Follow-up appointments at my continuity clinic have given me the opportunity to look at my clinical judgment in snapshots. Unlike on my inpatient rotations, where I see the same patients every day, I have to wait for a month or two to see if a medication is working, or if a patient is satisfied with their progress in physical therapy. Sometimes I have a crisp memory of my clinical decision-making from the last visit, and other times, I am relying on my notes completely.
Once the rhythm of outpatient clinic became more natural, I started to get a skeleton of my note done in the patient’s room. My progress notes became more accurate and helpful in my decision-making. It was much easier to tell if my patient was weaker or stronger when I was able to document a more detailed narrative of his gait at the last visit, rather than the hurried “normal gait speed, and good balance” that tended to happen when I left all of my notes until the end of the day. By that time, it was hard to remember whose foot drop needed bracing or whose fingers were so clenched into fists that I could not open them.
One day, I was typing a few sentence fragments in clinic while talking to a patient who we’ll call Eugene. Eugene had had a stroke many years before and had noticed that he had gotten weaker after a recent bout with pneumonia. The computers are arranged in such a way that we cannot make eye contact with our patients while typing. Instead, they are left to watch our backs. I used my usual technique of starting the appointment face-to-face, then asking a few run-of-the-mill questions with my back turned, and turning back to face Eugene when I asked the more sensitive questions, trying to remind him that there was another human in the room.
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