WAIT—I already do this! 

All day, every day at work I talk to people.  I query their perceptions about their health, their habits, relationships, and leadership.  I ask about their families, challenges, and struggles.  We get as personal as they are willing, and it is always a privilege and honor to be allowed into people’s lives like I am.  Between the pre-call, the morning interview, and the debrief, I spend about two hours with each patient during their annual exam, reviewing the year past and anticipating the year ahead.  The best days end with me feeling joyously spent, having attuned and attended to each patient intently while mining all my cumulative expertise, both personal and professional, to compile the most collaborative, relevant, and holistic action plan I can muster.

I have saved face sheets from these annual exams for the past year, all the encounters that felt meaningful to me.  Each paper bears my notes from the interview, essentially a list of ideas/concepts, resources, and recommendations to include on the action plan.  It’s a set of organic notes for myself, a record of how I know each person, what stands out about their life today, the most salient aspects of health and relationships this year.

Internal Medicine is a ‘cognitive’ field—we don’t do procedures.  “I think, therefore I.M.” my American College of Physicians mug says.  I literally talk to people for a living.  And then I write about it.  Each clinic note reports my patient’s state of being, in the context of their life at the time.  Every year I add on to the cumulative ‘social history’—work, eating and exercise patterns, sleep, stress, and relationships.  Reading through that section of the note, I can see how many years I have known the patient, and how each of these aspects of their health has evolved over time.  They rise in the ranks of work, change jobs.  Weight fluctuates.  Kids grow up, graduate, leave home and go to college, get married.  Grandchildren accumulate.  My annual exam note is the record of a person’s life as I hear it.

Each encounter note’s ‘Assessment and Plan’ is essentially a problem list with my description of each active medical issue, interpretation of potential causes and implications, and plan of care.  It serves to guide anyone who cares for the patient in the future (myself included) and to inform patients themselves, so they may know the rationale behind my recommendations.

This past week, I started a new journal to document each encounter for my own benefit—to recall and reflect on each interaction and log my own perceptions (intellectual, relational, visceral, and otherwise) and insights.  Each entry ends with the heading “FEELING”—my attempt to articulate how the encounter affected me personally, what meaning I derived from it.  I LOVE this new practice.

Similarly, I have often journaled feverishly after conversations with my best friends—the deep, philosophical, and bonding ones wherein I grab my journal in real time to jot ideas, insights, and epiphanies.  My days off fill up with calls and coffee dates well in advance, and I now set aside time after each of these encounters to make similar recordings to those after my patients’ annual exams.  Between friends who have known me decades (‘stem cell friends’, as I have named them this week) to lovely new ones who may be decades younger or made in specific contexts (‘tissue friends’), the connections made of late flourish as if doused in Miracle Gro concentrate.  And I’m writing it all down!

This blog will be ten years old in April.  This is the 630^th post.  It all started because I wanted to write a book on physician-patient relationship and how to save it.  And yet the focus, content, and organization of Book has eluded me all this time.  But it’s okay; I’m having so much fun with the process, feeling my way through, attending to and reveling in each twist and turn of the journey.  I’m getting closer.  I have no deadline or expectation, no goal other than fostering and honoring what emerges from the most organic and authentic places within me, for no other reason than to connect with people for whom it will be meaningful.

I talk to people.  I listen.  I connect.  I write about it for all our benefit, so our bonds may hold strong long after each encounter, cumulatively, in the most intersecting and inclusive ways.  I do it for a living—not just for an income, but for my very livelihood—I traffic in the spoken and written word to make the highest, deepest connections and meaning in life.  Wow, what a duh-HA! revelation.  And how lucky that my life calling and profession should align so perfectly? 
Book will come eventually, I am confident.  I can feel it. 
Onward.