Ask Wednesday: Whitman Reardon, MD on medical doctoring

When we last saw (or were seen by) our primary care physician, we asked her if we could interview her. We wanted to provide our readers a  medical doctor's first-person account, so we were ecstatic when she agreed!
    Whitman Reardon, MD, is an internist in Chapel Hill, North Carolina, where she practices office-based medicine. As the photos in her office and examining room attest, she is married, and besides a husband, has two teenagers and two dogs.
    [Our questions are in italics.]

What made you go into medicine?
    I became interested in medicine during my senior year of high school when I did an internship with a pediatrician. The pediatrician had a great bedside manner, and she was well respected. I enjoyed watching her care for her patients and I knew that I wanted to be a physician.

How did you envision your future as you started medical school?
    Medical School was tough and required a lot of memorization. I did not know what type of medicine I would practice until we did our clinical rotations during my third year. The clinical rotations expose you to the hospital and the different specialties. Initially, I thought that I would like surgery or pediatric surgery. But internal medicine suited me. I found it intellectually challenging while fostering a close doctor patient relationship.

How have things turned out?
    I expected the practice of internal medicine to be very different from what it is now. I had envisioned myself in a medical group, which I am, but I envisioned having more time with my patients, more time for coordinating patient care with other physicians, and a lot less busy work. Medicine was very different when I started med school in the 80’s. There was much less busy work and unnecessary documentation. Originally, the purpose of a patient’s medical note was intended to explain a patient’s story—his or her medical history, physical findings, objective testing, and the physician’s assessment. Now physicians are required to update the Electronic Medical Record (EMR) and meet certain criteria or “bullets” to justify a patient encounter. The patient’s story gets lost in this template-driven process. We also do a lot of justification with insurance agencies in order to obtain medications or tests. We spend an excessive amount of time on busy work that has nothing to do with patient care.

Do you like doctoring as much as you thought you would?
    Being a physician is an honor and a privilege. People allow me into their lives and entrust me with their health. I enjoy being with my patients, discussing challenging cases with my peers, and solving complex medical puzzles. I appreciate that it can be scary at times to go to a doctor, particularly if you're worried about your health. If I am able to help someone, then it makes my day worthwhile.
    Unfortunately, the parts that I enjoy are often obscured by the busy, hectic days and excessive paperwork.

In internal medicine, who are you patients, mostly?
    Internists do not practice pediatrics. I take care of adults. Most of my patient visits are with people over 60, since they will have more health issues typically. However, I have patients aging from 18 to over 100.

Have your patients changed over time? Age-wise? Complaints?
    I have been at Chapel Hill Internal Medicine for 18 years. A lot of my patients have been with me for 15 years or more. This is fun for me, as we get to know each other better and age together. I get to know people well and enjoy learning about them and their families.
    Certainly with age, there come more ailments. Hypertension, coronary artery disease, diabetes, and skeletal complaints are common. For me, malignancy and dementia are the most painful diagnoses. Telling someone that they have cancer is very hard. It is scary for them and their families, and their lives are turned upside down in an instant. Dementia is painful as well. Typically, a family member will raise a concern about dementia, and it becomes my job to determine the type of memory impairment; i.e., common senile dementia, vascular dementia, or Alzheimer’s dementia. Dementia is something that most people fear as we get older. Lack of control is a struggle for the elderly, and it is magnified when the elderly person has dementia.

How do you think of your “mission” when it comes to seeing a patient?
    My mission is to provide excellent health care. That means having good medical skills and a bedside manner invites patients to open up. Trust is a big part of a patient-doctor relationship, and patients need to know that their doctor actually listens to them and cares. It also means trying not to miss an underlying illness, particularly an illness that I can potentially have a positive impact on.
    Medicine is always a challenge, and I think that most physicians worry about misdiagnosing an individual.

What would you say to someone who “doesn't like doctors” and maybe hasn't been examined by one in, say, twenty years?
    This situation happens to all physicians. We all like to have control of our lives and this situation calls on doctors to let wary patients know that they are in charge of their own health decisions. Having a good bedside manner is very important in this situation, which sometimes takes extra time to acquire a patient's trust. I think we need to be careful and not push our recommendations onto people. Ultimately, patients are in charge of their own body. A physician can provide suggestions to guide them in caring for their body, but patients always have the final say.

What are your greatest challenges as a doctor?
    Not enough time. I do not have enough time in a day to be the doctor that I want to be. I think most people feel this way about their jobs. Everyone is too busy, and that can take the fun out of things.
    Physicians tend to run late and this frustrates patients, office staffs, and physicians. There is no good answer to this dilemma because we often cannot anticipate a day’s events. If a patient needs help, then we do not like to turn them away. Therefore, we try to do more than is humanly possible in a set amount of time. Compound this typical physician's day with the added burden of excessive bureaucratic paper work, and I have very little time left for my family.

If you had it all to do over, would you have chosen medicine? Chosen a different medical specialty?
    This is a very good question. I believe physicians struggle with this question. We have been squeezed from insurance companies, Medicare, and Medicaid to do more work for less pay. The tedious, time-consuming and boring paperwork detracts from the physician’s time, which would be better spent studying medicine. The “practice of medicine” means that we continue to practice, learn, and improve. Therefore, we need time to read and study. All this said, if I had to do it over again, I would choose medicine and become an internist. I still enjoy being a doctor, but I wish that my frustration level were lower.

What would you say to young persons who thought they might like to become a doctor?
    I hope that we will continue to get bright and motivated individuals to go into medicine. If I am fortunate enough to live into my “golden years,” then I will need a good doctor who is much younger than me. However, the current atmosphere is making it more difficult to attract these individuals, particularly for primary care. I hope that things will change to make it more attractive to pursue primary care. I would encourage people to pursue a career in medicine, but they need to be aware of the frustrations as well.

What question (or questions) would you like to answer that we didn't ask?
    I thought you might ask me what it’s like being your editor in chief’s primary care physician.

Well, we might, but there’s that doctor-patient confidentiality thing, isn’t there?
    Indeed, and that’s why I was only kidding.