The topic of healthcare came up during a recent dinner with friends. Between bites of pizza and swigs of beer, I told them that things were challenging for doctors everywhere but that this was especially true for primary care physicians. I launched into the well-known litany of reasons: more patients to see in less time, reams of insurance paperwork that must be filled out to get paid, the uncertainty of healthcare reform, an aging population with more chronic disease, and on and on. With those daily burdens, it was easy to forget the core values that got us into medicine in the first place.
Then one of my dining companions chimed in about his own experience with his primary care doctors. He said something that went straight to the heart of one of those core values: "More than once, I've been the beneficiary of a curious physician."
His comment has been nagging at me ever since. It forced me to think about the last time I had been curious about something or someone in my day-to-day practice of pediatric medicine. I was disappointed to realize that I couldn't remember.
Curiosity. It's a fundamental trait. If you watch the medical drama "House," you see it in every episode as the title character (played by Hugh Laurie) chases the diagnosis of the week.
All of it made me wonder: Outside of good TV shows and academic research centers, is curiosity in medicine dying at the hands of the modern healthcare climate?
In talking about it with other doctors, we agreed that the drive in modern medicine was not to deeply explore our patients' ailments in biological, psychological and social contexts. Rather, it was to be efficient and productive in managing disease. Some physicians I've spoken with even compared their day-to-day work with being on a factory assembly line.
Doing our best under these circumstances can be tricky. Most primary care doctors see a patient every 10 to 20 minutes. (I get 15 minutes for my appointments.) In the few moments between consultations, we are often answering messages from other patients, following up on the myriad lab tests and referrals we've ordered, filling out the litany of forms patients need us to complete and trying to keep up with the unread journals piling up on our desks.
With so much to do, it's hard to slow down and be curious. Instead, primary care medicine has become more algorithmic.
As a second-year medical student, I was mentored by a crusty internist from South Africa. "What we practice," he said with his crisp accent and pedantic tone, "is pattern recognition."
I didn't realize it back then, but he was right. We spend most days trying to make patients fit into patterns we can manage in minutes: A 3-year-old with a monthlong cough? Try an inhaler. An adult with high cholesterol? Start a lipid-lowering drug. And if a patient doesn't fit into one of our heuristics? Order more tests or make a referral to a specialist. Instead of taking time to think, we blink and move on.
But whether we're stationed in big hospitals like the fictional Dr. House or, like me, are community doctors in the trenches, we all need some level of curiosity to thrive in medical practice. It pays off for people on both sides of the doctor-patient relationship. For patients, a doctor's interest can be therapeutic in itself and can help strengthen the bond with their physician. For doctors, curiosity leads us to the eureka moments we all live for, when the correct diagnosis comes into view. It also leads us to indelible experiences we can share with our colleagues.
Consider this story from Dr. Faith Fitzgerald, a UC Davis physician who wrote about just such an experience for the journal Annals of Internal Medicine. In her essay, Fitzgerald recalls the case of an elderly woman who was presented in a cursory manner by a resident during morning rounds. Fitzgerald inquired more deeply, prompting the patient to reveal that once, years ago, she had been hospitalized for a broken arm because a steamer trunk had fallen on it. When Fitzgerald pressed further, the patient said the boat she was on had lurched because it had hit an iceberg. That boat was the Titanic.
A nice dose of curiosity to break up an otherwise humdrum day.
Parikh is a physician and writer in the San Francisco Bay Area. He is a contributing writer for Salon.com.
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