I spent 20 minutes listening to Michelle and asking her questions to understand why she was not taking her insulin as recommended. The appointment was for 15 min, 5 of which were used by the medical assistant who had to check the vitals and “do an A1C”.
I did not ask Michelle whether her feet were tingling or numb. I did not ask her whether she had her eyes checked this year. Instead, I felt the need to stop the generic factory madness, and actually focus what the primary issue was… instead of typing “non compliant” in my note, and having all the aspects of diabetic care addressed to justify the high complexity of the encounter.
I did not force a checklist on her. I could not.
Michelle was also due for a reminder to schedule her mammogram, but that box remained unchecked. I also “forgot” to listen to her chest, which is part of a routine for almost every doctor visit.
The chest auscultation ceremony is where I linger sometimes, just to regroup my thoughts. It is many times the only time I have a patient quiet. But I actually needed Michelle to talk, and I needed to listen.
Yes, I “only” listened for the most part.
On paper, that did not meet the standards of diabetic care for that day. Still, the encounter lasted for a total of 30 minutes, since we had to come up with an action plan.
What we are taught often time is what I call “generic regurgitation”. A one-size-fits-all approach with little room for outliers or actual patient priorities. Something we have to do or say, otherwise we would be providing substandard care to the eyes of a third party.
Michelle had to come back, so I could catch up on checking boxes, and also assess her progress.