In medical school, I remember a particular lecture where a poem was read from the point of view of an older woman, speaking to the physicians caring for her. In the poem she implored them to look beyond her bent posture, wrinkled skin, and graying hair. She asked them to consider her to be more than a list of diagnoses and a life marked by a dwindling number of days. She did not want to be known as “the gallbladder in room 614” or “the MI in 1230” as busy health care workers have been known to do. She urged a metaphoric peeling away of her aged surface to behold who she really was- a spirited child, an adventurous teenager, an intellectual, a lover, a mother, a cherished friend, and a revered grandmother.
For many years, I have strived to practice medicine not using labels, but names. The pace of outpatient medicine afforded me the time to learn patients’ names, to use patients’ names, and to visit with patients long enough to get to know them.
As recently as last year, I saw patients in a five-exam room pediatric office, in a medium sized office building, located conveniently to neighborhoods and shopping. As each patient was roomed, a medical assistant would pop their head into my office to let me know that “Jonathan was ready in room 2.” They would give a summary of the conversation they had during check-in. “Teachers are concerned about behavior in school” or “Jonathan’s grandmother has taken ill.” The office assistant who would check in patients would personally transfer calls or walk back to my office to make sure I took urgent messages promptly. And most remarkably, when my mind could not recall the name of a mother or the last name of a patient, all I had to do was ask my medical assistant, because she knew names. She used names.
I now see patients in a twenty-five-exam room office at the edge of town, in an industrial area convenient to Interstate 95 and Union Station. There are 120+ patients scheduled per day, and medical team members communicate via instant messaging. I know my patient is ready to be seen when a yellow circle turns green on my computer screen. When the front desk staff calls to notify us of late arriving patients, they are referred to as an appointment time. “Your 9:30 just got here,” or, “your 3 p.m. called to say they will be 10 minutes late.” I have never met in-person the staff who schedule appointments. The clinic has been labelled “transformative” and “a national model for innovation.” Yet the people serving the model rarely know someone’s name.
For many years, I have strived to practice medicine not using labels, but names. The pace of outpatient medicine afforded me the time to learn patients’ names, to use patients’ names, and to visit with patients long enough to get to know them.
Leslie Sude, MD
What exactly have we innovated medicine into? The high-volume-well-reimbursed model now affords clinical assets previously unavailable to our patients such as co-located behavior health and care coordination services. It is truly a benefit and an advancement. We enjoy the conveniences of MyChart message, e-check-in, virtual visits, and online pre-visit questionnaires. What might have been once a figment of medical science fiction is now a reality.
However, as we move forward and technology transforms health care, let’s peel back the surface layer and remember that people with names, families, relationships, and so much more, are at the center of it all.