Wednesday, April 11, 2012

Family Medicine Activist: The Patient's Story

I look on the front of the patient's medical record to look at their "sign-in" form where they write the "reason for this visit".  Often, it says "to review labs" or "doctor told me to come back" and I feel disappointed that we're not connecting.  I know they can get a better experience if they enter a health goal or personal life goal such as: to have a strong enough back to pick up my grandson or to breathe well enough to visit my daughter in New Mexico this summer or to have enough stamina to finish the motorcycle repair on my Harley before my spring vacation.

The Family Physician enjoys their personal goals and the opportunity to share the challenges with the patient and their family.  We want to hear their story.  It's usually the most important thing happening in the examination room.  The physical exam supports or refutes the doctor's and patient's diagnostic hypotheses that evolve during the patient's story.  Imaging and laboratory tests, if warranted,  further clarify the probabilities associated with both patient and doctor hypotheses.  Sharing the hypotheses and the probabilities between patient and physician as they change enriches the potential for an accurate diagnosis and treatment plan- a treatment plan that will align the patient with their dream.

The patient's story is the key to goal alignment for both patient and family doctor.  It's also the key to enhancing the patient- physician relationship which grows over time, promoting better outcomes for all involved.

Keep telling your stories, Folks, we love them.


  1. If you want an answer to "What are the goals of your visit," perhaps you could try actually asking *that* question, instead of "reason" for visit.

    Just a thought. ;)

  2. your office discourages this by admonishing patients for bringing
    up anything that is not part of why the appointment was made -it is posted on the wall - you also charge extra for "outside" questions

    so don't be surprised when you get just part of the story

  3. Thanks for your suggestion, MTLA. I'll probably add a goal section to the sign in form. We have limited time each visit, but get to know people over time since we have a relationship based specialty-not a parts focused specialty. Because of the vast potential for patient problems and goals and the real world business aspect of Family Medicine- there is a fine line between being everything to everyone and focusing the clinical encounter to achieve reasonable outcomes. Multiple visits is one solution for the quality vs quantity challenge, but some patients who are good consumers press for more problems to be dealt with and may accidentally dilute the quality potential for their original concern. I've written about this in various posts for two years. Each patient situation is unique and each physician situation is unique and each of our business or financial situations is unique.

    Anonymous, thanks for your complaint. We hope that people will be focused on the goal they had in mind when they scheduled the appointment and expect to hear the story related to that issue. Most add two problems per visit beyond what they scheduled for. (Please read the sign again when you come in the next time and you'll notice that it is an explanation for why we have people waiting longer, due to the extra problems brought up by the patients ahead of you. It's seen by some of our staff as a confession that our physicians can't control patient flow because they are dealing with the extra problems-not telling patients to curtail their "extras"). Is it fair for us to take extra time to relate to those problems? Should someone expect that we will not charge for extra services?

  4. It is great to read a doctor write about needing to understand the patient first through their personal narrative and then trying to use the clinical signs to piece together a medical plan. From what I read and hear, you are a rarity rather than the norm.

  5. I am a very private person, and before reading your blog never would have dreamed of sharing any stories with my doctor. I'd be brief and to the point, and leave as soon as possible. My doctor probably wonders why, after a decade of monosyllabic answers, I suddenly started providing extra information :)

  6. Thanks for your comment, WarmSocks. I hope your doctor finds your stories helpful and heartening. Your blog is certainly helpful to lots of people. Your sharing validates the experience of many of your readers and enlightens at least one physician (me) while providing practical tips for patients. Blog On.