What's right with you?

One of the things that I think is off about modern medicine is that we are constantly asking "What's wrong with you?"

Part of the reason with this is that the main governing body that dictates most healthcare policy, the Centers for Medicare and Medicaid Services (CMS), won't pay for a patient visit unless we have a chief complaint.

If you think about that, it's an absurd way to approach life.  Imagine this any other domain of life. Imagine you went to a restaurant, and they asked "What's wrong with you?  What's your problem?"

There is an alternative approach, which is asking about your goals, your aspirations, and what barriers prevent you from achieving these goals.  I find this a much more positive way to talk to patients, and leads to a happier end point.

Along those same lines, in the Impression/Plan section of our notes, we often include a list of all the things wrong with a patient, which again strikes me as an overly negative way to approach medicine, and to approach life.  One of the things I try to include in notes with patients are predictors for success.

For example, I just met a lovely 63-year young retired educator with multiple musculoskeletal conditions.  I made sure my note included:

Predictors of good outcome:
- kindness
- intelligence
- nice skin (a marker for overall connective tissue health)
- non-smoker
- married
- educator
- minimal focal weakness
- has not hired an attorney
- primary motivation is to exercise

One of the joys of working in a physician-owned practice with my partner Garrett Hyman is that Garrett and I have the latitude to focus on the positive aspects of patient care.  CMS may not think these things are important (.... and you can see where CMS's true value system is, because they don't pay you for talking about the positive, only the negative), Garrett and I think it's important.  And we think that a focus on the positive is the "secret sauce" that leads to better patient outcomes.