One of the underpinnings of the Affordable Care Act is the notion that everyone should have a primary care physician, ideally in the community in which they live. For patients, bumping into their physician on the street or in the supermarket can help remind them to schedule that missed visit or refill a prescription. For physicians, interacting with patients inside the community lends them a different kind of insight.
Danielle Ofri, MD, PhD, a physician at Bellevue Hospital in New York City, co-founder and editor-in-chief of the Bellevue Literary Review and contributing writer to various publications, recently penned an article in The New York Times detailing just how valuable knowing patients outside of the office walls is.
Dr. Ofri generally liked seeing her patients milling around town, but she began to feel slightly uncomfortable seeing them in the school setting. When her children began attending the local elementary school, she said, "I felt a discomfort that was different from what I had experienced on the street," and she could sense her patients felt just as awkward. Exchanges were limited to quick smiles and hellos.
But one experience with a patient changed her perspective. Dr. Ofri was called in to evaluate a woman with pneumonia who had been in a psychiatric ward for several months. Severe depression had led to numerous hospitalizations over the last decade, making her unable to hold a job or spend much time with her kids.
"It broke my heart to hear this, imagining how difficult it must be for her children," Dr. Ofri wrote.
When Dr. Ofri parted the woman's hospital gown to place the bell of her stethoscope, she saw an elaborate tattoo of a "one-of-a-kind" name across the patient's back. Dr. Ofri recognized it immediately. It was the name of one of Dr. Ofri's children's classmates.
As it turns out, Dr. Ofri knew the child had behavioral difficulties and struggled socially. "Now I had the context for this," she wrote, "the painful effects of a parent with mental illness."
"As I listened to the reedy murmurings of my patient’s breath, I tried to sort through my own feelings. Part of me felt guilty that I was in possession of 'insider information' from the nonmedical part of my life," Dr. Ofri wrote. "On the other hand, this knowledge offered me a broader and more empathetic understanding of the implications of my patient's illness. It wasn't as if I'd obtained this information in any sort of unethical manner. Yet it made me uncomfortable."
Although the experience produced conflicting emotions within Dr. Ofri, being a local physician has advantages. With a more nuanced understanding of each patient as a person with a family, family difficulties, personal interests and aspirations — not just as a medical chart — physicians have access to the information and tools necessary to provide the most patient-centered care possible.