We had our visits at the Senior Care Institute at UPMC Shadyside last Friday. They
scheduled our appointments back-to-back, and advised us to allow up to three hours
to meet with various members of the team. There were careful instructions on
where to park and how to find the office, and an introduction to the various things
that might happen in an initial appointment. The doctor’s office called several days
ahead of time to ask the nature of the visit, whether we had any specific medical
issues, and whether we wanted to meet with a social worker. We had filled out a
health history form, and brought it with us along with previous medical records,
advance directives, and medical powers of attorney.
Steve met with a nurse practitioner and I saw a geriatric resident. The resident had
read all of the materials and had five points she wanted clarified. In the previous
experience, I found it annoying to have filled out all of the information ahead of time,
only to have the initial contact person ask all of the questions again. After she
examined me and we discussed my goals for the visit, she relayed that information
to the doctor. They returned together and the doctor proceeded to introduce me to
his practice, which is run like an “old fashioned general practice,” despite being
housed in a modern medical center. There are five geriatricians who rotate call on
weekends, but during the week they answer their own patient’s calls. And
whenever there is a test result to be shared, it is your doctor who makes the call. He
spent time getting to know me and what I was hoping for in coming to the practice,
and was genuine and self-disclosing enough to make me feel that we were beginning
a real relationship. It reminded me of what medical care used to be before
insurance companies started calling the shots.
Steve’s experiences were similar. His conversation with the physician was positive
and collaborative. And it didn’t hurt that he started off saying he was familiar with
Steve’s research.
There is an art to the practice of medicine that is more than the sum of the numbers
in an algorithm. We’ve always known that best diagnosticians are doctors who have
seen many and varied patients, and who can recognize patterns of symptoms as well
as unusual variations. These very special doctors allow themselves time to get to
know their patients well, including listening carefully to what they say and how they
say it. They use clinical data as a supplement to their own judgment, not as a
substitute for it. They use current research where applicable, but their medical
practice does not come from the evidence-based cookbook. Most importantly, they
recognize that for any medical intervention to work, there has to be a relationship of
trust and collaboration between doctor and patient. The Senior Care Institute has
these same principles as their credo, and as far as our first experience went, we felt
respected and heard and understood. To paraphrase Humphrey Bogart in
“Casablanca,” I think this could be the start of a beautiful relationship.
