FEATURE
WINTER'S Wind
Kara Curry, MD
I
t hit me like a gust of wind you don’t quite
expect when going outside for the first
time in January, when you open the door
and the cold air bites you. That’s Winter
announcing Her arrival, just when every-
one thought we were safe. I was shocked by
the harsh blast and wondered why I had such
a visceral response despite all my warm layers
and years of experience.
After years of being the underdog medical student, then grad-
uating to internship followed by my second residency year, I still
had more uncertainty than confidence, but was finally a third-year
resident. I felt this year of training was finally revealing some fruits
of my labor. After all of the long hours on the wards as part of either
a patient’s primary or consulting team, I had just enough experi-
ence to treat patients with unfeigned confidence in the outpatient
world, where the entirety of my program’s third year of training is
spent. I had finally found my niche in the clinics after doubting I
would ever want to absorb the hustle and bustle of hospital culture
into my daily routine. The pleasant surprise was that the patients
responded to my newfound confidence and acquired experience,
and trusted me. When they came to the outpatient clinic, their
appointment was with me. My name was on the sign-in sheet, and
both my dependence on and the patients’ attachment to an attending
physician for oversight of their care were becoming less and less.
Developing relationships with patients was energizing and fulfilling.
It reinforced my belief that I had not picked the wrong profession,
just had not yet met the best setting for me, until now.
But, on a freezing cold day, I found myself thinking I was mis-
taken. Although patients are less acutely ill in the outpatient setting,
I found just as much work and preparation involved as on the
inpatient side. I routinely look through their previous visit notes,
from providers both within and outside my specialty, labs, imag-
ing, notes from phone calls they may have made to our clinic in
between visits, discharge summaries, etc., all before finally having
a face-to-face meeting with them. It is no small task to adequately
prepare for a patient’s outpatient visit and this is something habit-
ually done by all physicians in some form or fashion. After careful
review, I learned it was important not only to address the patient’s
current complaints, but also to follow up on any loose ends from
previous visits. Thus, while new onset back pain may be on the
forefront of the patient’s mind today, the provider must also reorder
the fasting labs the patient had forgotten to get. Although the back
pain is aggravatingly apparent, silent but uncontrolled blood fats/
blood pressure will cause much more aggravation in the future if
not promptly discovered and treated. In effect, because provider
and patient often have a different ranking of the necessary agenda
items, a sort of disconnect is often felt between the two stakeholders
of the patient’s health.
Despite a common goal of better health, this misalignment of
agenda items may lead patients to perceive their physicians as aloof
to their most pressing concerns, not sharing their goals of care, or
FEBRUARY 2018
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