Tuesday, September 1, 2020

Visiting the New Doctor

 What I Learned When I Tried a Direct Primary Care Practice

Physician tenure is usually longer than manager tenure though increasingly uncertain.  The independent practice model took its toll on me ten years ago and on my own primary doctor this summer.  He could have distributed us among the remaining independent colleagues but opted to parcel us out to the dominant medical center owned practices.  I latched onto one with some effort but completed the initial visit.

I expected to encounter a more robust enterprise.  Two old colleagues, crossed my path, one recognizing me with a hello and brief chat, the other not.  With three physicians on-site the waiting area, marked for social distancing, seemed devoid of patients.  Check-in, also marked for distance only had one other patient, a new one, also a refugee from my doctor's senior partner.  I appeared the sturdier and more independent.  His son toted his record, something I had provided the previous week, his being much bulkier than mine.

My turn came.  Height by stadiometer, weight by digital scale, blood pressure by electronic doo-dad.  All on target, though I've lost a smidgen of height from my peak, though it's never been measured with a stadiometer in the past.  Waited for the doctor and her resident to come by.  Resident didn't say a word.  As a new patient I provided a history while my new doctor checked the template circles.  Currently asymptomatic pretty much except for the planned obsolescence of chronic arthritis, and that had improved greatly from its peak severity.  Family history given.  Heart and lungs auscultated by the attending physician, not by the resident.  Usually don't find much on exam, and the younger doctors have largely lost the skill.  Neither has a lot of experience with paper medical records, commenting more about handwriting than the more important retrieval of content.  An innocuous encounter to be rescheduled for six months.

When I completed residency, that was the type of job at the top of my list.  Instead for convenience, a hospitalist position came my way as the first job out of residency.  The better choice in the long run.  Despite being on Medicare, I am an easy patient with a small list of recordable problems, preventive care up to date, and nothing medically challenging to be pondered.  I require more processing than reasoning, the most challenging decision perhaps how far into the future to schedule the next appointment.  I would bore me if my medical clones occupied that exam room all day long. 

Most surprisingly to me, the office at the centerpiece of the primary care network of the large regional center did not seem a beehive of medical activity.  Covid-19 probably limits occupancy of the office, but it's usually best when the docs on site look reasonably frazzled by not fully overwhelmed.  Maybe some folks with later appointments will challenge them more.

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