, 19 tweets, 12 min read Read on Twitter
1/ It’s been a week.

It’s well into Friday evening & I just got off the phone with a patient who had urgent radiology results. This was after spending > 40 min on the phone w another patient discussing the same this afternoon.

(18 more to come; stick with me.)
2/ I only got 2 items on today’s long “to do” list done — but that’s on me. I was finally able to sit down for a couple hours uninterrupted and dig deep into a few patient cases from the week.

(And I “don’t work” on Fridays.)
3/ As I hung up the phone, I reflected on how #directprimarycare has enabled me to get to the heart of medicine & the doctor-patient relationship.

During that call, my patient’s spouse broke down and — through sobs — simply said: “Thanks for being so kind.”
4/ This caught me off guard.

(Quick detour! Shout out to @L_Abhyankar on her recent @AAFP Fresh Perspectives piece about this subject & the power of simply listening: aafp.org/news/blogs/fre…)
5/ I feel odd being thanked for something I feel isn’t hard. It’s not hard to be kind as a physician when you’ve got time to listen. Or when your goal is healing — not endless mounds of paperwork. Or when you’ve flipped the economic model to prioritize care.
6/ And it’s not hard to care for people when they’ve hired you — directly — to do just that.

To care.
7/ In the last 10 days, we’ve welcomed 22 new members into our practice. Of those 22, two were in acute heart failure exacerbations — both new diagnoses. A third had a new pneumothorax and rib fractures after a fall.
8/ They all refused to go to the #ER or the #hospital. So we’ve been helping as we can. In the #outpatient setting.

Is this risky? Sure. Do they know? Of course. Do we still care for them? Absolutely.
9/ Thankfully, not all of our new patients are on the brink: one was fresh into recovery & was ready to start a journey into health. Another was a newborn -- added at no cost! A younger man in his 30s was just wanting to prioritize health given his family history.
10/ It’s not just new patients we help: a middle-aged patient we hadn’t seen in 8 months walked in, bloody from the face down after a small explosion in his shop with lacerations to his face and arms. Meekly, he just said, “I tried to call first.”
11/ It took an hour and a half, but we got him cleaned up, numbed up, and stitched up. His tetanus vaccine was up to date, and there were no other injuries, so we sent him on his way. That visit — alone — saved him enough money to pay for us for years.

12/ These are just the stories from the last 10 days in one small, #solopractice #DirectPrimaryCare clinic in the #urbancore of #KansasCity.
13/ Back to my PM call re: the #radiology showing #ribfractures, a #pneumothorax, and a #parotidmass (his presenting concern): when his spouse broke down, it was b/c she felt that her partner wasn’t judged & that he had a place where he could get care.

For the first time.
14/ And that makes me uncomfortable.

It hurts.

A lot.
15/ It hurts because #physicians don’t go into #medicine to make their patients feel judged and rushed. They don’t. I can guarantee you that exactly zero successful #medicalschool applicants write essays exhaling their futures as bureaucratic claims processors.
16/ Exactly zero #medschool applicants announce their desire to push patients through their clinic in 15-minute slots. None floated the idea of training for a decade just to retire early — or move to part time — to preserve their sanity and mental health.

17/ Yet this is where #healthcare in America has found itself.

And we wonder why our outcomes don’t stack up to our peer countries?
18/ #Directprimarycare isn’t a panacea. But it does put care into a sharper focus and aligns physicians and patients on the same trajectory: to be well.

After all, this is what health care is supposed to be about.

#DPCRising #DPC #patientcenteredcare #healthcareforall
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