It has been a frustrating time in family medicine in recent years. It seems that we are battling constantly on many levels. I have been torn between seeing patients, improving clinic functions, and trying to move rural medical education along.
When the letter came, I had just finished with my small group of first year medical students. We completed presentations by students where they viewed a videotape, researched a common problem in primary care, did the SOAP note, coded the visit, wrote the prescription, did a differential and discussed it, etc. They excelled in most areas except for coding. The discussion turned to why we had to put up with things such as coding and RVU and various other forms of bureaucracy. I was able to give rational arguments about RVU’s being a method of determining the time and effort and intensity of care. We talked about the current environment in medicine, the uncertainty that is out there.
We had finished and the students were packing up to brave the icy streets. They were talking to one another and on the way out, when one student brought out concerns about primary care being at the center of the frustrations. The focus was back on me. I noted that primary care would always be a focus for concerns, because of the role of primary care doctors in caring for patient needs. I highlighted our discussion from a few minutes before about how important it was to care for a patient as if the 3 month old that you are seeing is your own child. It was important to do the care that you were proud of, regardless of whatever system was in place.
I noted that they often saw two different things in medical school. In the hospital on rotations they usually observed the medical part of taking care of patients. As first year students seeing patients with preceptors or as students on rural rotations, they saw much more than the medical part. They saw the challenges of being a doctor, father, community person, manager, etc.
We finished by talking about doing what your dream is, what you are called to do, and not getting distracted by what seems to be getting in the way. They were attentive, asked a question or two and then it was time to go. I gathered up my materials and took a look at the stack of mail to review. 70% hit the trash and then I saw it. It was barely legible and God only knows how the letter made it to the clinic at all. The zip and address were incorrect. It looked like a letter from one of my crazy patients and I thought seriously about trashing it, hoping to spare some extra effort or concern. I decided to open the letter anyway.
The writing was the torturous kind that obviously took a long time to write. There were multiple whiteouts and writeovers and incorrect spellings, but the message was clear:
To: Dr. Robert Bowman
I came in the clinic. I was a patience in the family medical clinic, it was in the last part of 1999, I, , had a sinus infecation, also had a real bab back pains. I want to give you, thanks for all you as a doctor, I as a patience, for me, thank you.
On the back:
Also for you, as a doctor praying with me, as I had a lot of personal deaths in my family in 1998 and 1999 (several described). I can never forget that evening at the clinic. I hope you and all your family the best always. May God always keep you in His care.
She scribbled in at the sides a thanks to Dr. M. Sotitious, (Sitorius, my Chair) You are a God send doctor, also you have a good staff, also I pray for all the doctors in families clinic 2001, all I write come from my grace to you all, 2001. Did over all staff God keep you and all your doctors in his care 2001.
I wish I could uphold this standard always, but I can only try. I will share this with my students and perhaps they will learn more from this letter than from my words. I have had similar episodes before. I have heard from nurses or seen chart information or looked at patients and made judgments about patients before I had even gone in the room to talk to them, only to have my preconceived notions shattered. These episodes only confirm that we are not in control. There are sources and strength and comfort and healing that none of us will never understand completely. Just spending time with a patient, personal touch, the way we look at patients, prayer. Perhaps that is one of the reasons that I enjoy medicine. Suspect there is not a code for such a procedure, but there are other rewards. This one should keep me going for at least a year or two.