Fam Pract Manag. 2003 May;10(5):71.
Office manager for a day
My morning routine is to open my office at 8 a.m., turn on the lights and computers, put on the tea water and listen to my messages. Yesterday, my third message had me in a tizzy. “Dr. Brown,” a shaky voice said, “This is Dalia. I’m sick. If you need me to come in, I will, but I’m really not feeling well.” With some trepidation, I called my wife and begged her to fill in for Dalia. “No,” she said, simply. After years of being my backup office manager, she knows what works best for our relationship. “OK,” I thought, “I can do this by myself.”
I looked at my schedule and saw I had lots of blood draws for the day, so I went ahead and filled out the lab forms. Then I changed the message on my answering machine: “This is Dr. Brown. Dalia’s out sick today, so if I don’t answer the phone, it’s because I’m with a patient. Leave a message and I’ll call you back.”
My patients were very understanding, and the day went off without a hitch. In fact, when my patients heard the telephone ringing during their visits, they were solicitous enough to ask if I wanted to answer it. Between patients, I was able to call in prescription refill requests, enter billings, post payments and make appointments. I was really cookin’.
Before backing up my files at the end of the day, I took a few minutes to review my electronic claim submissions from the previous day and fixed two suspended claims online. Then, I took a few more minutes to call patients with reminders about their next day’s appointments. I was out of the office with enough time left in my day for a few games of racquetball. “You should have seen me do it all today,” I crowed to my cronies at the health club.
“So, how did it go?” my wife asked me when I arrived home that evening.
“Terribly,” I said, “I really could have used your help.”
One of the income rivulets in my practice is doing insurance exams. I enjoy them because of the compensation and also because they’re easy.
Most people pass the physical screen, which is fairly basic, but occasionally someone will have a measurement so out of line that I know there’s no way anyone’s going to sell them life insurance. This happened just the other day. Mark, a 59-year-old businessman who didn’t have a personal physician, had a blood-pressure reading of 210/120. “Has anyone ever told you that you have severe hypertension?” I asked him.
“They always said it was white-coat hypertension,” Mark said.
“In case you haven’t noticed, Mark, I don’t wear a white coat. Insurance companies like things to be within normal limits. If I record a blood pressure for you of anything over 140/90, you can forget about life insurance.”
Mark agreed to become my patient and get worked up and treated for high blood pressure. “A treated blood pressure of 120/80 will more likely get you underwritten than an untreated one of 210/120,” I told him.
Then, I began to think about the thousands of Marks out there, people who are responsible enough to insure their lives but won’t do the periodic maintenance necessary to stay alive. Maybe it’s the ostrich syndrome, where people stick their heads in the sand and ignore the symptoms and signs. Or maybe they just don’t think about seeing a doctor while they’re feeling fine. Regardless, this kind of behavior is epidemic. I can understand why some 40 million Americans without health insurance may not see doctors in a timely fashion, but what’s the excuse for the rest of us?
A friend in need II
The call from Karen, my old friend Oliver’s sister, was unexpected and foreboding. I knew, with dread, what she was about to tell me: Oliver was dead at age 55. His doctors suspected he had died of either a heart attack or a stroke, and the memorial was set for the next Saturday. “Would you like to speak at the service?” Karen asked.
“Definitely,” I said.
A year before, I had diagnosed Oliver with diabetes, hypertension and hypercholesterolemia, set him up to see colleagues in the city and thought he was doing well. But too many doctors and too many drugs may have done Oliver in. The mix of drugs was producing too many unpleasant side effects, and he had stopped taking many of them. He was his own worst enemy. A brilliant lawyer whose counsel was sought by many, he was simply unable to take the advice of others.
The eulogies at Oliver’s memorial were deeply moving, highlighting the traits we all knew him for: warmth, generosity, loyalty and an inability to let an injustice stand. They also revealed facets of Oliver that many had never glimpsed, such as his competitiveness in sports, his obsession with antique furniture and his seeming uninterest in watching his favorite baseball team play even though he went to most of their games. (He preferred to talk politics in the box seats.)
At the conclusion of my remarks, I said, “I only hope I was as good a friend to Oliver as he was to me.” Perhaps that’s the only way we can let our loved ones go without regrets.
Dr. Brown, a solo family physician who lives in Mendocino, Calif., is a contributing editor to Family Practice Management. These excerpts from his journal illustrate the many stories, lessons and characters family practice has to offer. No real patient names have been used.
Conflicts of interest: none reported.
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