{"id":1107,"date":"2017-08-17T15:17:03","date_gmt":"2017-08-17T15:17:03","guid":{"rendered":"http:\/\/blogs.nejm.org\/frontlines-clinical-medicine\/?p=1107"},"modified":"2017-08-17T16:20:31","modified_gmt":"2017-08-17T16:20:31","slug":"primary-cares-got-talent","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/frontlines-clinical-medicine\/2017\/08\/17\/primary-cares-got-talent\/","title":{"rendered":"Primary Care’s Got Talent"},"content":{"rendered":"
\"\"<\/a>

Elizabeth Donahue, RN, MSN, NP-C, practices adult primary care medicine in Boston, MA.<\/p><\/div>\n

There is one hour\u00a0each day in the office that I refer to as the \u201cgolden hour\u201d – from 6:30 to 7:30, either AM or PM. For the sake of my personal life, most days I aim to be at my desk for one of those two slots but not both. During this time, I\u2019m usually alone in the office and I find myself being uber productive; tackling notes and other tasks without distraction.<\/p>\n

Last Thursday night, after all the patients and staff had gone, a colleague and I sat at our desks, listening to Dave Matthews Band and charting\/chatting away. We got onto the topic of a certain tooth straightening system that rhymes with \u201cshmin-vizza-line\u201d and how we were both considering treatment. We wanted to know where we could see experienced providers for treatment in Boston, so we searched the brand\u2019s website. To our surprise, the providers vetted by the company were ranked in a five-tier system from \u201cpreferred\u201d all the way up to \u201ctop 1%.\u201d And because I love to ask inane questions that make others go \u2018hmmmm,\u2019 I began a quest to pester my coworkers into answering this question: What do you do that would rank you in the top 1% among primary care providers?<\/p>\n

\"\"<\/a>For me, the answer came easily — if my office voted for \u201cpap queen\u201d instead of \u201cprom queen,\u201d I feel I could run uncontested. In fairness, I see a lot of young, female patients, I am a stickler for preventive care, and I\u2019ve covered years of \u201cpap only\u201d visits for male physician colleagues. Therefore, some of this bravado is a direct result of quantity. But still, I maintain that I have a gift for finding a cervix — it can run, it can hide, but I will find it. On one occasion, I even found two instead of one! A septate uterus with bilateral cervices… \u00a0if that doesn\u2019t qualify for top 1%, I\u2019m not sure what does.<\/p>\n

My pharmacy colleague suggested she might fall in the top percentile when it came to insulin management and diabetes control. She is a CDE and a self-proclaimed \u201ctype A personality,\u201d so the numbers game of diabetes is where she excels. My NP teammate in the office shared her expertise and confidence in treating chronic pain; she had spent months shadowing specialists, studying guidelines (on cross titration, non-opioid management strategies, etc). In her words, she took something that primary care did not train her well for and \u201cfigured it out,\u201d so now rather than being \u201cscared of it,\u201d she can do it well. When I asked my evening charting buddy what she excelled at, she sighed deeply and told me that her special talent was \u201cmaking my patients cry.\u201d (She has found, sometimes to her chagrin, that she has a way of letting patients open up.) A male physician colleague, always the jokester, responded immediately, \u201cI inhibit that response, that\u2019s my talent!\u201d (An open-concept team room makes for frequent group conversations, but that\u2019s a blog for another day.)<\/p>\n

\"\"<\/a>Finally, one very seasoned colleague, who I\u2019ll call Bob, new to primary care but with years of experience in emergency and hospital medicine, patently refused to answer the question. \u201cI\u2019m so new (to primary care),\u201d he said. \u201cI don\u2019t think anything I do is in the top 1%,\u201d he said. \u201cI\u2019m never answering that question. Forget about it.\u201d Finally, under protest, he gave his answer — that maybe (just maybe) his talent across his years of practice was connecting with the patient quickly and \u201cmaking them feel like I give a damn.\u201d In response, I told him I might award him the \u201ctop 1% in humility.\u201d He laughed sheepishly. I just love that Bob.<\/p>\n

This initially lighthearted question led to a deeper conversation among my colleagues that uncovers for me a few of the beautiful things about primary care. First, you can find a different problem to manage each day behind each exam room door. Also, as a provider, you can choose to hone specific skills \u2014 those that interest you, or which demand or trends might dictate \u2014 or you can bring a gift that comes naturally to you to each patient you see. And in a team-based care environment, we have the ability to rely on one another’s gifts and talents. To adapt the old adage, “jack of all trades, master of none” to suit my point, I’d suggest that my talented colleagues in primary care are jacks of many trades, masters of some (they just need to be asked which ones … unless you ask Bob, because he’s still not fessing up!)<\/p>\n

P.S. Names have been changed or withheld to protect the innocent subjects of my extracurricular pursuits.<\/p>\n

 <\/p>\n

\"Register<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

There is one hour\u00a0each day in the office that I refer to as the \u201cgolden hour\u201d – from 6:30 to 7:30, either AM or PM. For the sake of my personal life, most days I aim to be at my desk for one of those two slots but not both. During this time, I\u2019m usually […]<\/p>\n","protected":false},"author":1265,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[26,29],"tags":[242,204],"class_list":["post-1107","post","type-post","status-publish","format-standard","hentry","category-nurse-practitioner","category-patient-care","tag-primary-care","tag-team-based-health-care"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/frontlines-clinical-medicine\/wp-json\/wp\/v2\/posts\/1107","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/frontlines-clinical-medicine\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/frontlines-clinical-medicine\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/frontlines-clinical-medicine\/wp-json\/wp\/v2\/users\/1265"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/frontlines-clinical-medicine\/wp-json\/wp\/v2\/comments?post=1107"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/frontlines-clinical-medicine\/wp-json\/wp\/v2\/posts\/1107\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/frontlines-clinical-medicine\/wp-json\/wp\/v2\/media?parent=1107"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/frontlines-clinical-medicine\/wp-json\/wp\/v2\/categories?post=1107"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/frontlines-clinical-medicine\/wp-json\/wp\/v2\/tags?post=1107"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}