Saturday, August 9, 2014

Family Medicine: The Generalist

"By the way, Doctor, what is this spot on my cheek?"    "Oh, there's only one more thing, Doctor."  "While, I'm here, I want to tell you about the pain in my right foot."  "Oh, I almost forgot, I have this lump on my back (left wrist, or right leg, or left eyelid, etc.)"

""Oh, I passed out last month."  "I'm having the palpitations again.  Do you remember that we discussed them before (actually, five years ago)"

Many patients (about 60% by my conservative estimate) add these comments after the family physician has completed the engagement with the patient for the problem for which the visit was scheduled.  They realize that we do lots more than deal with simple problems.  We diagnose and treat thousands of diseases and conditions.  We enjoy it.

It's part of the challenge of being a generalist.  We know a lot and people appreciate it.  They may not appreciate that they have to pay more for additional problem.  It seems that people get excited as they realize how much we can help with their "odds and ends" problems.  We get excited, too, but it's often more because of getting behind on the schedule and having fleeting feelings of disappointment about not staying on time and having the next patients wait too long.

That's part of the Generalist practice.  People and problems.  Problems and people.                                                                                                                                                  


  1. I'm not sure there's a solution to this problem. As a patient I usually come to the doctor with an assortment of complaints. Often it's hard to summarize everything that's going on in a few short statements on a form or when making an appointment. Issues come and go. New things may have come up since the appointment was made.

    Also, being an old guy, I think I was trained by the doctor I saw several decades ago to simply talk about everything that is bothering me during an appointment. And I sometimes wonder if some minor problem may contain information that would be helpful to the doctor in understanding the more serious problem...and could actually be connected to it.

    I come to the doctor not as a symptom, but as a person with a number of reasons to seek medical attention. I greatly appreciate the fact that I can come to a family doctor that way and not have to visit a bunch of specialists who may have conflicting ideas about what's wrong and what to do about it. All that's good for me. The downside for you is that I will probably take more time than it would take just to address one symptom.

    I wonder if a statistical analysis of the average time you spend on each appointment might make it possible to set appointment times to allow for all this. I have to think that over time a pattern would emerge.

  2. Thanks, Dave for your comments. We have the continuing creative tension between patients and physicians, trying to figure out the big and little picture at the same time as enjoying a continuing relationship of humans. We might have "little picture" visits and "big picture" visits, to balance focus needs with long range needs. The patient's story remains central to every visit. Both persons stories remain central to the relationship of patient and physician- which we could find a better way to emphasize. Your comments are very insightful and right on.