Blogging again

Beginning on a light note:

I playfully asked a nearly-three year old girl what she was going to be when she grows up.  Without missing a beat … "a woman"  she says.

We'll see if I can sustain blogging this time.  After nearly 4 years of blogging .. I took a break over the summer.  Have been very busy with patients in the office and with some other projects that I hope to write about soon.

Today's reflection is about listening – something that physicians still do rather little of.  Longtime readers (are any of you left?) will recall that I sometimes do reviews of physicians for the New York State OPMC. It's alwasy interesting to do this – and it is usually hard to witness and even participate in the end of a physician's career.   The most recent participant is a kind person, and I think a rather good physician who made some mistakes and is therefore under review.  We talked a lot about listening – and I heard so clearly that this physician felt that LISTENING to the patients is so important – yet so hard to convey in the chart.  It's the quality of a "good physician" that we will never be able to guage from a chart review – or even a physician interview. 

And so I was reminded when this evening – one patient talked for 35 minutes straight, and another asked (when I advised a counseling referral) why I can't be the counselor.

What usually gets documented in the chart is something like " we talked about _____ for __ minutes and greater than 50% of the visit was spent face-to-face counseling"  The 50% part of course is to document for billing purposes that this was a counseling visit and therefore I am billing based on time.  Ugh.  It sure is a bad representation of what really happened.  The richness of the experience – the connection – is not portrayed.   Then again .. so what?