I love seeing patients out in the community. I don't acknowledge them unless they acknowledge me first and then I just say hi. I don't engage in any conversation about their health. I just like seeing people in little
snippets of their lives because it adds texture to the picture I have of them in my mind. Occasionally I see patients at stores around town, walking down the road, at the park or playground, at community events or waiting for a bus. Most of the time I assume that patients don't remember me because they may have just met me once when I was shadowing another doctor. I have not had many patients of my "own" so far so I don't run into those precious gems often. The context in which you see a patient can highlight aspects of their history or medical issues. I like to see a patient, who has been working on things like lifestyle changes or stress reduction, out for a walk. It can be telling to see a patient who claims to be in 10 out of 10 pain with a terrible limp, walking easily up a hill.
Once I saw a patient heading into a pharmacy a few hours after getting a
prescription for antibiotics for her child. It was a freezing cold day. A few days later I saw that same patient on the other side of town near a part of town that she probably lived in. I knew she didn't drive and that she had had to walk a few miles, pushing her son in a stroller on a cold, windy day to go get those antibiotics. I think it helps to have as telling a picture of your patients as possible. You can ask all kinds of questions but actually seeing people in moments of their daily lives adds a much more tangible element to the care that they can
receive from you. A psychiatrist once told me that you have to care about a patient in order to help them. For me that
continuum comes more easily the better I know a patient and the more connected I feel with them.
Once I saw a patient who I felt I had completely blown it with in the office. Her kids were actually the patients and she was a tired mom who had been up all night with a sick child. I just managed to fumble through the visit, probably adding to her already fatigued level of elevated stress. I happened to be with my daughter when I saw her out in the community and found myself wishing that she would see me and remember who I was and see a
snippet of my life, as a mother, and maybe see that I could relate to her a little even though I was not the best student doctor that she saw that day with her sick kiddo.
To me this is part of what family practice is all about. I envy the doctors I work with who have been seeing the same patients for ten or twenty years. The doctors know a lot about their patients and the patients know a lot about their doctors. They see each other in and out of the office. Their kids might know each other. They might have the same mechanic or hairdresser, and they might fight for the same issues at town meetings. Or they might have very different opinions about the community they share. When I grow up I hope I live in a community where some of my patients live.
I celebrated Earth Day and the two day interlude between Family Medicine and Internal Medicine by going to a really beautiful part of the world with Ms Perpetual Motion. It turned out to be the perfect mix of sun, fun activities for kids, and hands-on with sea creatures. We both returned home a little brighter and little sleepy from a whole weekend of walking!!! After arriving we did not drive once until we got in the car to go back home. It was really nice because now I am driving about 40min. each morning to go learn from really, really sick people. Yesterday I felt a little overwhelmed after spending several hours in the afternoon in the ICU struggling to understand the dynamic process of multiple organ failures...cardiac, lung, renal...in the same person. OK, since I was raised a Human Ecologist, I should be able to grasp this concept pretty easily. Everything is interconnected. The heart is like the watershed, the lungs are like the trees and the kidneys are like the wetlands. If you destroy the wetlands, then silt and junk builds up and becomes toxic. When the trees are gone the world becomes hypoxic. And if the watershed is interrupted plants and animals starve or get flooded out. 
