Meeting Patients Where They Are
It’s not uncommon for new patients to immediately blurt out “I hate doctors!” upon meeting me for the first time. If a patient in my insurance-based practice would have started a visit like this, I likely would have shot back “Then why are you here?” In my DPC practice, however; I hear “I’ve been mistreated by doctors in the system. I’m hoping that you’re different, but I’m skeptical. Can you reassure me?”
I let these patients know that doctors are victims of the system, as are patients, and that I left the system for my own sake, as well as for my patients. I explain that I view myself as a teacher, a guide, an expert they can come to for medical advice. I promise them that they are ultimately in charge of their own bodies, their health, and their medical decisions. I may at times make very strong recommendations depending upon the level of risk, and I will not prescribe any medications, order any treatments, or perform any procedures if the risk of harm outweighs the potential benefits. However, most of the time, our management plan will be a conversation that we undertake together. After all, no treatment will work without buy-in from the patient. If the treatment plan is too difficult, too inconvenient, too expensive, or causes unpleasant side effects, it won’t be sustainable, and it ultimately won’t be successful. DPC allows plenty of time for these conversations both during and in between appointments.
Lifestyle changes can work wonders for most medical conditions, but they take time, effort and motivation. I know that I continue to struggle to stick with healthy habits. Most of us do. Our chances of success improve when we focus on making one small positive change at a time. Sometimes these changes just aren’t possible for those who are dealing with severe physical and/or emotional symptoms or if there are life circumstances which are overwhelming. DPC allows time for motivational interviewing and identification of barriers for change. It also allows for creative solutions. In the past year, I saw a young adult patient who was struggling with depression and had stopped his daily practice of distance running; he was also consuming a lot of alcohol and processed foods and had gained 30 lbs. He had been trying to get back into shape and restart his previous diet and exercise routine, but he felt overwhelmed and ashamed. He had done a handful of runs, but he would beat himself up if he missed a run or if he cut his run short. In addition to readjusting his medication, we decided that he was only allowed to make one tiny change for the next month. He would run for exactly five minutes per day, no more, no less, and after the month was up, he would continue daily runs for as long as he wanted. He was really excited about this plan because he was sure he would be able to accomplish it. After six months, he was back on track with his daily distance running with significant improvements to his diet and a 20 lb weight loss.
DPC has allowed me to slow down and meet patients where they are. Often my initial reaction is to reject the idea of a supplement or treatment that haven’t heard of. Instead of immediately recommending against it, I let patients know that I am not familiar with it and will do some research and get back to them. Sometimes I am surprised to learn that there is some evidence of benefit for certain conditions. Other times I learn that there isn’t good evidence or that the potential treatment could be harmful. At this point, the patient and I can discuss the risks and benefits of the suggested treatment as well as alternative treatments which may have stronger evidence. Patients will usually opt for the most evidence-based treatment option as long as it’s affordable and convenient without significant side effects. They simply want to be heard and understood and for their perspective to be considered and respected. I am a much better physician in my DPC practice than I was in the system because I have more time to educate myself and my patients and more space for empathy. As a DPC doctor I have rediscovered my love of medicine, and hopefully DPC patients will rediscover their love of doctors.
This is a great article Dr O’Rourke! Thanks for your humility and vulnerability!