Wednesday, September 07, 2005

time with patients

The one thing that is so great about being in school is having plenty of time to spend with your patients, to engage them about their lives and to really attempt to develop workable solutions to their health problems. That just isn't feasible in community health. It's all about the numbers. It's such a rip off that you are held to this standard of a patient each 15 minutes, but are also held to a standard regarding patient outcomes. A perfect example of this is Hgb A1C levels in diabetics. Our clinic measures them as a component of a grant collaborative (as well as for regular care, of course). As we all know, achieving glycemic control is extremely difficult. It's more difficult when your patients don't have SBGM equipment and even more difficult when all of your counseling is in crappy Spanish. Now add on an inadequate amount of time. It's bad news.

Today, I had a sort of difficult pelvic exam on a 29 year-old. It was one of those exams during which the cervix is elusive, hiding from you. It took me three times of inserting the speculum to find it. I know that this is extremely lame and it must have been totally hideous for the patient. But I apologized and acknowledged how difficult it must have been for her. And do you know what? After the exam, she thanked me for being compassionate and understanding. Now that goes to show that a little humanity is a great help in the clinical encounter. I know that it is idealistic and that providers are strapped for time, but it took me a matter of seconds to acknowledge what I knew to be difficult and it made a big difference to her.

I don't think we should be made to see 30 patients per day. I think that both patients and providers suffer with that workload. And I haven't even seen that many yet!

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