I’ve been thinking a lot about balance lately. Well balanced meals. Work life balance. Balancing needs in a relationship. Actual physical balance as in yoga and most other exercise practices.

Balance is a good thing, most people would agree. Balanced doesn’t have to mean even, it just means that there is some weight on both sides, even if unequal.

In health care, balance is most difficult to achieve.  Even in a community health center (and I shudder to think how it is in a for-profit practice), providers are pulled in different directions. See as many patients as possible, stay on time, keep up with your charting and labs.  Oh, and don’t forget the metrics that measure the quality of your performance.  It’s one of the ways health care providers are evaluated these days. If you don’t press the button or check the box, your care isn’t up to snuff.  Even if you took well-documented excellent care of your patient. How can that be right?  The measures are correct, but the requirement of sometimes having to do double work to get credit for them, that’s not correct.  Maybe in the future AI can read the note and give you credit for your thinking and care without you having to stop and toggle.

Don’t get me wrong, I love metrics.  I have a probably unhealthy attachment to my Peloton and my Garmin watch which track my workouts.  But when I’m using them, I’m just in the moment, exercising,  I don’t have to do anything but what I’m doing to get “credit. “

I like to think I have a balanced approach when seeing patients.  Open to their unique perspectives and ideas about their maladies but not so much that I don’t consider the other possibilities.  That is, in fact, my job.  Or as we say, taking into account the differential diagnoses: a list of possible explanations for a specific set or subset of symptoms.

There has to be balance in our communication with patients.  You want to really pay attention to and listen to them but you don’t need their life story, and in 15 minutes there is also not much time for small talk.  You have to cut to the chase to get at that vital piece of information that will help you rule out or rule in a specific diagnosis.

You want to discuss the abnormal test results. But you don’t need to go down the rabbit hole of every possibility and scenario following that one test, which could lead to needless stress and worry.  One step at a time, together.

For both patient and provider, health care today requires a balance between the idealized view of practicing and receiving health care and the reality of too little time, too few resources and systems that seem to alienate the givers and receivers.  I hope we can do better.

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