What makes exceptional primary care? Part 1

Pillar #1 - A clinician who understands themself, their emotions, and their biases

Making difficult clinical decisions is as much about knowing ourselves as it is knowing our patients. These moments pull for our own intense anxieties, which cloud our assessment of risk (often towards short-term risk aversion at the sacrifice of long-term gains). Common situations include recognizing when the “evidence” doesn’t apply, where guidelines are myopic, and when high complexity leaves us feeling helpless.

A clinical example - An elderly, homebound patient of mine with sky high blood pressure and cholesterol, with depression and chronic pain - willing to take only one medication. A reflex decision to send her to the ED for a scary number (chronically high without symptoms) would’ve been more about my discomfort than her well-being. Similarly, using our one shot on a blood pressure pill would've been short-sighted - a maneuver primarily for us, not for them.

We played the long game in treating her depression and chronic pain first, holding our own discomforts and (successfully) working towards BP and cholesterol control at a later visit.