Question: What do you call a doctor’s practice when the office is closed for vacation?
Answer: Dead. Prognosis grave. Death imminent. Call the coroner.
My running joke since starting New York House Call Physicians: Your Doctor in the Family in 2005 is that I ask my patients to get sick only Monday-Friday 9am-5pm but they never listen.
Patients have the audacity to get sick on weekends and even on the holidays. The nerve. Can’t they respect a doctor’s time with their friends, family, religious and social obligations, etc?
These are all obviously rhetorical questions.
My patients want direct access to me when they are sick, period. Whether in rural Maine now where I am on my first “vacation” in a year or Christmas Day, my email and smart phone are alive and well with patients calling, labs coming in, prior authorizations that need me to sign off on, the normal rumblings of a medical practice/small business go on 24/7/365.
My office doesn’t close for vacation. i don’t close for vacation. Illness doesn’t close for vacation.
Bottom line: If you want to keep your practice alive and thriving, always pick-up the phone, a few minutes spent while on vacation will save hours of work when you get back.
Secrets of a House Call Doctor Part II
A good house call doctor is only as good as the equipment carried with them including medications.
Let’s face it, as 21st century physicians, we can do little without our gear.
Not to be forgotten are the house call doctors that preceded us–which essentially means medical practice since Hippocrates as doctors performed house calls regularly historically.
Terms like “Urgent Care Facility” or “Tertiary Care Hospital” would not have been translatable easily to Galen or Liston.
One of my first house calls was for a sore throat, that was what the caller said anyway. Upon arrival, in addition to the sore throat, they mentioned they had “twisted their ankle” and could I “take a quick look at it and wrap it.” I’m thinking: “Why would I bring ace wraps for a sore throat, why didn’t you mention this when you called, I have plenty at the office.”
The ankle appeared mildly sprained. I hustled down to the nearest pharmacy, bought an ankle wrap for 10 dollars (they cost 1 dollar if that wholesale), and wrapped the ankle.
When I do home visits now, I have so much gear it actually scares most patients, seriously. Imagine calling for a headache and a doctor walking in, cargo patents bulging with equipment, rolling with more gear than two strapping paramedics might carry. That’s me. Better to have it and not need it than vice versa.
While I do not drink alcohol, I treat many patients who suffer from alcoholism–the new politically correct term is Alcohol Abuse Disorder. Why medicine has to keep renaming it’s diseases is beyond me, I think so we can sounds smart at cocktail parties but in seriousness, because in the 21st century, we are realizing that many illnesses like Autism to Asperger’s are spectrum disprders, that is, some people have it worse than others.
So it is with alcoholism.
According to the National Institue on Alcoholism and Alcohol Abuse (link to https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics):
Nearly 88,0009 people (approximately 62,000 men and 26,000 women9) die from alcohol-related causes annually, making alcohol the fourth leading preventable cause of death in the United States.
In 2014, alcohol-impaired driving fatalities accounted for 9,967 deaths (31 percent of overall driving fatalities).
To give you some perspective, nearly 800,000 people in the United States die annually from diseases related to artery clogging like heart attacks and strokes. That is 2,191 deaths every day in the United States from a preventable illness to some degree (there are those with genetic predispositions and bad luck). For perspective, about 2996 people died in the attacks on the Twin Tower on 9/11 [Source: https://en.wikipedia.org/wiki/Casualties_of_the_September_11_attacks].
My point: alcohol is certainly a problem but tobacco, uncontrolled blood pressure, diabetes, obesity–all the risk factors for artery clogging are the real killers statistically in the United States and the media seems to overlook this on a daily basis.
In my opinion, the headline of every newspaper every day should be “Thousands more die from Heart Attacks again today, again”
Now that I am no longer the only doctor in New York City doing house calls, I figured I’d spread the wealth and teach some of you newbies on some secrets of house call medicine.
A good house call physician does two things better than any other doctor:
1. He (or she) answers the phone when called NO MATTER WHAT (this includes email, mms, text, vm–welcome to the 21st century–no need to make sure your horse is well fed so you can hustle off in your buggy.
2. Know how to improvise. Since we are only as good as our knowledge and the gear we carry with us, improvisation in clutch.
Further details to follow, off to administer cefepime IM to a patient with pneumonia (that’s right, I wrote IM or intramuscularly, not IV)–cefepime can be mixed in lidocaine and given IM with equal efficacy to IV form. And you then do not have to fuss with the IV and the drip and wait around for 30 to 60 minutes to run the drip–time is money. I am out of here?
Let’s face it, children have good intuitions. As we age, these get muddied by things like co-pays, co-insurances, prior authorizations, long hold times on the telephone listening to recorded messages telling yo how great the doctor’s office is.
A 6 year old would know to ignore all this.
An adult seeking a new medical doctor for themselves or a loved one could learn a lot form simple childhood observation.
For example, we all know we should wash our hands and stay clean. A doctor with a dirty lab coat is a bad sign, stay away.
Another example: 6 year olds learn to read and write neatly. Bad sloppy writing equates with bad medicine. This is not just my opinion. This is shared by JCAH0 (https://www.jointcommission.org/) who insist on neat writing or electronic medical records, no medical jargon, no latin, and no abbreiviations.
Other examples I always look out for both as a doctor and patient:
- Is there a plate of security glass between me and the receptionist. If so, why? Do you really think I am going to steal your stapler or the multitude of redundant forms you are going to make me complete?
- When I call or email or text my doctor, does he answer the phone and get back to me in a timely manner? This sounds straightforward for a 6 year old but really, we live in the 21st century, a time of ultra-accessibility. Pick up your phones doctor and loose the pagers!
- Speaking of pagers, if you doctor uses one, he probably should be placed in a time machine like Back to the Future.
- My 4 year old daughter wants everything NOW. You know what, so do I as a New Yorker, especially when I am sick. If you doctor makes you wait for more than 5-15 minutes in the waiting room, then has their medical assistant put you in a paper gown and sit in a tiny room by yourself freezing for another 30 to 60 minutes, this is a bad sign–in fact, it sounds like you are about to be hosed down before entering prison!M FYI my office has no waiting room. The term is an oxymoron. Patients are seen on time. In New York City where space is precious, why dedicate so much of it to a room full of old National Geogrpahics that nobody wants?
- How many pages of redundant paperwork asking the same questions did your doctor’s office give you to complete. Plus, some offices also make you complete information on a tablet or ipad. Why ask me my name, birthday, and what medicines I am allergic to a dozen times. Makes no sense. My office paperwork is completed by my stafff so the patient only need sign their HIPPA medical record release and r=then we go right into practicing medicine.
More examples and good stuff to follow, be well.