When You Need to Be Known, Not Just Seen

“There is a sacredness in tears. They are not the mark of weakness, but of power.”

— Washington Irving

Tears in the Exam Room and Being Known

In healthcare, there are telling moments of quiet: the ultrasound tech's pause, the doctor looking up from their screen, or the patient's soft admission, "I'm scared." These are moments when tears fall—not from weakness, but from the surfacing of something deeply important. While medicine trains us to recognize pathology and track vitals, the human experience is not so segmented. The most critical signal is sometimes not in the labs, but in the silence, the sigh, the averted gaze, the tear.

To be known in medicine means having your full story considered. Not just your symptoms or surgeries, but you and your context, values, fears, and goals. It means being treated as an individual with a unique life, not merely as a case. Even those with the same medical history, different people need different care. That's the distinction between treating problems and treating people.

Continuity of Care: A Quiet Power

This is where the concept of continuity of care comes in—though we rarely name it as such in everyday conversation. At its core, it means seeing the same provider (or care team) over time. It’s the antidote to being re-explained. To being re-evaluated with fresh eyes but no memory. Continuity allows for familiarity. For patterns to emerge. For nuance to matter. It makes space for the patient to be known.

Unfortunately, this continuity has eroded. Many delay care, opting for the first available appointment over a familiar provider. Urgent care centers handle over 89 million visits annually in the U.S., and nearly a third of Americans use the ER as their primary care source. System pressures make this feel like the only option, often resulting in encounters with excellent but unfamiliar providers. And they’re trying to make sense of us in ten minutes or less. Some health policy circles now argue that primary care should primarily focus on prevention, and that chronic and acute issues be left to specialists. But here’s the problem: specialists, by design, are focused. They excel in depth, not breadth. And when multiple specialists are involved, it’s easy for care to become fragmented. What’s good for your kidneys might not be good for your heart. What seems neurologically normal might actually be a cardiac emergency.

The Missed Diagnosis: One Story

Take the story of a woman in her 60s, living with Parkinson's disease. She had been remarkably active and healthy until recently, when she began experiencing random fainting spells with no clear trigger. Unfortunately, these spells started right after a cross country move. When she finally saw neurology, the team attributed it to Parkinson's progression, and she trusted their judgment. However, the episodes worsened, culminating in her passing out entirely while driving. Even then, it was difficult to shift the focus away from her existing diagnosis. Her heart rate was erratic during a routine physical therapy session, so a cardiologist was consulted. But the cardiologist reviewed the AI-generated report of her heart monitor, saw nothing concerning, and moved on. It took months to get to an electrophysiologist, and only because the patient—persistent, articulate, and exhausted—insisted something was wrong. That specialist reviewed the monitor again, zoomed in frame by frame, and found it: heart block. It wasn’t Parkinson’s. It was her heart. But it took time, attention, and someone willing to look beyond the obvious.

Why Continuity Matters for Trust and Safety

This is what continuity makes possible. It creates a thread between visits. A story arc. It helps your provider spot what’s new, not just what’s abnormal. It helps them see when you look tired in a way that isn’t just sleep deprivation. In the case of the above, if there had been one provider who had heard her story over and over again, instead of intermittent specialists, maybe the answer would have been found sooner.

Continuity also builds something harder to quantify: trust. The term "psychological safety" can be met with skepticism, sounding like HR jargon or therapy language. However, in medicine, it's essential. As a patient, you're already vulnerable—perhaps undressed, unsure, or unwell. Your questions may seem naive, your fears dramatic, but they are real. Psychological safety means feeling secure enough to voice the scary thing. To admit what you’re worried it might be. To tell the truth. If you don’t feel known (or safe) you might not speak up. You might go home with a question unanswered. A concern unshared. And that silence can cost you.

When Grief shows up as fear

“No one ever told me that grief felt so like fear.”

— C.S. Lewis, A Grief Observed

Many people enter medical appointments grieving something: a diagnosis, a lost ability, a former version of themselves. But often, that grief presents as fear. Or fatigue. Or frustration. And if the provider doesn’t know you, they might miss it. They might interpret your silence as compliance, or your emotion as overreaction. This is not a critique of clinicians—it's a recognition that all of us need context to make sense of what we see.

How to Be Known in a Busy System

So, how do we build this kind of care? It starts before the visit. Patients who prepare—who jot down their questions, summarize their concerns, or reflect on what’s changed—help create that continuity, even if the provider is new. At Storyline, we offer tools to help you do just that. But the goal isn’t just organization. It’s to bring more of yourself into the room. More of your actual story. During the visit, continue by voicing your fears, clarifying information found online, and discussing what matters most, such as attending your grandson's wedding or avoiding medications that cause drowsiness. Evidence-based care is not just research. It’s the integration of clinical knowledge, your provider’s experience, and your values. That conversation is the care.

In the End: Being Known is part of the Medicine

Continuity doesn’t just help your provider be better. It helps you feel safer, speak clearer, and get care that fits your actual life. And when things are hard, it means you’re not just seen—you’re known. That’s what we all need, in the end. Not just the right diagnosis. But someone who stays with the story long enough to understand what it means. Someone who knows that in the practice of medicine, space and presence are not extras. They are sacred. Just like the tears we sometimes shed when we feel truly seen.

References

Bazemore, A., Petterson, S., Peterson, L. E., Bruno, R., Chung, Y., & Phillips, R. L. (2018). Higher primary care physician continuity is associated with lower costs and hospitalizations. Annals of Family Medicine, 16(6), 492–497. https://doi.org/10.1370/afm.2308

Blendon, R. J., Benson, J. M., SteelFisher, G. K., & Weldon, K. J. (2011). Americans’ views on health policy: Urgent care and ER use. New England Journal of Medicine, 364(22), e42. https://doi.org/10.1056/NEJMp1101612

Epstein, R. M., & Street, R. L. (2011). The values and value of patient-centered care. Annals of Family Medicine, 9(2), 100–103. https://doi.org/10.1370/afm.1239

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Institute of Medicine (US) Committee on Quality of Health Care in America. (2001). Crossing the quality chasm: A new health system for the 21st century. National Academies Press.

Lewis, C. S. (1961). A grief observed. HarperOne.

National Center for Health Statistics. (2022). FastStats: Emergency department visits. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/fastats/emergency-department.htm

Shanafelt, T. D., West, C. P., Sinsky, C., Trockel, M., Tutty, M., Satele, D. V., Carlasare, L. E., & Dyrbye, L. N. (2022). Changes in burnout and satisfaction with work-life integration in physicians and the general US working population between 2020 and 2021. Mayo Clinic Proceedings, 97(3), 491–506. https://doi.org/10.1016/j.mayocp.2022.07.002

Starfield, B., Shi, L., & Macinko, J. (2005). Contribution of primary care to health systems and health. Milbank Quarterly, 83(3), 457–502. https://doi.org/10.1111/j.1468-0009.2005.00409.x