I practiced general family medicine for 8 years before moving to weight management and preventive medicine four years ago. I always felt that a critical aspect of providing top quality primary care was knowing your patient well. Yes, I know this sounds simplisitic, but it is certainly not simple. Besides knowing a patient’s baseline physical and mental health, it is also critical to understand whether a patient is “stoic”, or a worrier, whether he/she will not rest and relax until every reasonably aggressive workup is done, or whether he/she is content and prefers to sit back somewhat, and let nature take its course to some degree. Of course it is the physician’s job to help all patients, no matter what their inclinations, achieve the best health choices for them. It is the job of the physician to help the patient understand what is reasonable to fear, or not, and what are the reasonable possible approaches to workup and treat a problem. Part of being a top doc is working WITH the patient, to help the patient achieve his or her goals effectively.

Now that I practice weight management and preventive medicine, it is even more transparent how important it is to know a patient’s baseline and goals. Some of my patients are only slightly above a normal body fat percent, but are triathletes in training, and really need some intensive advice and counselling on diet, exercise, sleep, relaxatinon, and not overtraining or undernourishing themselves. Other patients are hundreds of pounds overweight, and initially just want to be able to move around more easily, improve some health parameters such as cholesterol, and feel in control of their eating patterns. Obviously baseline and goals of treatment are critical in designing programs for the variety of my patients.

One more thing to remember - baseline health AND patient goals can and do change over time. I’ve had patients lose over 150 pounds - and drop to a BMI of 22. At this point, a patient often begins to have very different goals. Other patients have been competitve athletes for decades, and are now suffering from osteoarthritis, which is beginning to limit their performance. One of my jobs is to help these patients revise and update their own goals, and help them move forward.

I remember a patient in her mid thirties, a relatively slim athlete, who was dealing with a succession of injuries, and putting on a little weight. One of her biggest frustrations and complaints was an orthopedic surgeon who advocated a very non-aggressive approach to treatment, and suggested that she stop competing. She felt he was telling her to go out on the porch and sit in a rocking chair! Obviously it is important to discuss both baseline, and goals with patients, to provide the best care.