| First,
Be A Good Doctor
Doctor?
What is the most important task you have with the
patient before you? First, to just be a good doctor.
Hands down, the most important thing to your patients,
and their families. It is your dharma, or correct
action, your real pathway as a healer. So, why do
we need to even discuss this?
 Two
reasons.
First,
it's never to my knowledge ever been mentioned in
practice building parlance as the true pathway to
success and fulfillment in practice.
Second,
with practice development at times, it seems it’s
always about new patients, money, this marketing thing
or that new technique. Just get more new patients,
and everything will be fine.
Now, I
will never dispute these things are important. They
are!
It’s
just when these items become the focus of the doctor
during patient contact hours, or worse yet a head
full of administrative BS on any given day, patient
care does suffer. Let’s admit it, we are all
human.
So, with
this in mind, I am sharing the following story. (Also,
if it’s been
a while, see “Creating
YOUR Perfect Practice”, for much much more
on
this issue).
Annie is
a real patient. She is about 45, sweet as can be to
myself, and my wife (who worked in the office for
20 years). I took care of her two older boys, one
of whom has just graduated college. Annie and Dave
her husband are fabulous people, wonderful family.
The kind I feel privileged to help care for over an
extended period, not to mention all those friends
and family they have referred to me.
Two
years ago, she suffers a lumbar disc herniation. A
big one, can’t get out of bed for three weeks
kind. She tells me she’s been to the ER, and
PCPs office, seeing different providers, mostly NPs,
on each visit. She was frustrated by all this, but
says that’s her insurance. She has to go through
all these steps.
When she
eventually makes it back to see me after, six months
have passed. She had an MRI, at month one, and has
been on meds ever since. She is unable to work, depressed
and really hurting.
I examine
her, she has partial foot drop, hyporeflexia etc.
I put up her MRI films, and within five minutes have
a neurosurgery consult set up. Now she really is hard
on herself for not calling me six months ago. I think
she said her friends and family scared her out of
it, because of the MRI results.
I
helped to keep Annie more comfortable for a month
until her discectomy. Recovery was prolonged, probably
because of the delayed surgery. A year after surgery
and more than six months of PT, her leg symptoms finally
left. I didn't see her again until about two - three
weeks ago.
Annie
now has had headaches, neck stiffness and fatigue
for one full year. She thought the fatigue was “just
stress”. With the headaches, she says, “Adjustments
might help me.” Her current doctors, as far
as she can gather after multiple doctors office visits
(not once with her doctor), think the cause is stress,
and “probably perimenopause”. In her history,
which she did not even associate with her chief complaints,
she says she has had five recurrent “colds”
and bronchitis in the last year, with four rounds
of antibiotics.
Annie still
feels like crap. On the verge of tears, Annie now
says, “Dr Hayes, I know you can tell me what’s
wrong with me.”
So, during
her exam, after my staff does their part, I listen
to her chest. It sounds clear. Her throat is mildly
injected. I go to look in her ears, and now she says
“Nobody’s looked in my ears, just treated
my cough”. Then I put on clean specula and examine
her sinuses.
She has
fluid in both ears, scarring in one and nasal turbinates
on one side that look like ground beef. Now she’s
perplexed. “Why didn’t anybody else do
this type of exam?” Says her husband will be
really pissed. Wants to circumvent any more HMO crap,
does not want me to call her PCP, and so I referred
her right to Mass. Eye and Ear @ MGH. Meanwhile, I
order all her labs, put her on immune stimulating
supplements, adjust her and train her on sinus acupressure,
which really facilitates sinus and Eustachian drainage.
She’s feeling better in about two days.
At MGH on the first visit, the ENT does a CT. She
saw me again the Tuesday before last, when I went
to St. Louis. .
She will be having surgery ASAP for a massive sinus
obstruction, probably due to huge polyps and debridement.
No wonder she had recurrent bronchitis. She was seeding
herself with bacteria every day from the sinuses.
Probably explains the headache and fatigue too.
Although I haven't stopped looking for answers there
yet either.
I told her, healthcare shouldn't be this hard. She
says there was no continuity in her care, both times
now in two serious illnesses, with people not even
bothering to take her seriously. Now she will be seeing
MY PCP, (Dr AC, who did an earlier coaching call with
our members) where patients don't get mishandled like
this.
The
lesson here this week should be obvious. I built an
enormous practice, at one point seeing 350 patients
per week solo, by being a good doctor. First. Then
I continuously developed fabulous systems second.
And I have continuously refined and adapted these
to the new times we live in.
First, be a good doctor. This is the only reputation
you need or want. Then, fully develop all the modern
systems to facilitate life on your terms, and maximize
your full potential and personal fulfillment.
We
invite you to join us on our blog
for continued discussion of these principles.
Dr.
John Hayes, Jr.
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