Our new practices are based on just a few simple principles that are very different than typical practices. The first is that our job is to meet the needs of our patients. While in virtually every other industry this is a no- brainer, it is actually deeply heretical in health care. This story I think illustrates the point well:

Several years ago, I got a call at about 10 o’clock one morning from a rather distraught gentleman. The previous evening he was awoken from sleep to see his wife, a previously healthy 35-year-old named Kara, having a grand mal seizure right next to him. If you have never seen a real seizure before, its very frightening. He quickly called 911, the EMTs arrived, gave Kara some ativan to break the seizures, and took her to a local ER where she had a negative CT scan and MRI, of her head, and saw a neurologist who loaded her with Dilantin, an anti seizure medication, and told her to follow up with the primary care doc in the morning. They got home around 5am, and waited by the phone till 8 when their pcps office opened.

They called, and after being placed on hold for several minutes got the secretary, who told them the next available appointment with their doctor was in 3 weeks, or else they could see a doctor they had never met the next day. The husband said “You don’t understand… Kara had a seizure, we were in the ER. We really want to see her doctor today. Please tell her the whole story, I’m sure she’ll agree.”

They waited again by the phone for an hour, and then got a call back from the secretary. “I finally caught her running between patients and told her the story. She said it seemed like you had the right tests and are on the right medication. There’s no medical reason you need to be seen today. She said she’ll see you in a week when she needs to check your dilantin level.”

The other doctor was technically right. Kara did have the right tests and was given the right medication, but she missed the point. Kara and her family really needed to be seen that day. Her husband remembered reading about our practice and philosophy in the local paper, and called us. As often occurs when our administrative person is busy, I picked up the phone myself. When I heard the story my response was, “Absolutely we can see you today. Come in as soon as you can, we’ll make the room.” We spent the next hour answering her dozens of questions, talking about what seizures were, what the next steps might be. After she left I emailed her a number of articles and links, and she later sent me a number of further questions we discussed by phone. I called her proactively a few times that week to make sure she was doing well. She could access her record as see her test results and my thinking, and again could contact us with more questions.

Imagine for a moment that Kara was your wife, your daughter, or even yourself. This is the way we would want to be treated. But unfortunately too many current practices treat her more like her old one did. It is comforting to think we can fix this by thinking small, setting up a series of committees or improvement projects. But I think this is wrong. To truly serve Kara, and all the rest of our patients, we need to have the courage to stop thinking small, and start thinking big, no matter what our size happens to be.