At my front door stood my neighbor and his daughter making their annual Girl Scout cookie trek. “Should I make it a baker’s dozen?” the girl asked, knowing I wouldn’t refuse. Her father chimed in, “I was just at a wedding where I sat next to someone who said you saved her life. She said some very nice things about your medical practice.”
The name of the patient he was mentioning flashed me back. Mrs. BB (whose name has been altered to maintain privacy) was referred by a mutual acquaintance who already used our practice. This acquaintance felt that maybe I could solve Mrs. BB’s problem, specifically because all of our practitioners are paid for time, which means we can listen and communicate to determine how we can best help our patients.
When I met Mrs. BB for the first time for a checkup (which was our only face-to-face encounter), she reviewed her medical history with me. She was struggling with perplexing symptoms characteristic of anxiety. At the conclusion of the history and physical I agreed with the three other doctors she had consulted over the past months that a diagnosis of anxiety fit her symptoms. I ordered some tests and told her to call me directly, anytime, day or night, if she felt the need. Two days later I called her with the lab results. Everything was normal, as expected.
Ten days later, I was at a winter party at a friend’s when my cell phone rang. I stepped outdoors to respond, the cold air giving me pause. Mrs. BB was on the other end, and she was in the middle of one or her episodes. It was the third “attack” she’d experienced since I saw her. Two of the three episodes came on while exercising, when she suddenly experienced rapid heart rate, blunted thinking, and panic, which are all characteristic for anxiety.
“How often has this happened with exercise?” I asked.
“I’ve cut way back on exercising since this seems to make some of my symptoms a lot worse.” Don’t you remember?” She asked, “I told you that at the first visit.”
“You did, but the meaning of this was lost on me at the time.” I told her. “In my experience, getting panic attacks in the middle of exercise is unusual for anxiety. Has anyone considered problems with your adrenal gland?” I asked.
She couldn’t remember.
“In the morning, go to the lab and do some tests. I’ll fax the order over to them tonight.” I told her. “It seems like once a year I order this for someone and after 25 years I’ve never seen a positive result. But this year you’re the one and I think it’s appropriate to order the tests.”
Three days later, her results were on my desk. I called her immediately. “It looks like you have something we call pheochromocytoma, which is a tumor on your adrenal gland. Let me make a few phone calls and figure out who you need to see and get the ball rolling for fixing this problem.”
I completed and faxed the orders for her MRI. The surgeon and I had several conversations. I called BB hours after completing her MRI that identified the location and size of her tumor. When she called the surgeon’s office they were ready with an appointment time and already had a complete copy of all our records faxed from our office. From here on out she was in the capable hands of the surgeon and his team.
She called me twice from the hospital to give me a brief update of her post-op progress. We were both relieved: She was going to make it just it fine.
“Well,” my neighbor’s voice interrupted me from my flashback, “BB said that a lot of doctors visited her bedside while she was recovering from surgery. They were all fascinated at what an interesting case she was and asked how did her doctor figure the problem out? Several of the doctors told her you saved her life.“
“It’s not magic and I’m not special,” I responded. ”There were other people involved. I was just there to listen at the right time.”
But here’s what I really wanted to explain to him but didn’t, something he and most people don’t understand (and seemingly, doctors don’t get it either based on their unwillingness to really do something about it): I get paid to listen, to think and to communicate. I get paid to answer my phone for any of my patients whenever they need help. Since my patients are able to call me back with an, “Oh by the way …” and to explain to me exactly what they’re feeling at the moment they’re feeling it brings an immediacy and a personalization that is virtually extinct from medicine today.
Instead primary care has condoned long delays, reduced physician contact, prolonged waiting room times and rapid fire 7.5 minute office visits before parading the patient out of the office with the words, “set up another office visit “(and for your troubles I’ll listen again for 7.5 minutes – maybe 10, if you beg me.) Many times it means the difference between getting it right … or getting it really wrong.
From start to finish she owed me $450. Her being around to say “thank you” made it feel like a whole lot more.
Until next week, I remain yours in primary care,
Alan Dappen, MD