I look at my ages as well! Saw a 99 yr old a few weeks ago and told him he won the award for oldest patient of the day. As a family medicine physician, I still have a handful (like on one hand) of kiddos. When I see some of the ages, I ask them how did you get to be 90? Then I realize I was 30 when I started seeing them and now I'm 65!
I listen to Sinatra’s “One More For My Baby” when a patient dies. That started after attending a case where a wife lost her husband of 65 years. It was playing as I drove away from the hospital. It seems most people die leaving at least one other person behind…
I'm glad that you do what you do and write about it. It restores my faith, especially (at 70 tomorrow) I am one of those folks you speak of. You likely have no idea what it would mean to me if I had a doctor who is as balanced as you. Love the line "some patients become friends, some friends become patients."
I had "angel food" and the little children here who visited (it was crowded!) decorated it and I had no idea but they said "THIS IS A HEART FOR YOU..." and so on... I was so blessed. My severely 32-y.o. autistic son ate the entire one (just a small loaf size) but of course I had a bite. OK, he weighs barely 120 so it's ok... I know that autism sometimes comes with obesity but he is that weight and I fight to stay over 100 so we're good there. God Bless You and Yours Always... thanks for responding.
A four hour block. Usually, the other half of the day is reserved for follow-up, teaching, our other academic pursuits. I’m lucky to have a very good gig.
I am 82 and have had 4 PCPs retire under me. I'm now on my 5th, who graduated from the medical school that I taught at for 17 years, although I left before she entered. Hopefully she won't move. I think she is too young to retire if she doesn't burn out.
I am going to be the mean post here but I will say how wonderful that there are still doctors out there who see their patients as human beings. I lost my dad and mom within 9 months of each other this past year. Both were in their 90's but healthy, only becoming ill a few months before their deaths (Dad: thymic cancer previously undetected; Mom: glioblastoma). Both of my parents, even in their 90's were the type who went for all the annual physicals and bragged about how their GPs told them how healthy they were. When they got ill, their GPs dropped them like a hot potato. Never to hear from them again and couldn't even make an appointment to see their regular GP. I know the corporations that control these things force the specialists to step in. But even the specialists didn't really care. It was difficult to even get appointments or any care for either of my parents. It felt as if because they were so old, they weren't worth the time or effort. It was as if they were no longer human beings. Hospice eventually stepped in, but neither one ever saw a Hospice doctor; the nurses ran the show.
Interesting. I started a concierge practice 5 years ago after 20 years in the big box system. I specialize in the elderly! Long appointment times, home visit when/if needed, coach families in how best to support elderly parent. Elder care is well-suited for concierge. (though I did switch to concierge to practice the way I wanted to, not to work part time and make more money. I do work long hours.)
My mother in law passed away this last September. I often took her to her doctor's appointments since she could no longer drive herself. Her doctor was a very warm and kind, younger (probably 30s if I had to guess) man who really spent time asking questions, and more importantly, listening carefully to her answers. I am so thankful for his care for her, especially in her waning days. The last appointment she had with him was within the last week of her life. She was so defeated and frustrated by her failing body. As he greeted her in the exam room, and saw her weariness, his eyes filled with such compassion, and he asked with earnestness "How are you Gail?" She replied, "Not very well, doc." with a tear in her eye. He came over and gave her a hug. There was very little he could do medically for at that point, but his compassion meant the world to her, and to me.
That is wonderful. I love to hear when doctors still show caring and compassion to their patients. And great to hear about young doctors who are caring and compassionate. Glad your MIL had good care and a supportive family.
Especially for me in my specialty obituaries are important. I often see people at their lowest and worst times, with them discharged / lost to follow up “when things are good”. I almost never hear about the good times: so to learn from the people who have loved/benefitted most from my patients is amazing. It so often paints in the best parts that are almost always ignored, not for want but for lack of time.
You seem like my dad’s doctor. He died of leukemia some years ago. When the leukemia entered the acute phase, his doctor mentioned but did not push a clinical trial. (This was before I understood about Big Pharma.) We thought it would be better than the weekly transfusions that were the standard treatment. We were probably wrong. I believe the trial shortened his life, and the end was rough on all of us. Whenever I think about it and start to get angry, I get some peace remembering his doctor, who came and sat at the foot of his bed after he’d died, contemplating, for a long time. You seem like that doctor.
Husband and I had the same doctor. After his death, our doctor called me to express condolences. I appreciated his kind words so much! Took the doctor just a few minutes, but meant so much to see how much he genuinely liked my husband.
When I trained at Duke back in the late 70's, we were expected to begin every H&P with a "patient profile", basically a mini bio. On rounds we presented the patient's profile first. I continued this habit for decades, until Medicare started "dinging" me for not having a Social History. So I had to move it into the note and actually call it SH.
Like you, I continued this practice with EHR, but the Social History was too rigid. I was lucky that CERNER gave us a completely blank page to use for whatever purpose we chose, so I put it there. I reviewed it every visit, and often started the visit asking a question of the patient about something in the bio. Any new info would be added. Far and away this was my favorite part of the visit, and of practice in general. Even the most humble patients lead such fascinating lives.
This is the secret sauce of internal medicine and is one of the reasons why I still love coming into the office every day for nearly 30 years. They don’t tell you about this in residency, and you don’t really appreciate it until a few years in when you’re not scared every day you’re going to see something you’ve never seen before. I went into internal medicine because I love solving problems, but I stay for the relationships.
Important and necessary reminder that a patient’s health issue is a very small part of who they are.
Your mini memorial is a lovely tribute.
I look at my ages as well! Saw a 99 yr old a few weeks ago and told him he won the award for oldest patient of the day. As a family medicine physician, I still have a handful (like on one hand) of kiddos. When I see some of the ages, I ask them how did you get to be 90? Then I realize I was 30 when I started seeing them and now I'm 65!
It’s nice to hear a doctor talk like this
I listen to Sinatra’s “One More For My Baby” when a patient dies. That started after attending a case where a wife lost her husband of 65 years. It was playing as I drove away from the hospital. It seems most people die leaving at least one other person behind…
I'm glad that you do what you do and write about it. It restores my faith, especially (at 70 tomorrow) I am one of those folks you speak of. You likely have no idea what it would mean to me if I had a doctor who is as balanced as you. Love the line "some patients become friends, some friends become patients."
Happy Birthday! Eat cake and enjoy!
I had "angel food" and the little children here who visited (it was crowded!) decorated it and I had no idea but they said "THIS IS A HEART FOR YOU..." and so on... I was so blessed. My severely 32-y.o. autistic son ate the entire one (just a small loaf size) but of course I had a bite. OK, he weighs barely 120 so it's ok... I know that autism sometimes comes with obesity but he is that weight and I fight to stay over 100 so we're good there. God Bless You and Yours Always... thanks for responding.
Thank you.
Are you glad you stayed in Primary Care?
Absolutely. It fits me perfectly and the longer I do it the more I appreciate the medicine and the importance of my role.
Is the number of patients on your list for a single day?If so, it appears a disservice to both them and you.
A four hour block. Usually, the other half of the day is reserved for follow-up, teaching, our other academic pursuits. I’m lucky to have a very good gig.
I am 82 and have had 4 PCPs retire under me. I'm now on my 5th, who graduated from the medical school that I taught at for 17 years, although I left before she entered. Hopefully she won't move. I think she is too young to retire if she doesn't burn out.
You should get a prize for “outliving” your docs.
I am going to be the mean post here but I will say how wonderful that there are still doctors out there who see their patients as human beings. I lost my dad and mom within 9 months of each other this past year. Both were in their 90's but healthy, only becoming ill a few months before their deaths (Dad: thymic cancer previously undetected; Mom: glioblastoma). Both of my parents, even in their 90's were the type who went for all the annual physicals and bragged about how their GPs told them how healthy they were. When they got ill, their GPs dropped them like a hot potato. Never to hear from them again and couldn't even make an appointment to see their regular GP. I know the corporations that control these things force the specialists to step in. But even the specialists didn't really care. It was difficult to even get appointments or any care for either of my parents. It felt as if because they were so old, they weren't worth the time or effort. It was as if they were no longer human beings. Hospice eventually stepped in, but neither one ever saw a Hospice doctor; the nurses ran the show.
Awful. I have a handful of patients “let go” by their concierge docs when they got to “complex.”
Interesting. I started a concierge practice 5 years ago after 20 years in the big box system. I specialize in the elderly! Long appointment times, home visit when/if needed, coach families in how best to support elderly parent. Elder care is well-suited for concierge. (though I did switch to concierge to practice the way I wanted to, not to work part time and make more money. I do work long hours.)
Unfortunately. This is becoming more and more common in our specialties. It’s the sad state of affairs. I’m really sorry you had to witness that.
My mother in law passed away this last September. I often took her to her doctor's appointments since she could no longer drive herself. Her doctor was a very warm and kind, younger (probably 30s if I had to guess) man who really spent time asking questions, and more importantly, listening carefully to her answers. I am so thankful for his care for her, especially in her waning days. The last appointment she had with him was within the last week of her life. She was so defeated and frustrated by her failing body. As he greeted her in the exam room, and saw her weariness, his eyes filled with such compassion, and he asked with earnestness "How are you Gail?" She replied, "Not very well, doc." with a tear in her eye. He came over and gave her a hug. There was very little he could do medically for at that point, but his compassion meant the world to her, and to me.
That is wonderful. I love to hear when doctors still show caring and compassion to their patients. And great to hear about young doctors who are caring and compassionate. Glad your MIL had good care and a supportive family.
Especially for me in my specialty obituaries are important. I often see people at their lowest and worst times, with them discharged / lost to follow up “when things are good”. I almost never hear about the good times: so to learn from the people who have loved/benefitted most from my patients is amazing. It so often paints in the best parts that are almost always ignored, not for want but for lack of time.
You seem like my dad’s doctor. He died of leukemia some years ago. When the leukemia entered the acute phase, his doctor mentioned but did not push a clinical trial. (This was before I understood about Big Pharma.) We thought it would be better than the weekly transfusions that were the standard treatment. We were probably wrong. I believe the trial shortened his life, and the end was rough on all of us. Whenever I think about it and start to get angry, I get some peace remembering his doctor, who came and sat at the foot of his bed after he’d died, contemplating, for a long time. You seem like that doctor.
Husband and I had the same doctor. After his death, our doctor called me to express condolences. I appreciated his kind words so much! Took the doctor just a few minutes, but meant so much to see how much he genuinely liked my husband.
When I trained at Duke back in the late 70's, we were expected to begin every H&P with a "patient profile", basically a mini bio. On rounds we presented the patient's profile first. I continued this habit for decades, until Medicare started "dinging" me for not having a Social History. So I had to move it into the note and actually call it SH.
Like you, I continued this practice with EHR, but the Social History was too rigid. I was lucky that CERNER gave us a completely blank page to use for whatever purpose we chose, so I put it there. I reviewed it every visit, and often started the visit asking a question of the patient about something in the bio. Any new info would be added. Far and away this was my favorite part of the visit, and of practice in general. Even the most humble patients lead such fascinating lives.
This is the secret sauce of internal medicine and is one of the reasons why I still love coming into the office every day for nearly 30 years. They don’t tell you about this in residency, and you don’t really appreciate it until a few years in when you’re not scared every day you’re going to see something you’ve never seen before. I went into internal medicine because I love solving problems, but I stay for the relationships.
Ditto!
"I went into internal medicine because I love solving problems, but I stay for the relationships."
Love that. Thanks.
Adam