Continuity of Care

My one year anniversary at my job is coming up. It is really hard to believe that I have been here for an entire year as an attending, adding on to the three years I was here as a resident, I have known some of these patients for four years. FOUR YEARS! I have known some of these people longer than I have known Aidan!

There are essentially two ways to categorize physicians: the ones that practice continuity of care, and the ones that don't. Typically, radiologists, emergency room physicians, costmetic dermatologists, and the like, don't follow patients over the long run. Psychiatrists, pediatricians, most internists, follow our patients for a very, very, very, long time. Some days, when I am so TIRED of the same compliant from the same patient, I think about how I would no longer have to treat this person, and the options are pretty limited. 1. I retire, 2. The patient fires me, or 3. The patient moves, or 4. I quit. Otherwise, most of these patients stick around.

I like knowing patients over the long run, to know them intimately is a privilege. Of course, it is also inevitably sad, since illness and diseases progress overtime. Just this week, a patient found a recurrence of breast cancer that she battled in 2000 (before I met her in 2003.) Another patient, with multiple medical problems, and schizophrenia, is also getting more and more sick. His primary care person and I already discussed his limited life expectancy (so I guess there is a fifth option, that the patient dies...) and I am prepared for the day when I get that phone call.

I think I am better at short term treatment, so in-patient work is definitely my calling- to discharge someone, wave good-bye, is a treat!