One time I was in the clinic when a resident came up to the professor and said she had a question for him. He replied,
“Are you asking as a student or as a mom?”
The student’s child was also a patient we came to find out. With that reply alone he taught us the distinction between objectivity and subjectivity.
I remember our very first newborn visit with him. He walked in the room, acknowledged our baby, sat down and started reading the chart. Casually, he said, “so, how are you doing?” to my wife. My wife responded by giving him what I imagine a morning report would sound like when physicians turn in their call. “Brianna is feeding well – every 2 hours – no signs of jaundice, no fever, her bowel movements are…” Her preceptor, and now our pediatrician, interrupted her and said “No. I said:
how are you doing?”
My wife nervously replied she was doing fine, sleepy, but fine. He then turned to me and said “Dad, how are you holding up?” “Are you being treated OK?” I was like… uh… treated? “yeah, I’m fine.”
“Good then,” he said. “Let’s see how little Brianna is doing” and he turned around and began his examination and started asking all the pertinent questions.
In retrospect, the lesson was obvious and in fact one that all pediatricians know all too well. Which is:
the well-being of the parents is very important to the well-being of the patient.
Many, if not all pediatricians embrace this notion with their patients. I find it interesting, however, that some peds fail miserably when they apply this to their practices.
I was trying to make this point to a solo practice pediatrician I was talking to the other day. She was sharing with me some of things she did in her practice. As she was telling me these things, I thought to myself, she is providing for her patients at the expense of her practice.
After hearing what she had to say, I told her, I think you are putting the well-being of your patients above the well-being of your practice. Although I’d agree it is altruistic, it can’t be a long term strategy unless you have other means to support your selfless efforts, I said.
I gave this example to the doc. Let’s say
a kid comes in to the office with terrible asthma for the 5th time this year.
You’ve done everything you can to help the child, but you can’t make progress in managing this patient’s asthma episodes. As it turns out, both parents are heavy smokers and smoke inside the house.
I asked the doc, would you continue providing care to this patient without at the very least try to address the smoking issue with the parents? Not to say you can make the parents stop smoking, but at the very least, you would try address the issue. Would you not? You know I’m not a doc, I said, but common sense tells me that unless the smoking issue is resolved (or at the very least addressed), the likelihood of the child having recurring asthma episodes is very high.
Now, extrapolate that scenario and place it in the practice. The well-being of the “medical practice” is very important to the well-being of the patient. If the “medical practice is not doing well, the patient will not do well. Thus, it is important to address any needs the “medical practice” has before one starts to take care of the needs of the child.
I’ve played this tune before on this blog. Guess what? I’m going to play it again. I know pediatricians didn’t go to school to learn to run a business. I know they are very busy and don’t have time for non-clinical practice related issues. But by not knowing to run a business (by not managing it properly), one is in essence indirectly neglecting patients.
Embrace the business
(or at least find someone to manage it for you).