Greater access to care means greater responsibility for doctors

May 10, 2011

The author discusses building trust with new patients.

I am saddened to see that a sibling died secondary to suicide and note the extensive history of substance abuse and mental health disorders in her family members. Turning to the last page of the form, I see that she has an artistic bent but is currently unemployed. She continues to drink alcohol despite her history, and she is a smoker but wants to quit.

I put my hand on the doorknob and enter the room. She sits in the chair, hunched forward, but turns to greet me as she hears the door open. I smile, offer my hand, and introduce myself. I sit down in front of the computer and log on.

"Thanks."

"I see you're here for a physical exam today. Do you have any other concerns?"

The visit continues; we discuss her health history, and the few symptoms that she volunteers. During the exam, I study her more closely. She has old eyes, clearly having seen a lot. Her hair is blondish-gray, slightly curling around her head. She is shabbily dressed in mismatched clothes, but clean. She is thin, emaciated even.

Carol sits up straight, however, and breathes in and out as instructed, sticks out her tongue, says "ahhh" on cue. She listens attentively as I discuss recommended screening tests and the need to supplement her diet with calcium and a multivitamin. In our tentative new relationship, I start the conversation about alcohol use. I will continue this conversation as trust builds between us.

AN AIR OF CONFIDENCE

Carol is certainly poor and disadvantaged, and judging from her medical history, this likely started at birth. She has neglected her health. She hasn't had a pap smear in more than a decade, and she has never had a mammogram. Her lipid panel and fasting blood sugar are a mystery. Although the clothes that hang on her slender frame are worn, I suspect that she has dressed up for our visit.

Despite all of these things, she possesses a certain confidence. She has a dignity in her newly acquired health insurance. She belongs in the exam room and she deserves the care I provide, if only because of the insurance card safely tucked away in her wallet.