Dear Patients

 By: Dr. Daniel Pepe, Family Physician | April 7th, 2019

When I first started medical school, I remember hearing from one of my mentors that I would learn more from patients and their families than any textbook, article, and mentor.

Needless to say, Dr. Kim was right. Throughout my clinical journey I have learned more from patients about medicine at 3 am on call, on a tuesday afternoon in clinic, and a last minute house call on a Sunday. At every turn, I am amazed by their resilience, ability to solve problems, and patience within an imperfect system. Patients put up with a lot. Being unwell is challenging and our system does not always do everything it can to alleviate that burden of suffering. To add to that, I was disheartened when I read a story about the family of Christina Gilman (@GilmanFamily) who was confronted with a sign that said "For your safety and ours,  please limit the discussion with your provier to one issue per visit" (1). 

 As a physician who sees between 22-30 patients per day, I can understand the idea behind trying to ensure that our time is used efficiently. However, when I read that article I was a bit disheartened. We are family physicians and we are here to listen. Thinking about how I could use my time more effectively, I realized that some days I run 45 minutes to 1 hour behind. The main reason for this is not that I am taking my time nor working inefficiently. Rather, I am spending quality time with each patient to understand their symptoms, listen to the impact their illness has had on their life, and genuinely try to come up with a plan to help them improve their health. Often times, this plan involves understanding a patients background, their family situation, financial situation, current employment, relationships and hobbies. Needless to say - as my wife and I build our family practice together, limiting patients to "One issue per visit" doesn't allow us to treat the whole person. 

As a result of Christina's experience, I felt it was important that I reach out to try and find a solution to her problem. Maybe it wasn't the patient's fault for "taking so long" - maybe I wasn't asking the question correctly or listening to the answer I was being told. Last weekend I decided to try and create a tool to help physicians better listen to patients and improve communication between doctors and patients.  

My Doctors Visit was just my simple attempt to try organize all of the things that are discussed during a typical doctors visit. Here is the amazing part of the entire thread - #patients started replying and my simple word document with text bubbles became something much more. I often read about and see people use the hashtage #codesign on twitter but it always seemed very opaque and difficult to acheive. What I quickly realized that night as patients, caregivers, and even physicians were chiming in is that this tool tapped into a strong desire for everyone to be equally engaged. 

Reviewing the tweets while writing this post I can confidently say that both My Doctors Visit & My Caregiver Visit began as just an idea to improve experiences for patients and caregivers but it has since morphed into something well beyond anything I could have imagined. Beyond the engagement and feedback we received in the first 24 hours we have also made a great connection with Cognisant MD who graciously optimized My Doctors Visit on OCEAN to help us with the roll out of this tool. 

Two weeks into this experience of real, live, crowdsourced co-design I have no doubt that this is just the first of many projects to be co-designed with patients. I can't express my thanks to each and every patient involved but will try to show my appreciation by keeping patients at the center of everything I do. 

Sincerely, 

A grateful GP 

References:

1. https://www.cbc.ca/news/health/second-opinion-one-problem-visit-1.5061506 | Follow Christina Gilman @GilmanFamily