A typical internal medicine patient has multiple medical problems, such as diabetes, hypertension and high cholesterol. Each visit I try and see if there is something to tweak. Perhaps the blood pressure is a little high or the cholesterol is not at goal. Maybe I can switch a medication to a similar one that recently went generic, or use a combination pill to simplify their regimen. I might correct the vitamin D deficiency I usually find, have them change their aspirin to an enteric coated one to lessen the risk of an ulcer, or try and persuade them to get a vaccination to prevent shingles. Most of us have room to improve when it comes to diet and exercise.
With each visit the patient is a little older, and on average, a little sicker. I hope my fine tuning, and occasional overhaul, will keep them going longer and healthier. In the rare visit where the patient has no complaint and I can’t find something to do, I feel like I’m forgetting something. The visit takes longer than it should as I struggle to come up with something other than telling them keep up the good work. That’s usually appreciated by patients, though.