A Patient Encounter

A Patient Encounter:

I was working in Tehachapi this week for two days. This morning the second patient on the schedule was a Punjabi woman who had seen me a few times since last year. She was here today to refill her medication. The last refill on her medication said to “establish with primary care physician” before next refill. On her chart her primary care physician was listed as one of my colleagues who is a Punjabi physician. I pointed out to the patient that her doctor is in Bakersfield and although inconvenient to drive 40 miles she should try to go at least once to establish care with her so in the future there would be no difficulty getting her medication refilled. She said “ but I already saw her once”.

Now I was confused. Why does it say to “establish with primary physician” if she is already established?

The patient saw my confusion and clarified. “I insisted that I want you as my primary physician”.

Oh!

It was a humbling moment. I thanked her but had to admit that since I no longer work as a full time physician I don’t have my own panel. Besides I tend to travel for months at a time when I go to India. 

She went quiet for a minute.

“I am shocked” she said after the pause.

Why?

“Why do you go to India for such long time?”

I told her I work when I’m there. 

Again silence.

Then she said “ I am just shocked that you will be gone for long periods. I connect with you in a way I cannot connect with anyone. You make me feel like family. You ask me how I’m doing when you walk in and even though you are quite direct in the approach to my symptoms I am comfortable with you. I am not comfortable with anyone else.”

Isn’t that how all of us are? 

We seek to be where we feel comfortable.

And that becomes our problem. 

We create two scenarios. One where we see comfort. The other where we see discomfort. The labels are created by the mind. And then the mind directs us constantly towards one and away from the other. When we are forced to go to “the other” we already have an existing bias. Experiences rarely turn out positive in that situation.

I had to address this woman’s concerns.

I said, the reason I treat you like family is because I know you are family. We have come from the same source, haven’t we? The others have also come from the same source as you and me. So they too are family. Even if they don’t know it, you know. See them just like you see me.”

She was on the verge of tears. “ I was thinking what if I die and you are gone to India for months?”

Well, just like your life is uncertain, so is mine, isn’t it?

She stopped me right there. No! Don’t ever say that. You are helping too many people. You should live a long life. No! Never ever say such a thing! Never!

It is funny how our mind works. We want good people to live long and those who are not good in our books, we don’t care if they go too soon. Yet, we conveniently forget that everyone has the same statistical chance to die at any moment!! We can neither expedite nor delay anyone’s leaving.

I couldn’t convince her! 

All I could assure her is that when you need to be seen, if I’m working here, I would be happy to see you. But because my being here is not always guaranteed, please try to see your regular doctor at least once a year so your medications are not disrupted. 

She nodded with reluctant understanding. 

Such trust and loyalty was something that mind thirsted for in the beginning of the career. One visit from a new patient and immediate request for change of physician would break the heart. 

Now, it feels different. The goal now shifts towards convincing patients to give every doctor the same chance that my patients who stayed with me for 27 years gave me. 

To make them realize that new doctors are just starting out. Don’t judge them too harshly. 

Perfection is not born in a single day. It is we who allow those around us to move towards perfection. With our patience, acceptance, encouragement and forgiveness. 

We will not live to see everyone get there. So what? Just like kindness, hope too costs nothing.