Is Your Doctor Giving You High Quality Care?
Six months ago when I started Simplicity Health Direct Primary Care (DPC), I didn’t realize how much it would change me as a doctor. I yearned for the ability to spend time with patients without “management” breathing down the back of my neck to see more patients. I was eager to not have to deal with the insurance hassles and headaches that plague physicians trying desperately to get their patients the care that they deserve in the face of endless corporate red tape. I was excited to actually have time to get to know my patients on a more personal level.
However, I wasn’t prepared for my transformation as a physician. I had previously thought that I always did a pretty good job staying up-to-date on the best medical care for my patients. I had always prided myself on delivering what I thought to be high-quality care. It wasn’t until Simplicity Health when I realized what high-quality medical care could truly look like.
I think it drives home the point best by illustrating what real patient encounters have looked like at Simplicity Health DPC versus what likely would have happened at my previous practice which was owned by a large health network.
Higher Quality Care Example #1
Previous practice: A middle-aged man comes to the office for a new patient visit. The patient spends 20-30 minutes of his 60 minutes at the office by waiting and filling out forms. I spend 20 minutes (new patient appointments always received more than the standard 7 minutes) in the room with the patient sorting out his recent medical history. As it turns out, he recently had a colonoscopy that was abnormal. Those records are unavailable at the time of his visit. He doesn’t recall much of what the doctor had said to him as he was still coming out of anesthesia, just that he was “supposed to get a CT scan” but he’s unsure as to why. I tell him, “Since you already have a gastroenterologist, we will let them deal with that,” and we set up follow up for 3 months. The patient leaves the office after 1 hour without much for answers and I, the physician, am left equally searching for answers. I have the office staff request his records which may or may not actually show up by his next appointment in 3 months.
Simplicity Health DPC: The same man comes to the office for a new patient visit. The patient spends 0 minutes of his 90-minute visit filling out paperwork or waiting. I spend 60 minutes in the room with the patient sorting out his recent medical history and he shares the same concerns about his recent colonoscopy.
At this point, we pause the office visit and I leave the room to tell my nurse Michelle that we absolutely need his records ASAP. The patient goes to his car to get his phone where he has some MyChart records. The patient spends 15 minutes scouring his MyChart records and during that same time we receive his records. This extra time allows for us to get a complete picture of his previous care so we are able to hit the ground running. As it turns out, he apparently had a biopsy of two colon polyps that were concerning and we still do not have those results. I then have Michelle place a phone call to the patient’s gastroenterologist. The issue regarding the colonoscopy results and why he is having a CT scan still remains unclear. Several other unrelated health topics are subsequently addressed and a very thorough physical exam is completed. Michelle then enters the room and draws his yearly blood work without him needing to make an extra trip to the lab.
The following day, the gastroenterologist returns a phone call to my personal cell phone. I spend 20 minutes talking to him about the colonoscopy findings and the reason for the CT scan. I share some family history that I uncovered during my initial visit with the patient that the gastroenterologist agrees could be a factor in the patient’s care going forward. The gastroenterologist is blown away that I spent 20 minutes advocating for my patient and his care (and actually gives me a very heart-felt thank you). Later that next day, I receive the lab results (which are thankfully normal) and send the patient an eight-paragraph, fully detailed explanation of exactly what was happening with his care and exactly why he is having the CT scan. I provide an explanation as to what possible outcomes we can expect and what to hope for with the CT scan findings. Instead of following up in 3 months, the patient will return for another lengthy visit in 3 weeks immediately following his CT scan results where we can make sure an appropriate plan is instituted going forward for his care.
Higher Quality Care Example #2
Previous practice: A middle-aged man gets very ill with fatigue, shortness of breath, and severe cough. He is tested for COVID-19 and positive. Nursing staff calls him and advises to go to the ER if his oxygen saturations are less than 92%. He is told to “go to the pharmacy” to get a pulse oximeter to check the oxygen levels. The patient continues to worsen and calls the office on Friday afternoon asking for advice. The nurse sends a message to my “inbox” that I will see on Monday at which point it is too late. The patient is very short of breath and goes to the ER on Saturday. He is admitted into the hospital for 5 days and is discharged on oxygen. He receives a $35,000 hospital bill 3 months later.
Simplicity Health DPC: The same man tests positive for Covid-19 and notifies us. Michelle and I are in communication with him nearly every 12 hours since his diagnosis. He doesn’t own a pulse oximeter and plans to order one on Amazon but it won’t arrive for another 2 days. I personally drive to his house and drop off my personal pulse oximeter into his mailbox at 8PM on Wednesday night to lend to him until his arrives. The patient continues to worsen and texts me on Friday afternoon asking for advice. I provide strict criteria for the patient to monitor and should he meet that criteria, I should be contacted on Saturday. The patient’s oxygen levels drop to 91% and I prescribe a course of steroids (which I dispense directly from my office and personally drop off for the patient in his mailbox on Saturday morning). By Monday, the patient begins feeling better and his oxygen levels (being closely monitored and reported to me via text) start improving. The patient proceeds with an uncomplicated course and recovery of COVID-19 and never receives a large hospital bill 3 months down the road.
Higher Quality Care Example #3
Previous practice: A middle-aged woman begins having some heart palpitations. She lives in Florida for most of the winter and is only coming back home to Ohio for a few days. She requests advice about the heart palpitations. The receptionist advises that the schedule is completely full for those days that she will be back in Ohio, but we could schedule her for 3 weeks from now. The patient now has to decide if she should return again from Florida just for a doctor’s visit or skip the appointment and spend the next several months worrying about the heart palpitations. Perhaps, the heart palpitations get so bad at some point that she ends up in the emergency room. However, she ultimately decides to return from Florida for the sole purpose of having said doctor’s appointment. The nurse puts her in the room and gets an EKG which ends up being normal. I enter the room for approximately 7 total minutes. I take a quick history and a quick listen because I’m running behind. All is normal. I tell the patient that “the EKG is normal and the heart exam is normal. Maybe it is some anxiety. Let’s order a 48-hour Holter monitor and come back in 3 months to discuss.” The patient leaves dismayed thinking that “it’s all in her head” and feels stigmatized about her “anxiety.” She once again returns from Florida to complete the Holter monitor ($3,552). Three months later, the Holter monitor shows symptomatic premature ventricular contractions (PVCs). I provided reassurance that this is nothing to worry about. The patient had the experience of traveling back from Florida on two separate occasions, getting a large bill for the Holter monitor, feeling increased anxiety about the heart palpitations for the last 3 months and now feeling depressed that she can’t “get ahold of her anxiety.” All of this to find out that the heart palpitations that she had been feeling are very real and she really doesn’t even have anxiety.
Simplicity Health DPC: The same woman requests advice about the heart palpitations through text messages to me. We get her in immediately while she’s still in Ohio. Michelle puts her in the room and gets an EKG which ends up being normal. After spending 15 minutes discussing her triggers for the heart palpitations and getting a thorough history, I then carefully listen to her heart. Normal. I keep listening. Normal. I keep listening… and there it is. After 2 minutes of carefully listening, I heard the heart skip a beat. The patient confirms with me, “Yeah, I just felt it too.” I have Michelle repeat the EKG. Sure enough, there it is – the premature ventricular contractions (PVCs). I counsel the patient that these are nothing we should worry about and give her some advice on how to decrease their frequency. The patient leaves that day with an answer. No further testing needed. No waiting 3 months until her next visit and no large bills for the Holter monitor. No feeling like her “anxiety” was somehow to blame.
Higher Quality Care Example #4
Previous practice: A patient of mine has a family member visiting from Oregon. The family member ends up having an infected toenail that becomes very painful. The family member is brought to a local ER or urgent care. Their visit together is marred by an emergency visit, lots of waiting, and an expensive bill to be delivered in the mail 3 months from now.
Simplicity Health DPC: The same patient sends me a text message at 6:30PM on a Saturday night regarding the family member with the infected toenail. We arranged to meet at my office at 7:30PM that same night. I perform a small procedure to alleviate the pain and send him out with an antibiotic. No ER or urgent care visits. The toenail improves over the course of the family members’ stay in Ohio and no extra bills show up in the mail.
I could have never imagined getting so much fulfillment from being a physician. Our Direct Primary Care model has invigorated me and has made me a better doctor. The shock, amazement and surprise on our patient’s faces when we say to them, “Your yearly blood work will cost $19, are you okay with that?” will never get old. The encounters where we save patients hundreds of dollars on their prescription medications will never get old. These stories aren’t uncommon and there are many more similar stories that I could share.
I hope you can find it as refreshing as I do.
Dr. Opperman
