American news outlets this week have been abuzz with news of the much debated, celebrated, and maligned health care reform legislation. What has caught my attention, however, is not the legislation itself, but all the hand-wringing over the costs of broader insurance cover and their effect on government spending, and the inadequacy of the current American primary care workforce to meet the needs of the nation.

None of this is really new news, but this public conversation brings to the national attention three issues we in primary care have wrestled with for a long time:

• Health care is just plain expensive, and American health care particularly so. Worse, many of those most in need of care, are those who have had to rely on personal savings, debt, or charity - or have simply gone without.

• We need more family doctors. This has long been recognized in primary care circles, as fewer and fewer students have entered primary care.

• We can't "fix" healthcare with more money, technology, or practitioners alone - we need a broad values-based consensus on what health and illness are all about before we can make progress on really knowing how to improve American health care.

I'd like to say that I have some wise and wonderful ideas for tackling these challenges - I don't. But, I do know that there are other nations, both rich and poor, around the world who do a better job of caring for their populace than does the USA. While the size and diversity of the US pose challenges not faced by many smaller countries, I am hopeful that the recently increased attention to what reform will actually mean may encourage Americans to see what others have done, and will draw the broader population into discussion of the challenges we in primary care have been facing for a long time.

Recently I’ve been making more of an effort to “personalize” my documentation to include names, rather than just descriptors, in my documentation. Rather than “The patient’s wife says he’s not falling so much…”, I think “Donna says he’s not falling so much” is far less clinically impersonal. Not a big thing, maybe, but it reminds me that these are PEOPLE and not just SUBJECTS. I’m finding, too, that I tend to both read and write my progress notes less like dry clinical data, and more like the stories that they are – stories of my patients’ lives, joys, sufferings, and challenges.

But why do I even need this reminder? I went into medicine to care for people, not numbers or lab rats, so why am I now needing a reminder of who they are? I think it is due in part to the medical short-hand of referring to diagnoses or room numbers, not names. How many times have we heard, or said ourselves, “the gall-bladder in room 16 is feeling better” or “the pneumonia in 202 is still short of breath.” Or perhaps just using the number, “Room 205 is ready to go home today.”

(Frankly, if “Room 205 goes home”, it will leave a big hole in the hospital hallway!)

The craziness of it is that the habit of referring to people by room numbers has at least partly to do with protecting their names! As we’ve become more sensitive to privacy concerns (and appropriately so!), using room numbers or bed numbers has become a convenient short-hand for identifying patients to our professional colleagues, without breaching their privacy to those in earshot who do not have a “need to know.”

So – we’ve tried to protect privacy, and in so doing removed a key reminder of our patients’ humanity!

What’s in a name? Many things – but most importantly a reminder of who each of us is as an individual. And while that needs to be protected to honor privacy, it also needs to be REMEMBERED as we document our thoughts and plan our care for our patients. Medicine is not just about clinical data, it’s about people – and perhaps the right use of names can help us remember that.

I’m a doer. I like being a doctor who can fix things, whether it is treating an ear infection, suturing a laceration, or managing a patient through DKA. But I don’t just like to “do” – I like to serve. I enjoy home visits. I enjoy going to the nursing home. And I particularly enjoy volunteering at our local free clinic for the uninsured. With the cost of healthcare in the USA steadily increasing, I enjoy being able to be a part of serving those who are left out.

I also like to be a thinker, and feel it is important for us as doctors to THINK about why we do what we do. So, when I’ve had the opportunity to speak about the opportunities and challenges in caring for the uninsured, I’ve been a bit flummoxed when listeners have told me they want more on “how to” and less on the ethics, principles, and ideas behind service and care for the poor. And, having had that feedback, I actually felt a bit vindicated to see the program for a recent conference on health care for the poor included a whole track on issues of service, professionalism, and the doctor’s identity. “At last!” I thought, “more recognition for the issues of identity, and not just ‘getting the job done!’”

However, I’ve also been reminded recently, that there is still more to medicine than thoughtful service – doctoring is more than just thinking and doing. Several encounters, with students, patients, and colleagues, both at home an abroad, have reminded me yet again of the foundational importance of the relationship. Medicine is nothing, if we lose the human, “I-thou”, person-to-person connection with our patients.

As doctors, it’s easy for us to see the need for our service. But for our service to make a difference, we also need to think carefully and reflectively about what we do. However, for our care to have VALUE, for it to be HUMAN medicine, we need to pay as much, or probably more, attention to the relationships with our patients and our colleagues.

Relating, thinking, and doing – each is a vital piece of medicine, and put together they make for even better doctoring.