Which is the greater good: to serve more people or to serve fewer ones better? To be more specific, in my current medical practice, I see a far greater number of patients than I did previously. Consequently, in a given day, I spend less time with each patient. I now can pretty much classify any new patient and their symptoms into one of a relatively small number of categories within the few couple of minutes of the encounter. Rapidly I can begin to triage their workup and select what diagnostic or therapeutic options I will employ. There is a limited number of clarifying questions I will ask. I try to do a little patient education regarding new drugs or unfamiliar diagnostic tests. If the patient has any questions I try to answer them. Then I speak some “transitioning” language so as to prepare the patient to be checked out by my staff. And I move on . . .

Many of our patients are poor or indigent. Many don’t have a lot of formal education. There’s a high incidence of smoking, obesity, diabetes, and sedentary lifestyles. It’s difficult to explain complex concepts of cardiac anatomy and disease pathophysiology to them. Usually if I try to engage them in the decision making process they just shrug and say “whatever you think, doc”. The most worrisome disorder - coronary artery disease - is highly prevalent and dangerous when undiagnosed. Yet the symptoms are often misleading or non-specific. The physical exam is nearly useless. But with a ten second CT scan that I might order, I can instantly see a “snapshot” of their cardiac risk that creates immediate direction for their therapy-or major reassurance when negative.

So what’s better? Should I spend more time establishing a relationship with these patients (most of whom, if new patients to the practice,are referred anyway by the primary providers for a consultation) or should I attempt to see a larger number so as to provide more of them with useful even potentially life-saving information and advice? I wonder . . .

Tags: obesity, technology, smoking