Sunday, July 23, 2017

A patient’s most strident complaints

A patient’s most strident complaints may vary widely from what health policy analysts and lawmakers fret about today: quality of care, access, and cost. The straight-laced puritanical woman rightly should have stood up to complain that everyone seated in my waiting room that day would pay a widely differing fee for professional services rendered, depending on age (Medicare), job (various private health insurance companies), or dire financial straits (Medicaid). That is a fact far more obscene than any risqué photojournalism found in the New Yorker.

There is surprisingly little correlation between the severity of an illness and the time devoted to it in the course of a patient visit. Complexity of care is more a function of a patient’s personality traits, such as maturity, adequacy, coping capacity, and social support structure, than of blood test results, X-ray and scan reports, or other objective findings.

Hippocrates, primary practitioner of Periclean Greece, presciently summed up the root challenge of medical office scheduling when he said, “It is more important to know what sort of person has a disease than to know what sort of disease a person has.”

A disconsolate young man, how-ever, scheduled to see me for a minor and transient somatic complaint, a sore shoulder, casually mentions as an aside that he is recently divorced, laid off from his job, shopping for a gun, and giving serious thought to suicide. Suddenly his ten-minute visit swells to sixty, triggers unexpected phone calls to secure speedy psychiatric help, and dams the flow of patients seated in my waiting room.

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