Sunday, October 14, 2018

The Antidote to Big Box Medicine - Private Practice

I prefer to do business with small, privately owned establishments rather than patronize the big box centers that have pushed smaller stores to the margins or off the grid.  Of course, I do spend money at the large centers for the same reasons that all of us do.  But, I miss the personal attention and interest that a single proprietor and the staff can provide.  South Orange, the small town, or actually village, where I was raised was full of these stores where we bought hardware items, sandwiches, clothing, medicine, shoes and ice cream cones.  I would periodically stop into the bank, with my passbook, to deposit my accumulated cash from my paltry weekly allowance. (As a third grader, I received 10 cents per week.)  When I would pop into to one of these places, the owners knew me and my family, not quite the COSTCO experience, where one guard has to admit me into the store and another must scan my receipt before I can exit. 

Village Hall in South Orange, NJ

I had an out-of-body, or an out-of-wallet, experience a few weeks before writing this in a frame shop in downtown Willoughby, Ohio, not far from my office.  I brought in two large newspaper photographs that captured two amazing scenes after the Cleveland Cavaliers captured the NBA championships.  These were to be gifts for two of my kids who have been devoted fans of our basketball team.  I handed over the items to the owner who gave my project close and careful scrutiny.  He conferred with his wife to verify that his framing plan of action was the best option.  I asked how much of a deposit he would need, and he declined my offer.  I told him I had never in my life left an item for framing elsewhere without being asked for a deposit.  What if his frame shop did the work and the customer never returned or might balk against the agreed upon price?   Apparently, this couple trusted me or simply trusts all of their customers.  When I came to pick up the items, the credit card gizmo wasn’t working.  No worries, I was told. Just take the items and give a call in a week or so with my credit care information.

Who does business like this?  While I acknowledge that these folks are deviating from sound business practices, there was a warmth and humanity from this transaction that affected me.  I will surely return there.  

As readers know, I am part of a small private practice where we do our best to provide consistent and close personal attention to our patients, who are our customers.  As solicitous as we try to be, we are not able to be quite as relaxed and casual as the frame shop proprietors were with me.  I wish we could be.  We do collect copays, for example, prior to the visit, fees that are established by the patients' insurance companies, not by us.  

Just like this mom and pop frame store, our practice is surrounded by ‘big box’ medicine.  Fortunately, we still have a loyal patient base that values what we provide.  We think that our environment is warm, welcoming and friendly. We certainly try.  No guard stands at the door checking patients as they enter or leave.  I remember how I felt when I used to walk into Beck's Hardware or Jerry's Boys Town as a teenager in South Orange village.  I can only hope that when our patients come to see us today that we make them and their families feel like the living, breathing human beings that they are. 

Sunday, October 7, 2018

When Diagnosing Colon Cancer Might be a Mistake


So much of life depends upon timing.   Sure, we plan, but we know how much of our life’s events are unplanned and unexpected.  So often, our jobs and our mates – two of our most defining accomplishments – are the result of a chance encounter or a random act.  Life does not reliably proceed in an orderly manner.

This is often true in the medical profession.   Here, physicians in our quest to seek out and squelch disease, often discover what would should have been left alone.  For example, is discovering prostate cancer in an older man a true benefit if the tumor would have remained silent throughout the man’s life?  Whenever possible, it is best to ask the question, ‘what will I do with the information?’, before recommending a diagnostic test to a patient.  There is a risk to disturbing the natural order of things.

Are we really just shooting dice?

Sometimes, medical events occur on their own without any prompting from a physician.  I was contacted by a physician regarding an 87-year-old man with rectal bleeding.   He had never had a colonoscopy in his life and had only minimal contact with the medical profession.  (Maybe this is how he reached the age of 87!)   His bleeding developed a few months after he was started on a blood thinner prescribed because of an abnormal heart rhythm, in an effort to reduce his risk of a stroke.  A CAT scan was performed which strongly suggested that the bleeding was coming from a cancer in his colon.

If the patient had not developed a cardiac rhythm disturbance, then he would not have been prescribed a blood thinner.  And, without the blood thinner, he would not not have developed bleeding.   And, his colon cancer would have remained a stealth stowaway in his large intestine, unknown to the patient and the medical profession.  Perhaps, the cancer would have remained quiet and never posed a threat to him.  Now, however, he will undergo a colonoscopy which may be followed by major surgery to remove the invader.   One need not be a trained physician to appreciate that major surgery in a near nonagenarian with heart disease has risks.

I cannot tell readers the denouement as the case is in progress.  But, it reinforces how much in our lives is far beyond our control and comprehension.   An innocent experience can create an opening that leads to a path that reaches a tunnel that connects to a labyrinth that ends by a bridge that crosses a river…

We all think we are such assiduous planners.   We might be, but to me it seems that we are often just shooting dice.  

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