By Kara Frame, MD
Return Patient Visit- Three simple words that, when put together, can mean so much. A year into my current practice, I am starting to see these words with a little more frequency but they are often sprinkled sparingly onto a schedule that is more dominated with a similar but very different meaning phrase- New Patient Visit.
Prior to this past year, I have never had the fortune of building a practice- of developing a unique panel of patients who anoint me as their doctor. When I dove into residency, swelling with excitement and trepidation at the start of a career in family medicine, the patients were already there: a nicely packaged group of people who had been cared for by a stack of residents before me. There was no patient recruitment required. Rather, I had inherited patients who were committed to remaining part of a residency practice and helping to train young doctors.
During the three years of my residency training, many of these patients became familiar- so much more than a name and a chief complaint. As I reviewed my schedule before each clinic session, thoughts of patients’ pets and grandchildren and the stubbed toe they had last winter would rise up right along with their litany of medical issues. As my medical knowledge and skills developed, so did my knowledge of and care for my patients as people. Even now, separated by an increasing amount of time and miles, I frequently find myself thinking back on many of them and wondering, not only about their health but more often about their lives.
But now, early into a new practice, I regularly find myself engaged in a kind of courtship- complete with the exhilaration and awkwardness that is typical of a first date. Patients come to me entirely unknown as we begin the dance of a medical visit- working to take care of the chief complaint but also vying to see if we are a good fit. Does my practice style fit with their needs? Do our expectations of the doctor-patient relationship align? This process has been exciting, but at times it is also exhausting. When every visit is a “first visit” there is no prior understanding, no relationship to lean on. I have loved the chance to meet and care for so many new people, to have them come to me, a complete unknown, and trust that I will do my best to care for them. It is humbling. And while starting fresh with each patient can be difficult, it also provides a wealth of possibilities. When each person is new, we are not bound by prior restrictions- we are free to build our bond into whatever feels most comfortable to us both.
Slowly, I am starting to build my “panel”- a group of patients for whom I am the primary care physician. I am starting to recognize more and more names on the daily schedule. On one recent morning as I looked down the schedule, every name was known; it felt momentous.
We are just entering residency interview season, which means that I have been reading numerous essays that answer the question: Why have you chosen family medicine? The responses are easy enough – the ability to care for patients regardless of age, to practice OB and care for the baby too, the massive spectrum of care you can provide. Why choose family medicine? For me the better question has always been: why would I choose anything else? But of the multitude of reasons to go into family medicine, there is one that stands above the rest: the very foundation of family medicine- the Holy Grail. For me, it is a lasting relationship with a patient.
Kara Frame, MD is an assistant professor (clinical) at the University of Utah Division of Family Medicine.