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Monday Aug 22, 2016

Everyday Heroes: What We Do Today Saves Lives Tomorrow

Midway through my morning schedule one day, I looked up and saw John, one of my patients, strolling down the hallway toward me. John wasn't on my morning schedule, but it's not uncommon for patients to swing by the office to drop off documents, make requests or just to say hi.  

John is fairly new to my practice. I've been seeing him less than a year. He is a tall, lanky man in his early 70s with silver hair and an amiable manner. I could imagine him stepping off the canvas of a Normal Rockwell painting, perhaps dressed in overalls with a farmer's cap and a slight smile. He adopted his grandson, who is now 11, when the boy was an infant, and you don't have to talk with John long to hear about Nathan.

On this occasion, however, the nature of his visit was even more personal.

"I want to thank you," he said, extending his long arm and taking my hand in a warm, firm shake.  

"For what?" I replied, feeling perplexed.  

"For saving my life," he said.

When one thinks of family medicine, heroic measures and saving lives are probably not the first things that come to mind. Such dramatic scenes are usually ascribed to fields such as emergency medicine, surgical specialties and cardiology, where the endpoints are more obvious and dramatic. Hence, in our current world of reality TV, you aren't likely to see Real Life Stories of a Family Medicine Practice.  

To an outsider, our day-to-day clinic lives could take on a kind of medical banality. But in true underdog-turned-hero fashion, I would humbly offer up family medicine and primary care in any competition to determine which specialty saves the most lives. 

In primary care, our manner of life-saving is qualitatively different from that of our subspecialist colleagues. We save lives in ways that our patients, and even we ourselves, are often unaware of.

Our lives move from beginning to end in a linear fashion. Picture a leaf drifting on the surface of a babbling brook -- every ripple in the water, a change in direction of the breeze, the brief touchdown of a dragonfly alters the path the leaf will take and, ultimately, when and where it will come to rest. This is the nature of saving lives in primary care.  

If I help an obese patient lose weight, it may prevent the development of metabolic syndrome and diabetes, which could have led to an early heart attack.

If I instill the importance of avoiding texting and driving to a teenager during a well-visit, that could prevent a car accident that would have taken the lives of multiple people.

If I treat the depression that plagues a middle-aged patient, it could prevent his or her suicide.  

Resolving polypharmacy in an elderly patient could prevent a fall that would have resulted in a broken hip and started a downward spiral.  

Though we cannot know all the variables and predict the course, there are times when one of us does become conscious of the change. For John, this was one of those moments.  

He had presented to my clinic about three months earlier for a routine checkup.  

"Has anyone ever told you you have a heart murmur?" I asked.  

"No," he replied.  

It was a 2/6 systolic murmur at the right sternal border, radiating to the neck -- an aortic murmur. He had some fatigue but had not thought much about it. After further testing, he was determined to have severe aortic stenosis and underwent successful valve replacement.  

"If you hadn't discovered the problem and got me to the right people, I might be dead right now," he said. "Thank you."

Family physicians do these things every day. Whether we're offering the simple touch of a hand or a sympathetic ear to managing a chronic condition the best we can or engaging patients to make caring for their own health a priority -- we have changed the course of that leaf.

How many lives have we saved? We'll likely never know for sure. But at the end of a hard day, if you wonder why you even bothered to get up that morning, consider that because you did, someone will live a long, fruitful life.  

Peter Rippey, M.D., enjoys outpatient family and sports medicine practice in a hospital-owned clinic in South Carolina.

Posted at 01:02PM Aug 22, 2016 by Peter Rippey, M.D.

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