The Quality of Patient Relationships is Immeasurable

Today was a great day in clinic for many reasons, but the best part was seeing two of my younger patients who I had the honor of delivering into this world. While they don’t remember me at the moment they hollered their first vigorous cry, I remember those moments well. One of my little patients took forever to be delivered because of a difficult presentation. After his birth, to take those first few cries he needed some help. While he is now a healthy and active preschooler, I recalled his challenging birth as he fought me during every step of the exam. Another patient had a relatively smooth entrance and smiled cooperatively at me throughout today’s exam, graciously offering me first the left ear then the right to examine. She concluded our very pleasant visit with a rousing rendition of her A-B-C’s (and only missed T and U).

Truly, one of the greatest joys of family medicine is the continuity we have with our patients - whether or not we had the great privilege of helping their transition from womb to world. Two other patients on my schedule were parents of children who were also my patients before they left this world too young. Just as it has been an honor to share the amazing moment of birth with my families, so too is it an honor to share death with them. One event is joyful and one is grief-filled but both are important, deeply meaningful, and have lifelong reverberations. As I speak with one of these patients, I realize that the anniversary of his son’s passing is next week. In discussing the rather mundane medical matters of lab tests and medication refills, I am touched by the depth of our physician-patient relationship that reflects the humanness of each of our life experiences.

We are in an age of data, statistics, patient satisfaction surveys, cost and quality data, and even Consumer Reports’ ranking of health care systems. These things matter a lot for insurance contracts, star ratings, my “online” reputation, quality bonuses, and so on. However, when I think of the type of day I had in clinic today, it doesn't really matter at all. Despite all the scientific advancements and transparency, the quality-cost index and the average cost of treatment, patient satisfaction and ratings, medicine is still a human business, a personal experience. While I am sure my patients would be reassured to know that I am practicing evidence-based medicine and not costing their insurance excessive amounts of money in delivery high-quality care, I think these measures miss the most important part of the equation.

When I have the opportunity to ask a young patient about their first day of kindergarten, while enjoying the memory of their birth or to listen to a patient’s lungs as well as the hidden meaning of their concerns that I can understand only by virtue of our shared history and understanding, I can clearly recognize what truly counts. I believe that not only does it matter to me but also matters to my patients. 

In an era of quantitative analysis of everything I do from the clicks of my mouse to the number of CT scans I order, I am reassured that the quality of my patient relationships is both immeasurable and invaluable.