People inherently ask me all the time why I do what I do. From patients to family members, residents, other colleagues. My answer almost invariably I didn't choose this. This chose me. The hours are not great-24 hrs/day. Including on call. The benefits- I have none, not exacly, some, but no golden parachute, I promise you this. The pay, considering the amount of time I went to school, figure in student loans, malpractice, 60-80 hrs per week, suddenly the pay is not that good. What is it that keeps me coming to the office on a daily basis? I can't explain it, but it starts I'm sure in a time long gone.
My father was 50 when I was conceived. Talk about muscle-bound sperm :). had he been alive today he would be 90. I do have 90 year old patients, they are not in short supply. One of the benefits of modern medical technology is that we live longer. I am most proud of an 89 year old patient, lets call her Sophie. What is interesting about sophie, is that I also cared for her mother who died peacefully at the ripe age of 109. She may have been my toughest customer. I also took care of her son, her 3 daughters, their 2 childrens, some cousins, neices and nephews as well. I knew where they all went on vacations, who got into college, who got married, who got divorced, who died, etc. She died peacedully surrounded by her family on a spring morning, which is exactly the way she wanted it. I digress.
Medicine today is very industrial. There is no shortage super groups that will scoop you up and take you as their patient and offer you 1 stop shopping for all your primary and sub-specialty needs. Got a cold, we've got an ENT for that. Stomachage? We've got a GI guy for that! Need your x-rays, ct scans and mammograms done too? We've got a full service radiology suite from routine radiography all the way up to state of the art 64 slice ct scanners that can actualy map coronary artery disease in your heart fairly accurately assuming that your heart rate is below 55 beats per minute. However there is a catch. I have gotten these people in my practice. They come to me very distrustful, almost jaded, feeling like they have been violated in some way. These people are moved through these practices like cattle. The days of fee for service are long gone and now we must muddle through the maze of managed care in order to receive payment that THEY deem as appropriate for the care that has been rendered. It is a complicated process that requires a sequence of diagnosis codes to match procedure codes that must be submitted in the proper format as dictated in their terms and conditions contract that we sign after we jump through all of the hoops of their credentialing process which typically takes in upwords of six months. I am not enthralled with the whole process. This us todays medicine.
Being conceived at 50 by my father however, I believe planted a gene in me, perhaps a mutation, that takes me back to those times. The times when doctors make house calls, which I do if needed. A time when you took the amount of time you needed to spend with a patient not distracted by a double booked schedule that will allow you to pay your bills and not take a salary. I frequently find myself running behind, sometimes by as much as an hour or two at times. Most patients are not too upset by this because they know that when they're time comes and they need extra time with me they will not be ushered out the door for the next patient to keep time. I also genuinely like to take the time to know my patients, not just their medical history, the medications they take or are allergic to. I want to know where they work, are they married, children, interests, hobbies, etc. That makes the peron whole. We do not treat lungs, we treat the PATIENTS lungs. We do not treat the heart. Wet treat the PATIENTS heart. The patient is the sum total of all these characteristics, and I find it helps me offer them a better standard of care. I also sit WITH patients, not across from them. I do not wear an imposing white coat. Hugs do not require co-pays. I come off as human as possible. After all, nurse practitioner and patient are equal. We are both humans, we share a similar gene sequence. We eat the same foods. We both go to the bathroom. We have children and families, we live in the same community. I am as human as they. So often is this lost. It happened in a time long gone.
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