Today I was faced with a choice.

To fire a patient or not?

*PAUSE*

“What do you mean “fire a patient”?

Well, I mean fire a patient. Dismiss. No longer care for. Discharge from the practice. Patients can fire their doctors and doctors can fire their patients. Who knew?! If a patient is being fired from a practice there’s usually a pretty good reason such as…

• repeated no-shows
• disrespectful treatment of the staff
• threatening the staff
• not cultivating a productive relationship with their physician [essentially blatantly doing what their doctor says not to do all the time]

Those are the most common reasons that I’ve seen so far. Unfortunately, I’ve had to fire 2 patients in the last year for disrespectful treatment of office staff and hostility that created an unsafe work environment. Yikes!

So today I received a message from our office manager stating that this particular patient had no showed several times and that this would be his 2nd warning letter, I could choose to send the 2nd warning letter or dismiss the patient from our practice. I’m sure some people wouldn’t have thought twice, this patient is wasting our time scheduling appointments and repeatedly not showing up. Just for additional context… this patient isn’t the most compliant with medications, continues to smoke, doesn’t follow nutrition recommendations for uncontrolled diabetes, can be rude, and is quite demanding. Even more reason to say “See ya buddy” right??

I can’t lie, part of me thought about it. I would no longer experience that instant feeling of dread when this patient’s name was on my schedule. I wouldn’t get frustrated as the diabetes and blood pressure gets more uncontrolled, it would be someone else’s problem.

Or would it?

I paused when replying to the message because I thought, “If our office doesn’t take care of this patient who will?”

This patient lives alone, has never mentioned family or friends, struggles to get to appointments due to lack of reliable transportation,  has several chronic conditions, and isn’t motivated to change any of this. I’ll be frank and let you that not many people are going to be excited to take on this patient.

As much as I get frustrated taking care of this type of patient, that’s kind of what I committed to when I chose family medicine as a specialty. We often care for the uninsured, underinsured, chronically sick, and marginalized.

Something else I thought… What if we [our office] is all this patient has? I’ve never heard this patient speak of family or friends.

SO MANY PEOPLE ARE ALONE

You wouldn’t think so, I mean its 2018. We have phones with video call capability for crying out loud! [I remember a friend of mine in elementary school somehow made me believe she had that capability on her land line phone…I was a gullible kid *shrug*] Within seconds we can be connected with people on the other side of the world via video chat, text message, phone call, email. All of this technological advance in the name of “staying connected” , yet so many are the most disconnected from family and friends they’ve ever been.

I don’t think we can excuse it away by assuming they don’t have access to the latest technology, while this is probably true for some it’s definitely not the reality of most people. Even if all you have is a flip phone and can text from it!

So why? Why in a society where we are supposedly so “connected” are people so alone. The followers, friends, likes, retweets increase but real connection is in the trash.

According to an article from Fortune.com, roughly half of the population feels lonely.

Half of Americans Feel Lonely.

Half?!? If you want to see more numbers and read about how loneliness increases your risk of early death, look at this article from the American Psychological Association.

So Lonely I could Die

I won’t quote a bunch of statistics, the bottom line is that there are a lot of lonely people out there during a time when we claim to be so connected! I honestly believe most of my elderly patients see me so often more for social reasons than medical, which is heartbreaking. BUT… it’s not just the elderly. It’s the young, the old, the middle-aged, and those that put on the biggest smile at work or school only to go home and suffer in silence.

So, how do we fix this problem? I’m no genius and my thoughts aren’t revolutionary, but we can definitely start with the basics.

• Pick up the phone and reach out. A call, a text, even a funny meme may be all it takes to start a conversation.
• Put down the phone…when you’re with people. I’m noticing more often that people can feel most alone when they’re with people. We spend so much time with our heads in our phones. Families and groups of friends will go out to eat or bowling, instead of talking with each other everyone is on their phone!?! It’s okay to put the phone down and have actual conversation and interact with real live people!
• Find groups of people with similar interests…offline. Whatever your passion, find people who enjoy the same thing and do it together. Bike, swim, play with dogs, woodworking…whatever.

In an act of complete honestly, I’m not the best at doing all the things I’ve mentioned but I’m trying. I’m working on putting my phone away when I’m with people and just being present in the moment instead of present in the moments on the inter-webs!

That was a long round about way of encouraging you to be present in the now and rethink how you communicate.

Sometimes I’m a physician, sometimes I’m just a person to engage with. I’m honored and blessed to be either.

Caring enough to listen and be present is sometimes the only prescription needed.