Family Medicine: Caring and Working are Clashing

Family Physician (FP) perspective:  Patients call for appointments with Family Physicians for lots of reasons.  They may be acutely ill, chronically ill or chronically well.  The lines between the categories are often blurred.  They blur more when the patient arrives for the scheduled appointment.  The patient has many needs and wants, many of which are "extras" in the eyes of the physician but "mandatories" in the life of the patient and the system in which they live and work.

The FP wants to make a difference in someone's life each day, to help patients to know that they matter.  The doctor wants to feel satisfied that they are still aligned with the desire to help people, not detoured by the avalanche of ever-increasing administrative and regulatory demands on their time (and soul).

The physician is hopeful that the daily schedule will flow nicely, allowing the work to be done.  Helping versus working.  It's becoming an "either/or" for the physician instead of a "both/and", losing instead of winning.  The FP knows that the patient has many expectations, some of which align nicely with the physician's expected work flow, some of which don't.

 How many times a day will the physician feel heavy hearted at not responding to the extra needs expressed by the patient during a scheduled appointment?  How many times a day will the physician respond to a need of the patient beyond that expressed when the appointment was made?  How much guilt and disappointment will the physician build up by the end of the scheduled work day as they get "behinder and behinder" (sometimes getting an extra jolt when the last patient asks for a bit of time to call the spouse about picking up a child at sports practice or day care, etc.) ?

The physician and office staff care about the patient, which sometimes aligns with the work flow and sometimes doesn't.  Caring isn't as "schedulable" as working.  Working and caring sometimes fit like a hand in a glove, and sometimes they clash viciously.  Financial issues, which I've mentioned in numerous previous posts, drive the squeeze.  Big hearts may forget schedules and go the extra mile for the patient.  The push of this era in healthcare (one word = the financial part as opposed to two words- health care which = the human/people part) is often stressful and sub-sensitive.

How might the Family Physician get back on track with actual patient needs as health care transformation happens?  I've posted numerous times about the Human Centered Health Home (HCHH).  The Patient Centered Medical Home (PCMH) is the current national strategy, which has lots of merits.  I'll post more about it later.

What do you think?