If you are a long-term subscriber, you might remember my patient Annie. You can read about her on my blog from late October 2007.

Anyways, Annie had presented with a constellation of symptoms which I ultimately referred her for an ENT emergency visit. I was her last doctor stop before her husband wanted her admitted for a workup.

In short, she had been having headaches, neck stiffness and pain, and when I queried,

she divulged fatigue, otalgia, and Sinusitis like Sx, attributed to "allergies" lassitude and on and off respiratory Sx for many months. She also had about three rounds of antibiotics, with no lasting changes. She had previously seen 3 PAs, an RN, and her PCP, (5 office visits) and when I put the otoscope in my hand she said none of had looked in her ears or checked her sinuses. I was dumbfounded by that. When I examined her, in addition to her spinal findings she had an acute otitis media, but when I looked at her sinuses with the otoscope, she had acutely swollen turbinates with nearly complete nasal obstruction on the side of the OM.

Certainly the nastiest I had ever seen. After I adjusted her and got her more comfortable, I immediately sent her to MGH, Mass Eye and Ear. A CT confirmed nearly complete nasal sinus blockage and acute infection.

Long story short, she had subsequent surgery for multiple polyps with obstruction. I saw Annie again for the first time in months yesterday. Now fully recovered, happy, incredibly thankful, talked about how long she suffered before getting relief, now comes in with her six year old daughter for evaluation of foot and leg pain.

Keep in mind, almost 20 years ago, I cared for her two then young sons, with similar issues. Callie is a cute, funny eight year old. Unfortunately, she has significant valgus alignment and pronation, which is asymmetric, thus affecting her pelvis and back. Anyways, she ended up her visit to us with temporary orthotics and a DPM consult, and will be back Tuesday for spinal/pelvic adjustments and exercise instruction).

Doctors, this is the stuff of which long term careers, and life long referrals are made. It can be this simple. I have tons of these examples after 27 years, and you probably do too. Like everything in a powerful practice, these are systems.

Simply excellent care, totally focused history, clear communications, tangible benefits and staff that can direct your movements during your day, collect your fee and schedule patients.

Referrals that flow like a river.

With the right systems, it is this easy.

Without, the office can be a chaotic nightmare.