Tinsley Harrison Internal Medicine Residency Program                        Excellence Without Ego

Essays from Alumni : “Small Batch Doctoring”

Anne DavisWritten by Anne Davis, M.D. (2001-2004)

"This man needs a doctor, and all he's got is you," said one of my favorite attending physicians, Dr. Glen C. Cobbs.  His wise words still resonate, whenever I am faced with a difficult patient. . . usually the one who's come in to get a quick fix for a cough and congestion when he obviously needs help with far more serious problems.  Hypertension, burgeoning weight, continued smoking and a difficult life situation…this man needs a doctor more than he knows. And for the moment, 'all he's got is me' to try and effect some change.


I practice medicine in my small hometown and it's often a challenge to know just where to begin in trying to effect change:  Which fence post do I work on first - the hypertension, the excess weight, or the difficult life situation?


Again, I recall Dr. Cobbs' wisdom: I was the senior resident on his service and we had just finished a particularly grueling night on call at Cooper Green Hospital.  My fledgling medical students were gamely trying to present the night's catch/cache of patients. But all was getting too complicated and convoluted.  Dr. Cobbs stopped them mid-story, took out a sheet of paper and drew a horizontal line on it.  'Now,' he said, 'tell me the story of the patient from beginning to end.'  The beginning of this time line was the patient's birth; the ending was what brought him to the hospital.  A simple exercise in analytical, sequential thinking- I use it often.  A timeline helps me decide which fence post is first.


Having said that, I must also say that the timelines I draw for my patients are rarely simply linear.  The look more like mature, spreading oak trees as I keep adding branches here and there--the patient's daughter, ex-husband, brother, and current mother-in-law…are also my patients.  They are all part of his story.  As I gaze at the tree I have drawn, I feel I have a real understanding of the patient's environment and context.  A small town internist gets everybody's perspective.

Practicing medicine in a small town with your father provides both unique challenges and opportunities. Our discussion of patients often leaves the office and finds its way spilling over into our usual Wednesday night dinners. This out of office conversation covers more than just their medical problems and frequently becomes more of a discussion about how those medical problems affect their home lives and the lives of those around them.

There is a truncated nature to the practice of medicine today. We have specialists and sub-specialties. We have hospitalists. We have strict office-based practitioners. We have too many health care providers who do not communicate with each other.  What we need is a polished, professional version of my father’s and my Wednesday night dinners.  We need 'transitional' practitioners who shepherd patients between the acute care setting and the office - ones who know enough about the patient's world to connect what happened in the hospital to what's now happening at home.

In Birmingham today, and in other cities all over the country, craft beer is the latest thing.  Every beer drinker knows that small batch is the best brew... and how satisfying it is-- to know that people who know their stuff are all working together, in close communication to produce this great beer.

I submit that 'small batch' doctoring, like craft beer, is quite likely the best…doctors are limited to smaller numbers of patients; they do all of the basic care instead of handing folks off to so many different specialists.  Patients who partake are more satisfied - they feel they're getting the best.

My dad is a small batch doctor and has been for many years.  My own earliest doctoring memories are of following him up and down the halls of Citizens Hospital, in and out of patient rooms, watching him care for and comfort patients and their families.  Of all the teachers I've ever had, I know I have learned the most about caring for people from him.  Formal classes and their content are all essential, of course.  But the art of developing and maintaining exactly the right degree of connection with your patients is irreplaceable in the process of healing.

Today, I am in private practice with my dad- and I am still watching him, still learning how to relate….and how to be the doctor that patients need.