A patient appointment for a physical could yield a cancer suspicion or diagnosis. An appointment for chest pain could lead to an intervention for domestic violence. A quick visit for a skin rash could land a high school senior in the hospital for a leukemia workup.
In this business we can never assume that a visit will be about what we somewhat callously have been calling the “Chief Complaintâ€. You have to be prepared to shift gears, sometimes because the patient drops a hint or a bombshell revelation they didn’t tell the scheduler, front staff or medical assistant. And sometimes because you hear, see or palpate something suspicious.
In some ways, we always have to be triaging, before we settle into a “routine†visit. Triage comes from the French word “trierâ€, which means “to sort†or “to selectâ€.
Primary care is messy. We have to sort who needs something done quickly for a high risk symptom or finding, who needs a different level of care, who needs simple reassurance and who needs a long term plan.
All of this without forgetting the screening and preventive health agendas, which is what we are graded on. There is no formal tool to evaluate our diagnostic acumen. So we are measured for what is easy to measure, the so called “street light effectâ€.
An Innocent Looking Rash
The Art of Listening: Beyond the Chief Complaint
Primary Care is Messy
