A day in the life of two front line docs

Here is a link to a post by Timothy Malia MD of Fairport NY (picked up by the NYT as an example of 'a day in the life.'  He describes the incredible variety of conditions and issues arising in a typical primary care practice. 

Below is a day with Dr. Jose Battle in NYC NY.

I post these as an example of the wonder and complexity that is destroyed in assembly line medicine.  The assembly line (or hamster wheel as many professionals are now calling it) is one of the consequences of a broken system.

Note in particular the difficulty we would have pigeon-holing these docs based on the current technology-infatuated 'medical home' or disease-based 'pay-for-performance.'  Sure technology and incentives to 'do the right thing' can help, but they are in themselves woefully inadequate measures of the real life of primary care. 

Through innovation, bravery, and by collaborating with others, these docs have created practices capable of getting beyond hamster wheel care and becoming the physicians they imagined they would be when they entered medical school.

Friday at noon 74 y/o lady walks in to my new office asking to see the Doc.  Patient comes from her actual provider who just gave her an appointment, 3 weeks from now, when she showed up complaining of vague abdominal pain.  As our policy is that if “you believe that you need to see the Doctor I would see you” my staff said off course no problem.  Lady’s son asked my staff if I was “any good” and they responded that “Dr. Batlle knows his stuff”.  Mrs. P gives me a story of “stomach problems” for a long time usually controlled by diet and some PPI [proton pump inhibitor] but this time is bothering her enough to go to the Doc, all she wanted was a prescription for a PPI and that was it. 

I take a look at her and find some abdominal discomfort and a positive Murphy sign and I tell Mrs. P that most likely this time it is gallstones and possible cholecystitis and that, most likely, she would need surgery.  Mrs. P proceeds to blow it off on her usual “stomach problem” but I convince her to go and get an US [ultrasound] at an associate’s facility very close by,  I give them a call and they say off course send her over and I’ll call you with the results. 

At 145pm Mrs. P passed in front of my door, with her son, stating that she is going for lunch; I told her to just wait for my call at home prior to trying to eat that I would have the US results.  

At 2pm I get a call from my colleague stating that Mrs. P’s gallbladder is full of stones and it is very inflamed and telling me that he is sending her to the hospital, he was pretty surprised when I told him that she just left my office.  I get a hold of Mrs. P who does not want to go to Hospital as she is not really sick, at that point I get son on the phone and explained, strongly, the implications of the diagnosis and that she can get very sick at any moment.  They came to the office and picked up the US Stat report and a letter and went to ED where another colleague was waiting for her. 

Mrs. P got surgery that evening with the findings of a gangrenous gallbladder and a Hospital staff that told them that “your Doc pretty much saved your life as you would have been septic pretty soon”.  Monday morning Mrs. P calls from Home, discharged pretty early that morning, thanking me for making her go to the hospital even so she was sure that I was just nuts.  Son took on himself to come to the office to thank me and give me a hug.

The amazing part is that all every provider involved did was what they are supposed to do: take care of the problem at that moment, no questions asked.

Jose from Upper Manhattan, NYC, NY

Comments

[Linda Lee]

Hi Gordon! How are you? I started blogging also
and I am on twitter now also! http://lindalee.posterous.com/a-common-cold

We need to catch up on things!! See you at the AAFP Assembly!