Editor's Note
Patients—Keeping Up with This Year’s Model
The challenge, and the fun, of practicing medicine is that 2006 patients are different from those of 1976 or even 1996.
When I was in high school, I took all that advanced placement physics and calculus stuff, but I never got to take the course I really wanted to take—gas engines. I wanted to know how cars and lawn mowers worked and how to fix them. My father, who seemed to know how to fix everything by some mystical sixth sense, told me the course would be a waste of time. Years later, I decided to learn how to fix people instead.
There are a number of similarities between cars and people and between auto repair and medicine. Cars break down, people’s health breaks down. For most people, a running car is as much a necessity as their own health. And a trip to the shop for a sick car or to the doctor when you’re ill is an unplanned, frequently expensive, imposition.
Cars have changed radically in recent years. Try to find a mechanic who knows his or her way around a carburetor anymore. Antilock brakes, turbochargers, or all-wheel drive surely weren’t covered in that high school gas engine class. And, increasingly, our cars are dependent on mysterious black boxes that seem as if they should be the province of white-coated electronic whizzes rather than greasy-handed repair people.
Patients, our theme this month, have changed, too. Certainly today’s patients are the same collections of DNA and protein that they were years ago. But 2006 patients are older. When I started in practice 30 years ago, a 90- year-old was an exception; I now can see three or four in a day. Patients are busier, with two-job families and supercharged school activities making health concerns just another “thing” to squeeze into a 25-hour day. They are smarter, with resources for and access to medical information unimagined even 10 years ago (see “Informed to the Max,” p. 32) And as the “miracles” of medicine capture headlines daily, they expect more.
So as “people mechanics,” we physicians need to continually study patients, not just their cholesterol levels or bone densities but also who they are and what they want. If the average age of the people walking into your office is 75, you need to have phone systems, examining tables, and support staff that accommodate their needs and limitations, and you need to expect that half of them will be accompanied by a family member with questions and concerns. If patients have little or no time to see you, you need to have same-day openings or lose them to MinuteClinic. If droves of your patients arrive with sheaves of paper from Internet searching, you have to understand the medical ideas that they bring with them and address those notions. And you have to bring the cold shower reality of medical science to the heated buzz of last night’s news report about the latest “cure.” The challenge, and the fun, of practicing medicine is that 2006 patients are different from those of 1976 or even 1996, and if we physicians don’t keep track of how patients are changing, we risk understanding their diseases but never understanding them.
Today when my car breaks down, my diagnostic approach is to open the hood and stare hopefully, but usually futilely, at the morass of metal and rubber, looking in vain for an obvious dangling wire that I can reconnect. Like my winning the lottery, it has never happened. I hope to do better with my patients, watching how they change and continuing to understand how they tick so that I can fix them.
Charles R. Meyer, M.D., editor in chief Dr. Meyer can be reached at cmeyer1@fairview.org