BY SHERI PORTER
 John Patz, D.O., instructs a patient about to begin detoxification. Her name is the first to be entered in Patz's buprenorphine journal -- a record of his patients taking the drug. |
In the spring of 2003, FP John Patz, D.O., realized he was tired of squeezing patients at the medical clinic into 15-minute slots day after day. He was fed up with insurance company hassles, excessive paperwork, corporate rules and lack of control over his professional life.
"I needed to redefine my practice to try to find a renewed sense of purpose," says Patz.
Fast forward to Feb. 2, 2004, and welcome to Patz's new practice, Ballard Recovery Services Inc. (in the Ballard neighborhood just minutes from downtown Seattle). The practice is devoted to addiction medicine and pain management. Patz sets his own fees -- about 20 percent below the average in this neighborhood -- and he operates on a cash-only basis.
Office rates for new patients range from $50 for a level one visit to $200 for a level five visit. Opiate detoxification is billed at $500 a week. Most patients require two to three weeks of treatment and initially must be seen in the office every day.
In Patz's view, prescription pain medications have become a significant problem. "Any physician who is starting patients on chronic narcotic therapy should have a plan to get them off," says Patz.
Patz understands why many FPs are both weary and wary of treating patients with addictions or chronic pain. It's not unusual to encounter patients who have been "fired" by their primary care physicians for nonpayment or noncompliance, he says. "These patients' problems are multifaceted, and their treatment involves psychosocial overlays that involve significant time." All of Patz's addicted patients take counseling sessions with Vincent Ingarra, M.S.W., the psychiatric social worker and licensed counselor who sees patients part time at Ballard Recovery.
"It is a bit unnerving to know that I'm now trying to attract the sort of patients that many family physicians would rather not have in their practices," says Patz.
All in a day's work
On March 1, one day before Patz's one-month anniversary, the appointment book shows only two patients, and the first is late for her 9:30 a.m. appointment. "I'm worried about her," says Patz, and asks the office manager to give her a call.
He's relieved to hear that the patient's just stuck in traffic. She's scheduled to begin opiate detoxification this morning. Patz will start her on buprenorphine, a drug approved for treating opioid addiction.
When he was in a traditional for family practice, Patz says, his schedule couldn't tolerate patients being late. "Now, if I were to turn someone away who was 30 minutes late, I might have missed my only chance to see that patient," he says.
Today, an unscheduled patient, trying to taper off of benzodiazepines under Patz's supervision, wobbles into the office with a friend's help.
"The tapering is just not working for him. He needs inpatient treatment," says Patz after the patient leaves. Despite his best efforts at paving the way for admission to an inpatient facility today, Patz doesn't know if the man will go. "But I can sleep at night knowing that I've done everything I can for him," he says.
Follow the rules
 A patient undergoing treatment for an addiction settles up with office manager Brenda Gibons after his appointment. Although Ballard Recovery Inc. is a cash-only practice, patients have the option of filing claims with their health insurance companies. |
Up to 30 percent of patients at Patz's previous practice were in treatment for chronic pain or addiction -- so he knows the pitfalls that could ensnare his fledgling practice.
"We will not enable addiction here, and I'm sure we'll show many people to the door," Patz says.
Addiction and chronic pain share common threads, says Patz, which is why he requires patients being treated for chronic pain to sign a patient agreement. The 22-point document, adapted from materials of the American Academy of Pain Medicine, says the patient will go to only one prescribing physician and one pharmacy. The agreement includes statements such as these:
It also says if a patient can't comply with this agreement, there may be an addiction problem rather than a chronic pain problem.
Reap the rewards
Will his practice succeed? "It's too early to tell," says Patz. "But I do feel I'm in the right place at the right time. These are exactly the patients I want to help."
There's another factor that draws this FP to treatment of addictions: As patients begin to recover, Patz sees them regain their integrity. "I've not gotten that reward in treating many other chronic diseases," he says.
To reach writer Sheri Porter, e-mail sporter@aafp.org.
FP Report is published by the AAFP
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Copyright © 2004 by
American Academy of Family Physicians.