The Doctor Answered the Phone?

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Julie was shocked when her doctor answered the phone.

She had called the office, expecting to ask Sue to schedule an appointment to be seen. Or maybe Dr. Herrington could handle things over the phone. Last time she had needed something, she was on vacation and couldn’t get to the office. Sue set up a time for the doctor to call her, and they had a productive conversation.

“I didn’t expect you to answer the phone!” she exclaimed.

“Sue is signing up a new patient, so I answered the phone,” Dr. Herrington said. “What’s up?”

“Well, I wanted to ask you about my neck pain,” Julie said. “I’ve been to the chiropractor, which helps for a short time. But then it bugs me again. He was wondering about a muscle relaxer.”

Her doctor asked her a couple more questions, then agreed to send in a prescription for a muscle relaxer. Within 5 minutes the exchange was over.

Julie remembered her previous doctor’s office, where there seemed to be roadblocks to communication. First, she would get the secretary, who would send a message to the nurse, who would then call her back with more questions. Once the nurse got a response from the doctor, she would call Julie back. Sometimes it took a couple of days to get an answer. Or sometimes she was required to be seen by someone in the office. She knew they didn’t get paid by the insurance companies unless patients were seen.

She was so glad she had switched to Pine Creek Family Medicine, the area’s first DPC (Direct Primary Care) practice, where patients paid a monthly membership in exchange for unlimited office visits and communication. Dr. Herrington doesn’t bill insurance, so she doesn’t have to answer to their regulations.

Medicine the way it should be!

Appointment When?

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John thought his head would explode. No one had better check his blood pressure right now!

He was standing at his doctor’s office, trying not to bite the head off the receptionist.

“What do you mean the doctor is not here?” he asked. “I have an appointment.”

The receptionist was annoyingly calm, explaining that the doctor was on vacation, and surely someone had let John know that his appointment was cancelled.

No, he hadn’t been told any such thing. He had taken the day off work, and he had his list of issues he wanted to discuss. It was rare that he got to see his own doctor, and he had planned to take advantage of this appointment. But now he was told that the doctor wasn’t even in the office.

“You can see one of the physician assistants,” the receptionist offered.

No, that was not a solution. “I would like to see my own doctor,” he said. “Can we make an appointment for that?”

The receptionist clicked some computer keys, finally offering, “He can see you in 3 months. I’m sorry, he doesn’t have anything sooner.”

John sighed, frustrated. No, this wasn’t acceptable.

Maybe it was time to see his wife, Donna’s, doctor at Pine Creek Family Medicine. Donna had been exclaiming how easy it was to get an appointment, and she would usually spend an hour with Dr. Herrington. When she had the sinus infection, she was seen by the doctor that same day. The one time Donna needed to reschedule, she was offered several appointment times within the next two weeks.

Donna paid a reasonable monthly fee, in exchange for unlimited office visits and communication. Dr. Herrington didn’t bill insurance, so she wasn’t stuck in front of the computer, checking off boxes. It was more personalized care, his wife emphasized.

Yes, it was time to make a change.

No Middleman

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I used to say that I was going to have a T-shirt made that said “Sorry for the wait.”

When I was in traditional medicine, I said that phrase to almost all my patients as I breezed into the exam room. If I were doing well, it was only ½ hour after their allotted appointment time. Many times they had been in the medical office for an hour by the time I could get to them.

Some people might imagine doctors chatting and drinking coffee while patients twiddled their thumbs in the exam rooms. But in reality, we were on the go, spending time with complicated patients, writing up the plans from the last patient encounter, reviewing the chart for the next patient, answering urgent questions from staff. Sometimes we took a couple of minutes to go to the bathroom. We hauled home our laptop computers so we could document in front of the TV before finally heading to bed.

Since starting my DPC (Direct Primary Care) practice, I feel like I’m in a different world. I stay on time. My waiting room almost never has anyone in it. I spend time with my patients in 30- to 60-minute visits, getting to know them and working together on improving their health.

I don’t bill insurance, so there’s no middleman for my patients’ care. Patients pay a monthly fee, and in exchange they get unlimited office visits and communication. They see me for every encounter, so we get to know each other.

If I were to have a T-shirt made now, it would say “Welcome. Working for my patients instead of for the insurance companies.”

Medicine the way it should be.

Assembly Line Medicine

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Do you remember the “I Love Lucy” assembly line episode?

Lucy and Ethel are working on an assembly line, wrapping candies. At first it’s easy. Then the candies come faster and faster, and the humor starts.

That’s what the traditional medical world seems like, from a doctor’s perspective (without the humor). You’re expected to see more and more patients, barely having time to think and interact. If you manage to do a decent job, you’re handed more work.

Insurance is calling the shots. They decrease reimbursements, while coming up with esoteric tasks to reportedly gauge whether you are doing your job well. Things like x% of diabetic patients need to be on a statin, or x% of Medicare patients need to have their annual wellness visit. If you hit those metrics, you might get a bonus from the insurance companies. The goal post is often changing.

And where does that leave the patients?

Almost two years ago I left my traditional medicine Family Practice. I started the area’s first DPC (Direct Primary Care) practice. Patients pay a monthly fee, and in exchange they get essentially unlimited office visits and communication. I don’t bill insurance, so I don’t have to check the required boxes. I spend 30 to 60 minutes with most patients, and I have office visits available the same day or next day if needed.

I have only one full-time employee. Patients have direct communication with both of us. I love this way of practicing medicine. It’s like a breath of fresh air for my patients and me.

Working for my patients, rather than for the insurance companies.

Who Do You Work For?

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I wish I had such ingenuity and talent!

I’m loving the videos from Dr. Glaucomflecken, who pokes fun while illustrating many of the interactions and frustrations with the US healthcare system.

This short video is SO accurate, involving the hold that insurance companies have over doctors and patients. Click here to play:

Do you want to see more (and maybe get a little frustrated)? Search for “Dr. Glaucomflecken and insurance.”

Blood Draw Diversions

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“But I don’t want them to do a blood test!” Alex said, covering his arm and looking to his mom for support.

“It will save us time,” his mom responded. “We would have to drive all the way back here another day.” He was in my office for his first visit, and I had discussed blood tests that might help us figure out the underlying cause for his medical problems.

I piped in, “My nurse, Linda, is still here. She’s slick at drawing blood.” I was glad I didn’t have to find the 11-year-old’s veins myself.

Alex resigned himself to being poked. As Linda sat down and started searching for a decent vein, Sue and I asked Alex about his hobbies. He played football. We kept the conversation going, asking him questions, as Linda did her thing.

When she was done, Alex looked at his Band-Aid and shrugged. That hadn’t been too bad.

His mom thanked us for the teamwork.

Medicine the way it should be!

Acid Test

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Paula couldn’t believe the answer had been so easy.

She’d had irritable bowel for years. She had tried a lot of different things… Lactaid pills, trying to avoid some foods (a difficult thing since she had a family to feed), and various medicines and supplements. Maybe it was her liver, maybe she had SIBO. Things would improve briefly, but the symptoms always worsened again.

When Dr. Herrington suggested she might not have enough stomach acid, she said no way. She never had heartburn or stomach pain itself. She just had bloating after eating, and she needed to rush to the bathroom at various times of the day.

Dr. H explained that many people have low stomach acid. Without adequate stomach acid, food isn’t broken down well in the first main step of digestion. Acid helps the esophageal sphincter, at the top of the stomach, to stay closed. So reflux is actually caused by stomach acid being too low, which is the opposite of what traditional medicine believes. And acid helps the food move into the small intestine, where the pancreas and gall bladder are stimulated to secrete their digestive enzymes, helping to break down food even further.

Dr. Herrington suggested a simple test. “First thing in the morning, on an empty stomach, take ¼ tsp of baking soda in about 4 ounces of water,” she said. “Time how long it takes to belch. Ideally it should be less than 3 minutes. But if it’s longer than 5 minutes, you have low stomach acid.”

She explained that the bicarb mixes with acid to form gas, which would make you belch.

Paula was sure her stomach was fine. But the next two mornings she was shocked to find herself belching after 8 minutes and 12 minutes! So she DID have low stomach acid!

She started drinking some apple cider vinegar in water before meals. And she ordered some Betaine HCl pills which were acid pills to use during meals.

Unbelievably she now had NORMAL bowels. No bloating, no rushing to the bathroom after meals. She couldn’t believe the answer had been so simple!

She was so glad to be a patient of Pine Creek Family Medicine’s DPC (Direct Primary Care) practice. Dr. Herrington had time to get to know her, and she was good at thinking outside the box.

Medicine the way it should be!

Prompt Responses

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“I have the same symptoms my wife had,” Joe texted Dr. Herrington on Saturday morning. “It started Thursday. I feel achy, fatigued and I have a sore throat.”

Within a couple of minutes he had a response from the doctor, listing off recommendations for Vitamin D, Zinc, Vitamin C, and I.VM. No matter what viral illness this was, those should help. He texted a couple clarifying questions, getting quick responses.

Yes, he was happy he was a patient of Pine Creek Family Medicine’s DPC (Direct Primary Care) practice, where he pays a monthly fee in exchange for unlimited office visits and communication. This prompt response was something unique in today’s medical world!

UTI Treatment

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“Oh no, not another UTI?!” Sue exclaimed, as Kim handed her the brown paper bag with a cup in it.

“Yes, unfortunately,” Kim said. “Let me know what it shows. I’ve got errands to run, but you can contact me when you check it.”

A few minutes later we dipped the urine. Yes, it looked like an infection. Sue sent it to the lab for a urinalysis and culture.

Meanwhile I sent Kim a note through Spruce, our secure texting system, letting her know the results. She could pick up the nitrofurantoin antibiotic at our office if she wanted. And since she had so many UTIs, I wanted to order some imaging and have her see urology again. She readily agreed.

Kim returned that afternoon to pick up the antibiotic for a few dollars. And she paid for the urinalysis and culture — $10.03 total. She told us about a friend who had a urine checked at the hospital. It had cost more than $100!

She expressed again how happy she was that she had joined Pine Creek Family Medicine’s DPC (Direct Primary Care) practice, where she paid a monthly fee in exchange for unlimited office visits and communication. The access to inexpensive lab tests, alone, was well worth the monthly fee. But having easy access was priceless.

No Medical Insurance

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Rebecca, my new patient, told me that several doctor’s offices had refused her as a patient because she doesn’t have medical insurance! She told them she would pay any bills, but they still refused.

She said when her family couldn’t take care of their medical issues themselves, they would end up in the ER, which was very expensive.

She was thrilled to hear about my DPC (Direct Primary Care) practice, where patients pay a monthly fee in exchange for unlimited office visits and communication.

Today she already enjoyed the relaxed atmosphere of a one-hour visit. And she scheduled low-cost blood tests and a return appointment. Yes, she was going to like this medical office.

Medicine the way it should be!