan of care without my blessing. My response to them is almost always to serve two purposes: reassurance and discovery. I reassure the patient that they were appropriately evaluated and that I trust the specialist’s judgment and support the plan of care (if that is the case). I also try to discover why the patient is concerned. Sometimes my patients simply want to know that the doctor who knows them best, whose first job is to look at them holistically, and feels that the plan of care is right for them specifically.
I am once again struck by the amazing privilege and responsibility I have as a primary care physician to cure sometimes and care always.