After 1 year of Direct Primary Care

A little over one year ago, I published one of my first ever blog posts entitled “After 1 month of DPC.” I thought it was only fitting to now publish a follow up to that blog post, “After 1 year of DPC.” After one month, I had no idea how the Direct Primary Care model was going to change EVERYTHING for me and my patients.

From a personal standpoint, I’m a refreshed doctor always able to think and work at my highest capacity. I feel no sense of burnout which has been ravaging through the physician community leading to high physician suicide rates and extreme dissatisfaction with careers. Physicians have lost their sense of purpose. They face endless administrative pressures that have stripped them of their lifelong passion of helping people. Now they are glorified paper-pushers for insurance companies and cash registers for the hospital systems where they’re employed. They are overworked and underappreciated. I know because that was me just over one year ago and the situation has only gotten worse. Physicians are losing their passion, empathy, and self-worth at an alarming rate.

By only having a fraction of the patient panel of a typical physician, I’m able to pour everything I have into each and every one of my patients and it is so incredibly rewarding. Additionally, the patient outcomes have been dramatically better as well.

The following are patient encounters over the past year that really demonstrate the Direct Primary Care difference:

Attention to Detail: An Early Cancer Diagnosis

·         Patient makes an appointment for a cough. Turns out that the cough had nothing to do with what was about to transpire. In an effort to get to the bottom of the cough, I reviewed all labs and records dating back 3 years. This was a task that took around 20 minutes alone and considering that the average doctor visit in the traditional model is only 7 minutes, this would not have been possible in my previous doctoring career. During that investigation, I uncovered that although his labs were technically normal (the computer wasn’t flagging them a different color in the chart alerting me to them being abnormal), they actually weren’t normal. They had been slowly dropping over the years and this would have undoubtedly been missed without having extra time to research. This prompted further investigation and lab work which revealed more troubling findings. I then decided it was time to go looking for cancer. I didn’t know where the cancer was located but had seen enough abnormal findings that it warranted some CT scans. We ordered the CT scans and, of course, his insurance denied them. At my previous traditional model office, we would have alerted him to the fact that insurance denied the scans and it would have been tough cookies. But instead, Michelle and I spent the next 2 hours fighting tooth-and-nail with his insurance company pleading to get the scans approved. The insurance company reluctantly agreed to approve one CT scan of my choosing, but not both. We chose correctly and unfortunately discovered a large, currently asymptomatic cancer. It had luckily not yet spread but was close to doing so. Michelle and I then spent the next 4 hours of that day researching and scheduling our patient with the absolute best cancer doctors and surgeons for his particular type of cancer. I can happily report that our patient has had a fantastic outcome to date. I honestly believe that his cancer was discovered and completely treated 6 months before it would have ever been found in a traditional model after he would have become symptomatic.

I started with the most dramatic example, but I think the Direct Primary Care model has saved at least one life over this past year.

Immediate Access = Better Outcomes

·         In another example, we had a patient benefit from being able to have quick access to her doctor. She had been suffering with horrible abdominal pain and had contemplated going to the emergency room. But because of her ability to get in to see us immediately, she decided to come in for an evaluation. After one look at her, I made the rapid decision that she needed to be hospitalized. We arranged the direct admission where she skipped over the waiting in the emergency department and went straight to the hospital floor. It was soon discovered that she had a bowel perforation and would require life-saving emergency surgery. While we didn’t perform the life-saving surgery, it’s my belief that her ability to have immediate access to her physician certainly payed huge dividends in her care.

Time Well Spent

·         Since I am able to spend time with patients, it has allowed me to adequately counsel patients on their diets and lifestyle prior to ever starting medications. In too many situations to count, we’ve successfully worked with patients to have them lose large amounts of weight which has resulted in much better health and less medication.

·         We’ve facilitated faster appointments with specialists because we have the time to advocate on our patients’ behalf.

·         I’ve solved mysterious patient diagnoses with patients of mine that have been patients for years. In the previous model, those diagnoses remained elusive. But now that I can dedicate enough time and energy to my patients, I have become a better, more thorough physician.

·         I’ve made diagnoses that have been missed for years by other providers in the healthcare system because they lacked adequate time to be thorough.

·         We routinely and successfully go to battle with insurance companies on behalf of our patients because we now have time and energy to do so. When insurance companies deny a test or medication, we work hard on behalf of our patients to fight their battles for them. When patients can’t afford medications, we apply for patient assistance programs on behalf of our patients or work directly with the manufacturers to help our patients get the medications they need.

Not Just a Number

·         I’ve had impromptu office visits on weekends and evenings. I even performed a small surgery the evening before Thanksgiving last year to help a patient and his family enjoy their holiday together.

·         I’ve personally hand delivered medications to patients’ homes because “I was driving by and it made sense to do it.” I’ve done house calls for the elderly so we can help keep them safe in bad weather and the young when they’ve been injured or are too busy to get away from work.

·         We’ve hand-written many congratulatory cards and mailed them to patients for their successes in life; not just for their health. We’ve sent cards to celebrate births, weddings, weight loss, new jobs, and dream houses. We have truly enjoyed being a part of our patients’ lives and celebrating (and sometimes mourning) with them. I no longer see my patients as medical conditions but rather friends. I have developed deeper relationships with all of my patients and have been blessed 100-fold in return. Providing care to people that you consider friends doesn’t feel like “work.”

·         We’ve treated many patients that have historically “hated doctors” or “hated going to the doctor’s office.” Our model allows for a much more comfortable visit. Many of our patients that used to dread seeing their doctor actually find their visits with us enjoyable.

Membership That Can Pay for Itself

·         We’ve been able to save numerous patients large amounts of money through access to affordable lab testing and medications. Our patients with high deductibles and our patients without insurance have been able to get affordable healthcare though us saving our patients thousands upon thousands of dollars avoiding the ridiculous markup in commercial healthcare settings.

I Can Text My Doctor?

·         We’ve been able to avoid countless visits through texting or phone calls. Patients no longer have to wait on hold, schedule a visit several days out, or take off work for a doctor’s visit that can be avoided by having 24-7 access to their doctor at the palm of their hands.

Perhaps the most poignant comment about our new practice came from Michelle one evening as we were closing up the office. She had said to me, “Doc, I really love this practice. For the first time in my nursing career, I truly feel like I’m really helping people.” Well said, Michelle. Well said.