I have spent my entire medical career in academic medicine, engaging in work that was more of a calling for me than a career. After 22 years of practicing traditional outpatient primary care and helping run a medical school, I decided to move to Washington, DC, to be near my children and extended family. It was one of the craziest decisions I have ever made. Who leaves a position as Associate Dean and moves to the East Coast without a plan? I ended up taking a different career path. I joined a concierge practice that would allow me to see fewer patients and spend quality time with them, practicing medicine as I had always envisioned.
Two months into my practice, I saw a patient for what we in concierge medicine call a “meet and greet.” It is a 30-minute conversation where the patient and physician decide if they are a good fit for one another. She is a young woman who was suffering from four weeks of sore throat, fever, and fatigue. The stressful part of this illness was that she had fallen ill one day after starting a new job.
During the meet and greet, she decided to engage me as her primary care doctor and requested to be seen the same day. I had an opening and got her in that morning. I surmised that this would be a straightforward 15-minute sick visit. She had developed a sore throat, was ill for about 10 days, had seen two or three different physicians over the following two weeks, tested positive for strep and had been given antibiotics. She was then told that she had “little abscesses” on her tonsils, was given more potent antibiotics, but then informed by a third provider that she had mono and didn’t need antibiotics in the first place. She was rightly confused and scared. Abscesses sounded scary. Did she need a CT scan? Didn’t abscesses need to be drained?
The medical part of our visit took a straightforward 10 minutes, but her concerns required a deep dive. Most of our time together was spent in conversation, untangling all that had transpired in the past four weeks, alleviating her very legitimate concerns, and helping her decide on next steps. Her illness had essentially upended her job, placing her position at risk. Her worries went beyond her sore throat. I didn’t have all the answers to her complex questions, but I transparently discussed my thought process with her. As the conversation progressed, I observed the stress leaving her body. Her shoulders began to relax. The entire interaction took 45 minutes, relatively long for a “sick visit”. However, it was 45 minutes that the patient desperately needed to make meaning of what she was experiencing. Equally important, it was 45 minutes that I had available to give her.
The time-restricted practice of traditional medicine can sometimes feel very transactional: Make a diagnosis, provide a plan, and move on to the next waiting patient. In this practice, however, I had the luxury of time to care for the patient in a way that was responsive to her needs, while also giving me the necessary space to understand the entire clinical picture. What I thought would be a simple diagnosis of mono resulted in a meaningful patient-physician dialogue and the start of a great relationship. I sat down. I took a deep breath. I am indeed in the right place.