My clinic

Sometime during my first year, I came to understand my relationship with my clinic patients. For so long, I'd been trying to be the general, ordering the troops. That was how I saw my clinic interactions. I was largely unsuccessful. I had a lot of noncompliance. I had a lot of problems that you'd expect with any resident clinic. And so, I decided that I needed to change my perception of the doctor/patient relationship.

And what I came to realize is that it's not at all like a general and a soldier. I can order my patients around all I want, but there's no imperative for them to actually follow my commands. Their successes weren't their own, but were mine. Their failures weren't mine, but theirs. They didn't have any control over their care. I did.

Touchdown, uploaded by ohad*.

And since I watch a lot of football, I realized that the doctor/patient relationship is more like a coach and a player. As a coach, I provide strategies, game plans, scouting, and the occasional pep talk. I know the challenges and each week, I prepare the player for competing. I even call the plays. I've got a staff of folks, from assistant coaches to equipment managers, who help to ensure that the players are ready to play. There's all sorts of tools available to help the players. But I'm not playing.

When the game's going, I'm on the sidelines. I try to give advice or coordinate efforts or direct the action, but I'm not playing. I'm just on the sidelines. And the victory doesn't go to me, it goes to the players. And the loss, if the players did their best, is on me. That's the role I have. There is no success of the coach without success of the player.

And even then, I find in my clinic that I have some Peyton Manning's. They can call their own plays, run their own offense, and they just need someone to coordinate the rest of the efforts. They need support, not leadership. And some in my clinic are Terrell Owens's. They don't want to listen to my advice or recommendations, and they fail to succeed on the field.

And so, with my patients, I try to be their medicine coach. I tell them the game plan and give them the strategies. I prep them and encourage. I have them work with the other coaches and staff. I make sure they've got the right equipment. But once they leave the locker room, it's on them to succeed or fail, and they have to want to win. Without the will to win, in sports or in medical care, it's hard to succeed.

Strangely enough, my patients love me. Really. My attending comes in and they shower me with praise. I listen well. I explain things. I address their concerns. I care. My attending told me I'm a natural at clinic because I have empathy and compassion, and those are two things you can't fake with patients.

And much like a coach, my accomplishments, they don't make me proud. I'm more proud of my diabetic patient with an A1C of 6.0 or my hypertensive with a BP of 110/70. Because they're out there on the field. I gave them the tools to win, but they're the winners.

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