Spaced repetition for tailoring therapy
I typically advocate for minimizing the number of follow up appointments for patients as much as possible. Making time and coordinating transportation to the office can be difficult, and I want to respect their time. I find it borderline unethical to make up reasons and excuses to bring patients in more often than they need.
But there are patients who just like coming in every month. Even if we talk about nothing and the appointment lasts 5 minutes, they choose to come in monthly. I can see how more frequent visits can be beneficial too.
The spaced repetition of monthly follow up visits ingrains the patient in my mind. I know when they’re well and when they’re sick. I know when the headache is a chronic headache, or something about this headache today is different. I know their medications and medical history by memory. Just like the Anki system of spaced repetition used for memorizing test questions, seeing patients for frequent follow up produces a similar effect.
I don’t mean to bring up the romanticized version of the patient-doctor relationship consisting of shooting the breeze about the kids, the grandkids, work, troubles at home, regrets, etc. But practically, the more familiar I am with a patient, the more tailored my recommendations can be.
For the man who never has any concerns who comes in with dizziness: I will take it more seriously. As opposed to another who has been coming in for the “worst headache of his life” for the past couple years, presenting with yet another debilitating headache. If I had been unfamiliar with these patients, I may have brushed off the first patient’s complaint, while sending the second patient to the emergency room.
This is what personalized, precision medicine is in my mind. No amount of genetic testing and esoteric blood tests, gut microbiome tests, metabolomics or nutrigenomics can meaningfully fine tune treatment options for a patient. Tailored therapy can only be gained by seeing someone often over time.