Now and again I peruse different platforms to dip my toe into what is going on in the primary care world. If you don’t know, I have been retired for three years now. I miss some things about the job: my past medical partners, owning my DPC practice, and many patients. Anyway, I just read this article on Doximity called The Three Minute Vacation and it proves again why some doctors burnout, take drugs, or kill themselves. Holy sh#t is it depressing! And the worst part? I don’t think it was meant to be. Since many of you can’t get on Doximity I am going to put it here because it is not long.
I wish I could travel more often than my life currently allows. I want to visit new places and return to destinations that I previously enjoyed. I want to sightsee, hike, birdwatch, people watch, nibble European patisseries. I want to explore mountains, villages, ancient ruins. I want to discover, learn, and relax. I want to spend more of my days in that vacation mindset, where you are wide open to novel experiences. The food tastes better, the historical facts are more intriguing. You notice more. Somehow a sip of tea on a hotel balcony is restorative and expansive in a way that the oolong at home is not.
In my regular life as a primary care physician, I spend most of my waking hours in cramped rooms with no windows and vinyl upholstery. I eat lunch facing a computer screen and a wall, sometimes gazing at a poster of a Mediterranean-ish seascape that I pinned over my work station. I drive home and in the evening, I may spend another hour or two entrapped in the harsh glare of that same computer screen.
In my regular life, most of my conversations are constrained to 15 or 20 minute sessions with each patient, and a brief rehash afterward with my scribe. There is no time to pause or meander. I enter the exam room. If I am behind schedule, I will cut to the chase: What brings you in? When I am on time, I ask, How are you? Anything new? On a good day, when I have a few minutes to spare, or when I just need a break in the crush of my day, I will ask one of my favorite questions: Have you been anywhere interesting lately?
This is a question that my patients typically love to answer. The query elicits calm, smiles, anecdotes, tales of a balmy beach, or a beloved aunt’s pound cake. I might hear about a trip of a lifetime over the past summer, or a visit to a local casino, a family reunion, a church cook-out, a new cafe down the street.
It’s a great question because it lets my patients show themselves at their best. We all want to be seen as more than the sum of our health problems and list of medications. It can be scary and vulnerable to come to the doctor’s office, to expose one’s intimate problems, to be judged on one’s body and its failings. When I ask about their travels, I allow the patient to be the expert. Is the fall a good time of the year to go to Barcelona? Was there a nice boardwalk in Ocean City? I’ve never been on a cruise, what was your favorite part? Each trip is a hero’s journey and by recounting it, the patient feels stronger and in control. Maybe the memory of tackling a busy airport or navigating a foreign city will empower my patient with the confidence that they can finally stop smoking or muster the courage to schedule the colonoscopy.
By listening, I learn about my patient’s dreams and motivations. It’s a great reminder that the real goal of my work is not to achieve lower blood pressure readings or to determine the cause of the microcytosis. The point is to allow each person to make more wonderful memories. To spend time doing the things that sustain them. I like to think of “primary care” as “whole person” care and when do we feel more whole than when we’re traveling?
But the truth of the matter is, the main reason I ask this question is because it makes my day more fun. I love hearing about these adventures and destinations. It’s a great break in my routine, a chance to visit a sliver of the world through someone else’s eyes. Maybe I’ll get the inspiration for a journey of my own. Often it serves as a reminder that even a cafe a few blocks away can provide a great respite. Maybe I’ll stop by after work one of these evenings; why wait for a vacation? Every day can be a chance to be open to that exploring mindset.
The world is so much wider than my exam room, my clinic, the vortex of my EMR.
My patient talks, and I can imagine the breeze ruffling the fronds of the palm trees. My sense of time expands. I breathe and relax. A miniature holiday in three minute’s worth of banter. Then it’s back to the medication list, the specialist reports, the exam, but perhaps with a little more lightness and ease.
Have you been anywhere interesting recently? Share in the comments.
Melissa Schiffman, MD is a community-based primary care physician who practices in Suburban Philadelphia. She enjoys books, birds, gardens, and word nerdery. Her favorite medical term is “borborygmi.” Find her on Twitter at: @MSchiffmanMD. Dr. Schiffman is a 2022–2023 Doximity Op-Med Fellow.
Dr. Schiffman, you need to get the hell out of this job and start your own Direct Primary Care practice. You are a Robodoc who has now become sentient and are living for scraps of your patients’ vacations so you can be happy. What the living f#ck is going on?
Please contact me Dr. Schiffman and I will personally help you start your own DPC practice. And I offer my service for free!! Then you will be able to truly spend time with your family as well as your patients. You can take your vacations and see Europe, and ancient ruins, or just drive across the country. You will make the same amount of money or more. You will have MORE time to know every patient because you have fewer patients and the visits are no longer 20 minutes long. If you want to expand your world then come talk to me and I will give your time back. I promise.