In the Clinic Building Relationships

Remember the scene in You've Got Mail when Joe Fox (Tom Hanks), having put Kathleen Kelly (Meg Ryan) out of business, visits her after learning that she is sick, and the conversation turns to relationships? The conversation went like this:

Joe Fox:  It wasn't...personal.
Kathleen Kelly: What is that supposed to mean? I am so sick of that. All that means is that it wasn't personal to you. But is was personal to me. It's "personal" to a lot of people. And what's so wrong with being personal, anyway?
Joe Fox: Uh, nothing.
Kathleen Kelly: Whatever else anything is, it ought to begin by being personal.

This is at the heart of all things....being personal. In the clinic we see this every day. Going to the doctor is of all things personal, right? Patients new to the practices may, in a matter of a half hour's acquaintance, be asked to get undressed or otherwise expose parts of their body to near strangers....zooming from, "Nice to meet you," to "Let's take a look at that sore on your___________. Would you please take off your shirt and pants?" Pretty darn personal.

In today's healthcare culture, the trend seems to be heavily focused on the "science" of medicine. We are blessed to be living in an age where technology advances enable practitioners to identify with greater clarity not only a patient's medical problem or condition, but also hone in on the severity of the condition. A cough can be a cough, or it can be the symptom of something more serious, which might be identified by imaging studies. The ability to use this technology gives medical doctors information that helps them better treat their patients' medical problems. It seems that the advances in both technology and drug therapy should improve the quality of medicine. Or not.

Certainly the ability to diagnose and treat conditions has improved and lives are saved, for which we should be grateful. The price paid for these advances can have an unseen but perhaps a negative effect. We see this every day in the clinic: Imaging reports from X-rays, CT, MRI tests, lab results and consult reports flood the office fax machine, mail, and email. Our providers spend much time each day reviewing data and planning the next steps in treating the patients who come through our doors. Ours is a small office; I can only imagine what the larger clinics must see, and wonder how the providers deal with the tsunami of paperwork in a practice panel of 2000 or more patients. Time consuming tasks that either bring the provider into the office hours ahead of clinic time to complete, or keep them hours beyond the time the clinic closes can negatively impact both quality and work satisfaction.

All the paperwork and reports needing to be completed for specialist referrals, insurance companies and the government pull doctors, therapists, counselors away from the "art" of medicine; the intangible something that should really be at the heart of working in a medical setting. Asking a physician or nurse why they chose the profession, the most common answer is not because they enjoy reading medical test results, completing forms to justify medical treatment for a patient, or even the money. The most common reason, almost to a person, is that they want to serve others by using their knowledge and skill to improve their patients' health and wellbeing, to treat them when they are not feeling well and to be there ready to help when needed.

So for what it is worth, patients don't know or remember that our doctors spend a great deal of time behind the scenes shuffling papers and jumping through hoops to get services or prescriptions needed in patient treatment. This is science and now bureauracy of medicine. Patients do know and remember, though, how they felt after seeing the doctor; the time spent in conversation with them; the caring touch received on physical examination or even in a handshake or hug; the tone of their voice; a smile. This is the art of medicine. It is building the relationship and feeling valued. It begins, grows and thrives by first being personal.