Rapport important as official guidelines when treating patients

I have had many patients recently comment about how they would never be able to find their way around without their smart phones. I have yet to use such a gadget to get around, as I actually enjoy finding my own way to places even if it means getting a little lost along the way. If I only ever took the recommended direct route, I never would have stumbled upon the best cup of coffee in town or my kids' favorite little playground that sits just off the beaten path.

Getting lost in conversation is an equally important way to stumble upon unexpected destinations. If I were only to focus on the recommended and most direct way of obtaining answers when taking a patient's history, I could have missed out on having a casual conversation with a patient that helped me solve the most perplexing case of stasis dermatitis I've ever treated.

This particular case was not perplexing in regards to the difficulty of diagnosis, or its management, but rather because the patient's symptoms continued to worsen despite my best efforts and the patient's strict compliance with the recommended treatments. At a follow-up visit, while applying yet another pair of Unna boots, our discussion drifted away from the stasis dermatitis and we began talking casually.

He shared with me how uncomfortable his lower back pain had been, and I asked how he had been sleeping. During the past several weeks while we were battling his worsening stasis dermatitis, he had been sleeping comfortably each and every night in his lazy boy recliner, but was quick to add, “With my legs elevated, just like you recommended.”

I inquired further to assess whether his definition of ‘elevated' was what I had recommended (elevation above his heart). I learned that in order for him to sleep comfortably with his back pain he had to compromise and only elevate his legs a few inches off the floor; good for his back but not so for his legs.

If we as physician assistants do not take the time to speak casually with our patients, we might miss opportunities to stumble upon significant insights into their lives, as well as relevant details that may lend to their current diagnosis and treatment.

I appreciate the many advances in technology and respect that some people may only want to take the most direct and uncomplicated route. As for me, I will continue to wander off course from time to time, connecting more with my patients and appreciating all that I stumble upon along the way.

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