Winter’s cold has finally come and I needed my heavy coat. I expected to find it pushed to the back of our closet by other season’s garb. I never expected to find, instead, the coat of a bygone era. The white hospital lab coat now relegated to the back of the closet was where I left it, and my traditional medical practice, December 31, 2013. That date marked, for me, a changing of the guard and a change of the garb.
There is a time honored tradition in medical school called the White Coat Ceremony. About half way through medical school students are awarded their first white coat. And even though it is a shortened version of a real doctor’s (RD) coat it is nonetheless a coveted rite of passage and the gateway to membership in an elite group.
Seeing my old hospital coat, with one of my stethoscopes still in the pocket, brought back memories of a career spanning four decades. I tell people, “I’m not retired,” when they ask me if I’m enjoying retirement. I love Mark Twain’s often dry humor. He once quipped that “The news of my death has been greatly exaggerated.” The same can be said of this doctor who has rediscovered the joy of practicing medicine again, outside the disintegrating modern “industrial-medical complex.” I now tell people I’m semi-retired and practice concierge medicine and explain that I no longer work for anyone other than my patients. Now, I’ve traded the longer version of a M.D.’s white hospital coat for the doctor’s bag given to me at my graduation from medical school in 1975.
For me life is certainly different as this New Year dawns. Looking back, I can honestly say that leaving the “system” was my destiny. It took two years of soul searching and a leap of faith – born of desperation – to walk away from all I had worked for since I was eighteen years old. Only later did I discover that concierge medicine and a new business venture would be a godsend. I especially identify with this word, because I believe in a deterministic universe with a purpose and plan and an Intelligent Designer. His Plan is often mysterious, perhaps because His ways are not our ways (Isaiah 55:8). Yet life and Creation are majestic.
Making house calls in my truck is certainly different than seeing patients in a medical office or in a hospital surrounded by technology, support staff and readily available colleagues, when consultation is necessary. Perhaps medical missionary work in Central America, far from technology, honed my diagnostic skills and now allows me to listen, observe and make decisions without a CAT scan. Don’t get the wrong impression; I’m not a medical troglodyte. I still order simple and complex tests on my patients. However, we should all question whether we do too much testing, take too many pills, and apply too little common sense. At this point in my life, I’ve come to understand what is right, and what is not.
Forgive me for getting a bit preachy and philosophical. You can take the boy out of the white coat, but not the white coat out of the boy. A few light hearted observations of concierge medicine might cause a smile. Ladies especially may empathize with a professional patient of mine who chose to come to my home for her annual exam because she didn’t “want to clean her house for my visit!” When my medical group broke up with a division of the medical equipment, there was an extra exam table which I took home and put in my library. My resourceful wife was able to balance “form and function” by placing an attractive screen in front of the otherwise out of place sterile table. Now, my grandson hardly notices the table when he naps in his bed on the other side of the screen.
Few would argue that, in general, men are less modest than women. I once did a delicate examination on a patient in his living room. Experience is a great teacher and while I was probing I noticed that the drapes were open. I hoped that the neighbors weren’t curious about the red truck in the driveway and weren’t scanning the windows. I won’t make that mistake again. Similarly, another patient was very concerned about a new lump in her breast. As I was examining her, it suddenly occurred to me how awkward this might appear to her husband if he were to chance upon his wife and me. Ordinarily, in my concierge medical practice, women maintain their relationship with their OB-Gyn, and in my former office practice I always had a female attendant during “delicate” examinations. Perhaps someone might explain to me why women physicians are not similarly required to have an attendant when examining their male patients.
Another milestone passed with the exit of 2014. On average I saw four thousand patients a year for almost forty years, and was never sued for malpractice. This is very unusual. Perhaps I was lucky; perhaps I was competent. I suspect it was more because those I cared for, knew I cared. We spent quality time with each other and our relationships transcended standard medical care. Many of my former patients remain my friends. I’ve made medical mistakes, but not because of a detached or reckless attitude. And friends more often than not, forgive each other.
A recent essay in JAMA (Journal of the American Medical Association) asked the question, “Who determines physician effectiveness?” My a priori bias was challenged when I discovered the essay was less about the government establishment of arbitrary standards, and more about the doctor-patient relationship. The authors emphasized the patient’s responsibility in his own healthcare, and the doctor’s responsibility as well.
We hear much these days about “best” medical practices judged by arbitrary surrogates like blood pressure readings, Hemoglobin A1c levels (diabetic control) or what percentage of a doctor’s patients went for mammograms. Perhaps these indirect markers are easier for bean counters to assess, than quality time spent with a patient.
Yes, there is a new look for Ferguson, and he is no longer bound by 15 minute office visits. I thank God each day for The Way, The Truth and my new life.