Thursday, March 7, 2013
Happy misfortune and house calls
I was furious. I went to the office on Sunday to see what work the electrician had done (and to discuss decor issues with my wife), and my office was deserted. The inspection was supposed to happen on Monday, allowing me to get furniture in the office and see patients on Tuesday. A text message back from my contractor said that the electrician would be in on Monday and the inspection would happen on Tuesday. Apparently he didn't realize I was so ambitious (read: crazy) to see patients so soon after construction was completed. Apparently my panic wasn't obvious to him.
On Sunday I broke with my usually placid demeanor (read: codependent) and expressed my emotions on the issue quite clearly. Many panicked calls from supervisors and electricians later (read: effusive apologies and promises to fix things), and the reality had not changed: inspectors would not be coming until Tuesday, and so my opening, already a month after I planned, would wait one more day. What a terrible way to start my new practice: canceling appointments on my first day.
Then I realized something: I don't need an office to do my job. One of the things I am trying to overturn is the practice of requiring all care to be conducted in the exam room. Why can't people talk to their doctor on the phone? Why can't they e-mail questions? Why not videoconferencing for visits? Why not texting me a picture of the rash (depending on the location, of course)? Why hold my expertise hostage to the ransom of an office visit? So then what's the big deal of not having an office?
So on Tuesday morning, Jamie my nurse and I set out for our first office visit, grabbing whatever we thought we'd need in the boxes of supplies we ordered, climbing in the Rob-Mobile (a 2000 Mazda Protege called "Zippy" which has 160,000 miles on it) and driving to the homes of my first two patients. What a wonderful way to start my new practice: not having to cancel appointments for the triviality of having no office, instead doing something very old-fashioned: house calls. Both couples (Medicare patients who couldn't stand losing their doctor) greeted me with warm hugs and expressions of disbelief that a doctor would come to their home. It turned out that being at home gave me a much better chance to look at medication lists, for them to run get hospital discharge summaries, and to have these lovely people be completely at their ease while seeing the doctor, something that doesn't happen much in our wonderful health care system.
I spent about an hour with each of them, straightening out confusion on medications and agreeing to work on getting things straightened out. One husband showed a spreadsheet he printed out with his wife's blood pressure and daily weight. I suggested he e-mail this to us daily, which he did the first day, but then we decided to use a Google Doc spreadsheet that would alert us whenever he added new information. He did that today and it worked great (although the Google Doc website strongly encouraged him to install Chrome, which confused him). We will probably set up spreadsheets like this for more of our patients, perhaps for diabetics to input their blood sugars and whatever else we think will help.
So, what started out as another in the string delays making me miserable (read: wallowing in self-doubt and whining), ended up as a delightful day opening my new practice by abandoning the "normal" way of doing things for a way that worked better. It's a perfect symbol to what I want to do in this practice. I told Jamie (when I was trying to convince her to join me) that we have the chance to ask the question: "Wouldn't it be great if we could ..." and then do it.
The days that have followed in the office have been a delight, spending time with people and getting the system figured out. We haven't over-scheduled ourselves, so we have time to figure out solutions to problems we run across. There are still huge problems we need to solve, but given our first day, I think we are firmly situated outside of the box, a place where it seems a lot of good ideas live.
After taking a year-long hiatus from blogging, Rob Lamberts, MD, ACP Member, returned with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind), where this post originally appeared.
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Suneel Dhand, MD, ACP Member
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