“My appointment was 47 minutes and he talked for 45 of them”

I am his fourth primary care physician in as many years. He described his sole encounter with his most recent physician something like this: "Hell of a nice guy and he worked as a volunteer firefighter during medical school. And so in talking with him … and out of my 47 minute visit, I think he talked about his days in the fire department for 45 of them. Now that's all fine and I'm happy to chat about the good old days but that's for the coffee shop on Sunday morning, not for my visit when paying him 140 bucks."

This happened on the same day that another patient called me and told me he was transferring care out of my practice. He told me he wasn't happy – frustrated because sometimes it was hard to reach me. "You're a hell of a nice guy Doc – but I need to be able to reach my physician more easily, you know?"

Patient-physician communication. It's at the core of what we do. My new patient was complaining because his previous physician talked too much and listened to little. My old patient was complaining bacuse I wasn't accessible enough to him.

Accessibility is very challenging. I do want to be as accessible as possible to all of my patients but it's so hard to call them all right back instantly when I have 35 telephone messages waiting for me every day. How can we possibly give such personal care to so many people?

When we started our practice four years ago it seemed impossible that we would become so busy as we have in such a short time. And the nurses today were complaining because "we've lost the personal connection" and we're getting too big.

And this may be true. It seems that we always strive for growth, as growth in business and therefore revenue seems to be so important as the pressures of daily practice (rent, salaries, mortgage, looming college education bills for our children) pressure us to maintain revenue and therefore always increase work.

But increasing work simply can't be done above a certain level. For the new patient coming in, I try my best to set his expectations at a level where I can deliver. No, I won't always call him back instantly, and sometimes he will get a callback from my nurse instead of for me and this has to be okay with him. At the same time, if something is very serious and he insists on speaking with me were coming in, I will always do my best to accommodate him.

The 9-year-old I saw this week asked he was my favorite patient. I hesitated, and told him that all of my patients are main favorites. He seemed disappointed. "Well, of course you're my favorite." A sigh of relief from the boy.

So today when a prospective medical student asked me what's the difference between family physicians and other primary care physicians I didn't have much trouble answering her. Yes, internists and pediatricians are compassionate, kind, thoughtful people. But family physicians are explicitly trained to address the psychosocial needs of our patients and those of us who deeply believe that this is an important part of what we do — do our best to live these values.