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Wednesday Sep 17, 2014

Choose Well: Helping Patients Act on Their Choices Reminds Us to Do the Same

When my oldest daughter was a baby, she came to work with me almost every day for the first nine months of her life. I co-owned a fledgling private practice then, and it was cheaper and easier to bring her to work with me than to send her to daycare. I loved every moment of bonding with her, and patients actually enjoyed having her there. Once I started leaving her at home with family, patients often asked, "Where is Ella?"

At first, my wife and I were somewhat concerned about possible exposures or infections she might pick up at the office, but these concerns were limited, and the advantages of having her there far outweighed the day-to-day risks. I chose to keep her with me based on multiple factors, including money, time and -- frankly -- safety. Recognizing that there are risks inherent in sending a child to daycare, my wife and I chose to live with any consequences that might arise from Ella being in the practice environment. She survived intact, and I spent several formative months with my daughter without sacrificing patient care.

Helping my patients made going back to work after a short paternity leave bearable. Here I am talking with Tracy Miller, L.P.N., about a patient on my first day back in the office.

Fast forward to today. After the recent arrival of twin girls, we now have three children younger than 2 years old. And with my current job, taking the girls to work isn't an option. That made returning after a brief five days off quite difficult.

I have a relatively straightforward schedule, though, and limited after-hours duties, so I've opted to return to work full time, which will allow my wife to return from maternity leave to her job as a pharmacist part time and give her the chance to spend more time with the girls.

My patients have been excited about the twins. Many even ask to see pictures when they come into the exam room. They've offered congratulations, and my pride swells each time I get to show off my wife and our daughters. Conversation eventually turns to the medical issues at hand, but I'm more than happy to talk about my family for as long as the patient will let me.

That simple act of sharing sets primary care, especially family medicine, apart from other specialties. We take care of multiple family members, often multiple generations, through all stages of life. In essence, we act as part of the family. We expect patients to share the most intimate details of their lives and their health with us, knowing that we must maintain the medical distance required for good judgment. I tend to allow some of my own life to bleed over into the conversation, though. Not intrusively, I hope, but as reciprocity. How can I expect a patient to tell me everything if I'm not willing to share? Building relationships requires work from all parties involved. My patient-physician relationships are stronger when we both share some of ourselves.

Working together to find the least objectionable solutions for illness is the part of the job that makes it more than just a job. I missed that when I wasn't working.

None of that makes leaving Sara at home with the girls any easier. I occasionally worry that I will miss milestones or the small moments that make life so interesting. Each of us chooses where we spend the 24 allotted hours of our day, so I'm not any different than anyone else in that regard. I just hope I'm choosing the right place to spend the time I have. So far, so good. Would I be excited and happy to be at home all day long with my wife and three little girls? Of course. There would likely be some psychiatric diagnosis attached to my personality if I wasn't. However, staying home is not an option, so I will continue with the choices I've made and live with the results.

I won't be home as much, but I am determined to work hard at being both physically and mentally present when I am. I don't turn off my phone (although I probably could), but it takes a backseat to my wife and daughters when they want my attention. It can be a struggle, but it is always worthwhile. We talk a lot about work/life balance in this blog, from what type of practice we have to how many extra activities we can fit into our lives. It can all be summed up, though, with two words -- "choose" and "act."

As physicians, we make thousands of choices each day -- some great, some small. We and the patients under our care live with the consequences of those choices. It's the small amount of control we can exert over our environment. Helping my patients make the best possible choices is, for me, one of the most rewarding parts of being a physician. I happily return to that part of my job each day. It was that part of the job that made returning to work bearable, considering what I was leaving.

Gerry Tolbert, M.D., is a board-certified family physician who practices in northern Kentucky. A lifelong technophile, his interests include the intersection of medicine and technology. You can follow him on Twitter @DrTolbert.

Posted at 02:55PM Sep 17, 2014 by Gerry Tolbert, M.D.

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