How this pediatrician practices medicine. Her way.


My thoughts settled on the Frank Sinatra song, “My Way,” when asked about necessary resources for rural health care to survive. Seven years ago, my father and I changed office buildings.  We closed the office that Friday to allow three full days to get settled.  However, we ended up seeing sick patients in the parking lot (seriously), while the movers were loading up the truck.

“All we need is a stethoscope, otoscope, and a pen to practice,” my father declared.  I have never forgotten his sound advice.

The thing missing from health care today is a long-term relationship built over time between the physician and patient. Patients need physicians who can look into their eyes and know if they are “sick” or “not sick.” Do you realize how rare and valuable that is? After 15 years taking care of the same child over and over, I know them like the back of my hand. I can read their minds. That is real medicine for the real world.

“I’ve lived a life that’s full. I’ve traveled each and every highway; and more, much more than this, I did it my way.”

My way of providing high-quality care to patients would allow for adequate time to spend with them.  It can take an hour or more to answer questions from vaccine-hesitant parents. Believe me; that is time well spent. I wish a government bureaucrat could observe the complicated conversations with parents who are making important decisions for their children.   Talking is a primary care physician’s job, let me do it.

My way would deliver comprehensive care to my patients. Ideally, my practice and my patients could benefit from having a behavioral therapist 2 days per week, a social worker 3 days per week, a lactation consultant 2 days per week, a child psychologist 1 day per week, and a child psychiatrist one day per month. Access to a dermatologist would be pretty awesome, but I won’t go overboard.

My way would trust the physician to treat the patient.  Elimination of all government mandates which overemphasize the need for data collection, yet serve as obstacles to provide care for the sick.  Offering one Medicaid plan as opposed to six Medicaid plans in one state would decrease our administrative burden tremendously.  I do not need a CEO, CFO, CMO, or BSO to tell me how to practice nor do I intend to listen to any who are going to take away my livelihood by reducing reimbursement rates based on ridiculous patient outcomes.

“I planned each charted course; each careful step along the byway … I did it my way.”

My way would pay physicians for their time.  If I spend an hour with a patient, what the heck does the government or insurance think I was doing, playing tidily-winks? I was exchanging information. A physician must be able to afford food, shelter, and clothing; it is essential to have enough revenue from our work to take care of ourselves and our families.

My way of providing accountability is simple. Look at physician outcomes: not patient outcome measures. How many visited my office and then visited the ER within 24 hours? Do not look at how many patients from my panel went to the ER. That is ludicrous and does not reflect care provided in any way; that data reflects a decision made by a patient.  There is no cost or copay to discourage them from going to the ER.   What percentage of patients came in for well child checks? Not what percentages are fully immunized? Parents have a right to refuse immunizations.  How many asthmatics were hospitalized who were not on a steroid inhaler? Doing it my way, the answer is zero in the last 15 years. There are twenty more metrics off the top of my head that would provide more useful information.

“But through it all, when there was doubt, I ate it up and spit it out.  I faced it all, and I stood tall; and did it my way.”

My way of making technology useful would be insisting data entry took 60 seconds or less.  If I see 15 to 20 patients per day, it should take 15 to 20 minutes to finish documentation and go home. That is what it takes me right now.  Do not force me to use technology which makes it more difficult to care for the sick.  Our time with patients is precious.  If pundits want data, they can send me a person to collect it from my charts. There is little use for red-tape disguised as technology and accountability; I would unplug my computer, if given the choice.

My way is the “9 a.m. rule.” If anything happens and a patient wants to be seen the following day for acute illness, accident, or injury, they walk in at 9 am and are fit into the schedule: no matter what. Do you know the comfort that brings to the family of a small child? They are never afraid to wait it out at home and avoid the ER because they know they can be seen. That type of service is popular, beneficial, and should be reimbursed adequately at urgent care rates.

“To say the things he truly feels; and not the words of one who kneels.  The record shows I took the blows — and did it my way.”

My way would involve fewer bureaucrats making significant health care decisions that impact the entire country and its population at large.  Both patients and physicians are taking blows from those in charge of the system who know nothing about the world of primary care.  The simple premise businessmen are unable to comprehend:  the provision of basic primary care requires a stethoscope, otoscope/ophthalmoscope, and a pen. The pen does double duty too; as a writing instrument and tool for emergency tracheotomy.  And that’s all folks!

“Yes, it was my way.”

Yes, I will figure out how to do it my way.  There will be many others who will do the same.

Niran S. Al-Agba is a pediatrician who blogs at MommyDoc.

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