In medical school, I remember one particular lecture where a poem was read from the perspective of an elderly woman, addressing the doctors who were caring for her. In the poem, she implored them to look past her hunched posture, wrinkled skin, and graying hair. She asked them to think of it as more than a list of diagnoses and a life marked by a decreasing number of days. She didn’t want to be known as “the gallbladder in room 614” or “the MI in 1230,” as busy healthcare workers often do. She pushed a metaphorical peeling back from her aged surface to see who she really was – a fiery child, an adventurous teenager, an intellectual, a lover, a mother, a cherished friend and a revered grandmother.
For many years I tried to practice medicine using not labels, but names. The pace of outpatient medicine gave me time to to learn the names of the patients, use the names of the patients, and to visit with patients long enough to get to know their.
Just last year, I saw patients in a five-room pediatric practice in a mid-rise office building close to neighborhoods and shopping. As each patient was accommodated, a medical assistant poked his head into my office to let me know that “Jonathan was ready in room 2”. They would give a summary of the conversation they had during the recording. “The teachers are worried about behavior at school” or “Jonathan’s grandmother has fallen ill”. The office assistant who checked in patients personally transferred calls or returned to my office to ensure that I took urgent messages quickly. And most remarkably, when my mind couldn’t remember a mother’s name or a patient’s last name, all I had to do was ask my medical assistant, because she knew the names . She used names.
I now see patients in a twenty-five-room office on the outskirts of town, in an industrial area near Interstate 95 and Union Station. More than 120 patients are scheduled per day and members of the medical team communicate by instant messaging. I know my patient is ready to be seen when a yellow circle turns green on my computer screen. When the reception staff calls us to inform us of the late arrival of patients, it is an appointment time. “Your 9:30 just arrived” or “your 3:00 called to say he will be 10 minutes late”. I have never met the staff who set the appointments in person. The clinic has been called “transformative” and a “national model of innovation”. Yet the people serving the model rarely know anyone’s name.
In what exactly have we innovated in medicine? The high-volume, well-reimbursed model now offers clinical assets previously unavailable to our patients, such as co-located behavioral health and care coordination services. It’s really an advantage and a step forward. We appreciate the conveniences of the MyChart message, electronic check-in, virtual tours and online pre-visit questionnaires. What could have been an invention of medical science fiction is now a reality.
However, as we move forward and technology transforms healthcare, let’s peel back the surface layer and remember that people with names, families, relationships and more are at the center of it all.