Delivering Bad News Is Always Hard, but Why Is It So Much Harder as a DPC Doc?

I recently posted on Facebook about this very topic because it made me think, and made me better understand why I carry so much more.

The unique thing about what we do in direct primary care is that we listen, we learn, we understand, and we are able to immerse ourselves in the stories and lives of our patients.

In our practice, we spend an hour during an intake visit getting to know our patients. We learn about their lives, their hobbies, their goals, their motivations, and everything that makes them who they are. By the end of that hour, we have a pretty good sense of them, and they have a pretty good sense of us.

Every so often, during these intake visits, there’s an urgent issue that we need to address.

In this particular case, the patient mentioned some throat discomfort. So I did my due diligence and started examining their neck.

And all of a sudden, my stomach dropped.

You know those moments when you feel like you’re about to get jittery and lightheaded? That sinking feeling when you know something isn’t right?

As I felt the patient’s neck, I began going through my mental checklist.

Yes, it was firm.

Yes, it was fixed. I couldn’t move it.

Yes, it was large. About 3 cm.

And then I looked inside their mouth.

And I knew.

Here was someone who had just walked into my office excited about finally having access to a healthcare system that would listen to them. Someone who wanted to be proactive about their health, who was living life with full zeal, who was active in the community, involved in philanthropic work, and passionate about their hobbies and everything they were doing.

I had just spent an hour learning about their life, their aspirations, and everything that made them who they were.

And all of a sudden, I knew their life was about to change.

Everything they knew, everything they had planned, was potentially going to look very different.

I struggled to find the right words. Because this person had just shared their whole life story with me, and I was sitting there knowing that the trajectory of that story might be about to dramatically change.

I did my best.

Within an hour, we had arranged urgent imaging, I had already mapped out a plan for specialist evaluations, and I knew exactly when I would follow up with them. I knew what needed to happen the next day we were open.

The patient didn’t yet know the potential severity of the situation. But there was one thing I made very clear.

“I am worried.”

I tell all my patients that I will always be very clear with them when I am worried.

And I was worried.

But what made this particularly hard was that this wasn’t the first time.

A year and a half ago, almost the exact same situation happened during a new patient visit. And shortly after that, it happened again with another patient.

And each time, it stayed with me.

At times, I wonder whether it would be easier for us to cope if we didn’t get to know our patients so well.

Because we carry that emotional baggage home.

And in some ways, direct primary care only makes that harder.

Because we don’t just see a symptom, a diagnosis, or a problem that needs to be addressed. We see their lives. We see their families. We know their hopes, their aspirations, their struggles, and their stories.

We know what they stand to lose.

In a traditional model, where visits are often rushed and time is limited, there isn’t always the opportunity to develop that same depth of connection. Sometimes, there isn’t even enough time to fully process the emotional weight of what just happened before moving on to the next patient.

But in DPC, we have that time.

We have the privilege of knowing our patients as people, not just as patients.

And with that privilege comes a weight that I don’t think we talk about enough.

We often talk about how direct primary care gives us the time to care for our patients. But we don’t talk enough about what happens when caring more means carrying more baggage home.

Remember, National DPC Day is November 1, the day when people start enrolling in insurance plans. Get the word out by sending them here.