In ENT, do you tend to have long term relationship with your patients? My knowledge on the full scope of ENT is a bit limited, but I can see this with something like meniere's disease. Is there anything else, or does ENT tend to not be like that?
Long term patients?
- Thread starter JP2740
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Like a lot of things, the ones you'd love to see over and over get better and move along. The ones with more challenging problems/personalities seem to keep coming back. You will have chronic ear patients that you will see a variable amount of times a year. Meniere's patients may come in some, but you should have them under good enough control that they aren't coming in all the time. Cancer patients, at least initially after treatment, should be seen on a routine basis (I do monthly the first year, every 2 months the second year, every 3 months the third year, then every 6 months to 5 years and then yearly thereafter). Sinus patients will come a decent amount too for flares of their sinusitis. Kids with tubes will have bouts of drainage or need for a tube check so they come in at least twice a year until the tubes are out. so in a nutshell yes, we tend to see our patients on a longer term basis than you might think. I've only been in practice short of a year, but I have a decent number of patients who continue to come back again and again, for better or worse
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Our academy, The AAO-HNS, has statistics that the avg patient will see their general ENT 2.5x. If you think about that it would make some sense. A pre-op visit, surgery, and a post-op visit. There are many patients who come in for something that needs 2 visits or less (a lesion to be biopsied, an infection to cleared, a 2nd opinion. etc).
H&N ENT's will see their patient much more often. A peds may be less than that avg, esp if they have residents or midlevels seeing post-ops.
The academy also says that only 15% of ENT pts end up going to the OR so clearly there are a number of medical conditions we treat that do not require long term followup.
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Terrific data, thanks for sharing. Much better than my anecdotes.
If I wanted long term patients, should I consider a different field? I suppose I wouldn't mind even if it was a smaller percentage of my patients as long as there are some. Certain fellowships, besides H&N?
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Medicine mainly treats, rather than cures disease. There are a few exceptions, including antibiotics (not that exciting), or chemotherapy for certain types of leukemia/lymphoma. But usually you are talking about regular follow up visits to review the patient's medicine list and make sure they are still on the appropriate regiment.
Meniere's is similar to medicine. You start with a medical treatment algorithm and progress through various procedures and surgeries, with symptom improvement considered success, not necessarily cure of disease.
In reality, it is hard to rank specialties on how well you establish long term relationships. I would consider ENT to be pretty good for that, but if you are looking at a 2.5 visit per patient number you might not think so. ENT (and most fields, really) have a lot of patients that need nothing done, except maybe a referral to another doctor. For example, someone who thinks they have Meniere's, but really needs a cardiovascular workup. You may be indicated to get an imaging study or other testing to reassure the patient that their symptom is not related to anything serious or treatable (by you). So, this group of patients, which I feel is pretty large - I would propose at least 10 to 20% - has only 1 or 2 visits. I think this type of scenario is common with specialties. I would say most otolaryngology practices have some patients that come back long term, but that is not a majority.
So, if you are really serious about having a good long term relationship with your patient, I mean you are prioritizing this very highly, then consider primary care. You could treat general medical problems, refer you patient to consultants as needed, get reports back from the consultants, and stay involved with every aspect of a patients care over a long time period. With family medicine, you would be involved from infancy to end of life.
Or, it may be that you think it sounds neat to see patients long term, but you are just considering your options... In that case, take some more time to consider various fields of medicine and surgery, and consider other aspects that are good and bad rather than just having a good long term relationship.
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I love patients. But let's be honest. Being able to help and move along is nice. The more I see you the more likely you have a chronic problem or are crazy. Either option can frustrate me on occasion.
