Residency has taught me that I cannot always be there for my patients.
I work with a panel of patients as their primary care physician. We meet every few months in clinic to manage chronic conditions and support their overall health. With that comes the privilege of being called their doctor, someone who understands what matters most to them.
At the end of each visit, I say, “Please reach out if anything comes up in the meantime.”
And then I disappear.
Not by choice, but by design.
Residents spend weeks at a time on inpatient rotations. During those stretches, my clinic in-basket continues to fill with messages from patients updating me on our prior conversations. Others describe new or worsening symptoms. I am no longer the one responding. Another resident steps in.
When I return, I begin to piece together what unfolded in my absence. I see that urgent visits were arranged, medications were started and referrals were placed. I feel grateful that my patients were cared for by colleagues I trust.
Yet there is a quiet ache: I wish I had been there for them. Part of me wonders whether hearing from the doctor who knows them might have offered more reassurance. Or simply the comfort of familiarity.
The work was done well, but something small feels lost.
Over time, I have come to understand that we work within a system that is imperfect by nature. Care is shared and often fragmented as clinicians take on one another’s roles. Each handoff is an attempt to bridge gaps we hope will go unnoticed.
I once thought that continuity in primary care meant constant presence. I still feel a flicker of guilt when I stop myself from saying, “I am always here for you,” because I know that, in the literal sense, I am not.
Perhaps continuity is something more subtle and durable. It is the act of returning to the same patients, understanding who they were a month or a year ago, and who they are now. It is moving their care forward with context, even within an imperfect system.
I imagine the day after training when those absences are less frequent. As an aspiring geriatrician, I hope to walk alongside my patients through more of their moments, not just some of them.
Until then, I am learning to navigate the spaces between. To pick up where I left off and stay connected, even when I am not the one on the other end of their messages.
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