The title of this article is rather straightforward. What is a patient looking for when they book an appointment with a clinician? Naturally, the answer is quite complex.
It’s similar to asking a person what health means to them. I’ve asked myself and my friends this, and it’s not a topic that is easy to think about.
Asking the Right Questions
If my patients come in with polyuria, paresthesia, and elevated home blood sugars, it’s acceptable to focus on the diabetes diagnosis and lower their blood sugar. This is often achieved by chasing the A1C with medications.
But many of my patients are on a silent suicide mission with their lives. It may not be apparent, but it wasn’t the mysterious diabetes diagnosis that needed to be made for them to turn their lives around.
The stress of day-to-day life, poor sleep, bad relationships, chasing a higher paycheck, living in shitty neighborhoods, traffic, and inability to deal with negative thoughts have left this person focusing only on their basic needs.
The right question to ask is, why are you here?
Why me?
What are you hoping to get out of the visit with me?
What kind of life are you hoping to live?
What are you willing to sacrifice?
What is holding you back?
What is your support structure?
Where do you think you might fail?
The Primary Care Mill
Most individuals obtain their health insurance through their employer. They didn’t really select their plan, and they certainly aren’t the ones making the premium payments.
They end up with a Kaiser Permanente plan, are assigned a primary care physician, and they show up for their appointment.
A set of labs are suggested, some routine screening tests are done, and, infrequently, there might be some time left to ask about that knee pain and sleep issue.
The patient is rushed out of the room, and the discussion is cursory at best. The next time you go back for a follow-up, your doctor might be on paternity leave, moved to a different clinic, or quit KP altogether.
The Target Shopper
I have a family member who is quite well off. However, she believes she is poor or should have even more money in the bank. For this and other reasons, she shops at Target.
The quality of the items she buys and the produce is abysmal. But she has chosen to save money on these items because they have little value to her.
Plenty of patients view healthcare in this same manner. Where can they get the quickest care, with the least friction, for the least amount of money? The Starbucks of clinical medicine.
The Primary Care Relationship
For all the press specialty care gets, in the end, most of your healthcare needs will be met by a primary care doctor.
I would go further and say that if your care comes only from specialists, you are getting bad care. If there isn’t a primary care doctor coordinating the care, then you’re a quarterback saddled with a coach’s job.
Building a relationship with a primary care doctor is low on the list for many. Primary care doctors burn out easily; they leave their jobs from one medical group to another, eventually retiring, leaving you searching for another.
“How do we fix this doc?”
In my health coaching practice, I screen my clients before signing them up. A few clients expect to “be fixed.”
They hope I have a magic answer that will turn their health around. Clear them of their diabetes and prevent them from taking 13 medications.
In reality, if we dug down deep enough, the patient is looking for empowerment. They dislike their dependence on the Western medical system but can’t find a way to conquer their health.
If I prescribe this person another medication, order another test, or some other quick fix, I will burn out. And I will also leave the patient just as dissatisfied.
Coach, Quarterback, Mother, Father
In the patient-doctor relationship, I want to be the coach. The patient has to show up ready for practice. I’m willing to help them find their motivation, but I won’t do the pushups for them.
As a second best, I could be the quarterback and juggle the patient’s care by managing their specialists, medications, and testing.
The worst patient-doctor relationship to end up in is where you’re playing a maternal role or paternal role. Feel free to assign your sexist stereotypes to each of these based on your upbringing.
Patients are looking for someone who cares. Even if there is resistance at first, most will recognize a genuine physician.
The Clinical Coach
As a patient, I want my doctor to get to know me and understand my limitations and what is important to me.
Hopefully, this physician can coach me to be my best, even if that’s far below someone else’s abilities.
I want my physician to help me discover what health means to me and what is in my power to change. And hopefully, this coach will know when it’s time to reach for medications, surgery, or testing.
Western medicine got sold out to the highest bidders and financialized into a business entity with all the rules, regulations, and algorithms in towe.
The New Patient-Doctor Relationship
I loved my basketball coach on our varsity basketball team. He wasn’t always nice, but he was always fair. He knew how much to push and how much to back off.
The new patient-doctor relationship has a doctor who diligently curates their primary care knowledge. Everything is intentional and well-researched and not just shat out from the most recent Up To Date article.
The patient in this relationship shows up at their best and expects to be educated about their health. They come asking questions or bringing a loved one who can ask the tough questions.
There is accountability in this relationship, and disagreements are worked out instead of a cancel culture.
Such a relationship doesn’t exist at KP and cannot form with a patient who doesn’t know who or how much insurance premiums cost.