I called my old professor the other day to ask a very specific question about the Geriatric Depression Scale and expressed to him a big frustration on my end on how we are no longer able to perform such complex assessments among our patients, especially in primary care. During residency, we are taught to take thorough histories and perform physical exams by the book, but in reality, it is very rare that we can still sit with our patients for hours and have conversations with them to talk about their hopes and dreams, getting to know them on a deeper level and evaluate whether they are truly happy in their last decades in life.

Perhaps it is just a simplistic expectation that most of our patients who come to the clinic are there just to get what they want and need, to refill their prescription or obtain a script for their annual cancer screening test.

The transaction of medicine

What started as a quick hi and hello to be cordial extended to a lengthy conversation about a very important challenge most of us in medicine deal with everyday: the lack of time, and how the true value of the doctor-patient encounter is easily being made murky by the business of medicine. That business primarily evolves around the transactional aspect of it and no longer about other metrics that are difficult to quantify, such as quality of care and satisfaction.

We ended our call deducing it might be just “a first world problem” that we spent time dabbling on, both seemingly empty-handed on a magic solution that will ease the frustrations we have on the burgeoning concern of how things have changed in the landscape of medicine where constructs such as capitalism and consumerism have become off limits to our level.

Hanging up, that conversation left a nagging thought in my head why big topics such as “health equity” or the geopolitics in health care always leave me stuck and helpless on my own conquest of how I could potentially help and change things. I felt compelled to reach out to my peers in the non-profit world reading through their mission-vision statements and while everyone seemed to have so much enthusiasm in helping out, it made me question whether a $20 contribution to a foundation that already bags hundreds and thousands of dollars everyday can still make a difference.

The illusion of generosity

Cynical as it may sound, it felt like the virtue of donating or giving for that matter had lost its appeal, having to go through the non-profits ethos all desiring to be “of help” but in reality when it is time to ask for a dollar in the streets, probably nobody from the board’s business meeting would stop.

I went about my day and the thought seemed to have worn off, knowing I too had a busy weekend and had to do some grocery shopping for the week ahead. For someone who had an extra $20 to spare, it is quite easy to give monetarily and be able to say you helped. But the question always lingers whether or not that money or cent I rounded up to give to a foundation actually meets the elements of the authenticity of a true act of generosity or helping, or was it merely influenced by a tactic that makes it more convenient for a modern man to donate because it is integrated in a paying terminal or an app. It seems that these approaches to giving or donating are starting to become aimless, short of becoming a chore like decluttering one’s closet or ridding our pantries of the canned goods we have bought in excess.

Finding the answer in connection

What stemmed out from that conversation was a simple realization on how difficult it really is to approach a very complex subject matter. True, seeing a change on the status quo would probably require decades of advocacy and with the way things are now, technology, AI, and all, it seems that the solutions are becoming harder to come up with by the day. Not sure either whether people have the time to really pause to arrive at more informed and conscientious decisions in their day to day life, let alone assess on a bigger picture where we are now and deconstruct how humanity has gotten here.

In the end, I am just quite glad I had a meaningful conversation with my professor whom I have not talked to in years. Maybe the answer is inherent to the experience itself: pausing, looking back and asking for answers, engaging in a meaningful conversation with another human being, and knowing what is going in their mind.

Maybe embracing that fundamental virtue of human connectedness in itself can strike a big difference, hoping someday something at the back of our heads stirs us to change our mindset and help us to approach things differently in our day to day moving forward.

Engaging with people and putting it out there is probably a potential solution, knowing that someone else is just as hopeful as you are can empower you to really make your thoughts translate into action and really going back to the basics, slowing things down and providing more quality time with someone.

Well, let me save that $20 by paying myself to sit down with a patient and spend that time genuinely knowing them beyond what illnesses they have and more importantly maybe try to shift the conversation to know how they had spent their weekend, ask whether they have achieved their hopes and dreams in life, putting that good old geriatric scale to use by going through it with them together.

Dean Robosa is an internal medicine physician.