I-70 or 285?

I ask myself every time I leave Centennial, on my way to Silverthorne. If I have time and nobody in the car who will complain, I always choose 285. It takes at least 45 minutes longer, and it’s a much prettier drive. Thanks to dear friend Rachel who took me this way the first time in 2012, I have now stopped at state parks I never knew existed and passed through beautiful valleys and plains that take my breath away. Less traffic also makes for a more relaxing, even contemplative ride, which I appreciate more and more. Fun turns that open up around the bend to expansive landscapes never get old, and depending on time of year or day, and of course weather, I never know what I’m going to get. Every time, I am richly rewarded with yet a new perspective on the path, the journey–this iteration of the way. I get to explore and learn, to savor and revel. I learn what exits lead to which trails, where to get gas, and where to stop for the best views.

I have the sweetest gig any primary care doctor could hope for. With 5% of a typical full time patient panel, I have the greatest luxury in all of medicine: time.

When someone presents with classic signs and symptoms of a well-described and well-understood condition, it’s okay to take the highway of standard testing and conventional treatment. When the story and picture are less clear and straight, we need to slow down, look around, listen harder, wander the side roads. What’s rustling in the bushes? What path was taken to get here, and what roadblock(s) encountered along the way? What equipment do we anticipate needing as we proceed, and will we know how to use it?

Sometimes even the clear and straight path turns icy, muddy, or otherwise unexpectedly obstructed. This is when knowledge of alternate routes really pays off; even better if those routes are familiar. So often I take extra time talking to patients, even when I think I know what’s happening. I ask more questions to flesh out the story fully, to learn more. Have you had this before? What’s same/different about it this time? What was the context? What made you call me about it? How much is this bothering you? What are you worried about? What’s going on in your life now that may have triggered this? What else is happening? What do you think is going on, what story are you telling? Anything else?

I never know what I’ll learn in these meandering exchanges; most of the time I just get to know my patient a little better. That’s worth so much in itself. And eventually, I have learned, all of this accumulated familiarity matters. My ‘impression and plan’ for any given problem can evolve quickly over a history and physical exam, sometimes taking sharp turns. And it’s the best feeling when my patient and I can look at each other and say, “Wait, remember when…?” and it sheds light from the past on what’s happening today.

Today’s objective may be relief of pain and discomfort. Depending on the severity and urgency of the problem, we may race to that end speeding on the freeway. Our journey together as physician and patient, however, is more like a long and winding road trip. We have much to explore, if we travel together long enough. When you’re not in pain and have some time, we can take the scenic route together, get to know each other better. All of the photos, wildflowers, stories, and memories we collect along the way just make the trip, and our connection, that much more beautiful.