My first in-person interview with Galileo was right here in Presque Isle with Dr. Ajay Haryani. He was one of three New York doctors who worked in my territory before i started here. He has now started his own practice and he is writing on LinkedIn about doctoring. His latest post is about the “Worried Well”. It starts like this:
The "Worried Well" is a derogatory label we give to patients who have health concerns but no obvious pathology on our tests. It treats these patients with very little grace, branding them as difficult.
But this misses the mark.
1. It ignores prevention. These patients are doing exactly what we claim to want - being proactive about their health. When did that become a problem…
I know one very big reason why many doctors today use this term and dread appointments with patients who fit this derogatory definition: Today’s typical primary care provider has about 10 minutes of face-to-face time in each patient appointment, with more time than that required to document the visit, whether that gets done in the office or from home when their family has gone to bed (we call that working pajama time).
The productivity demands of typical primary care has created burnout and eroded clinical curiosity and compassion. But in a perfect world, and in a perfect large practice like Galileo or Direct or Concierge practices, we have more control over our time and the flexibility to really address our patient’s priorities. And if after looking into their concerns we can reassure them that they really are safe, isn’t that as valuable as if we make some kind of exotic or rare diagnosis? We are either diagnosing or reassuring a fellow human being. I think both those things are valuable and good use of our time, skill and experience.
My personal vision, expressed many times before and repeated here again, is that so much of what we do in primary care today, especially the majority of preventive care, could be done by nurses, even on the telephone. This way we could devote more time to our patients, whether they have serious problems they were unaware of or experience normal behaviors of the human body that worry them.
Both of these things are worthwhile.