The Personal Touch: Doctors Who Think It's All About Me
The other night the phone rang and when I picked up I heard a friendly soft-spoken voice. "Hi, George," he said. Dan Marelli here."
"I got the lab tests you dropped off and your message. I see the cholesterol is still up, 228, and you have been talking with Dana and decided to go on a statin."
"Yeah, Zukor. You and I have been talking about it for a while and she thinks it's time and so do I. Tomorrow she's having me go in to get tested for liver function to make sure I can take a statin. We decided it would be best to get it through the VA, cheaper, and they mail it to you."
"I agree that it's time. What I'll do is have you come in three months to check on any side effects. If you feel any muscular pain, call me right away and we'll see what's going on. I also noticed that your blood sugar is up, 136."
"Yea, that's a first. Dana thinks it could be because I've put on some weight, probably from eating so much fruit. I eat a ton of it. She gave me a bit of a talking to about portion sizes."
"We'll start watching your blood sugar. Dana also suggested a colonoscopy?"
"Yes. She said it has been five years since I had a sigmoidoscopy and I have never had a colonoscopy. She said that because of VA scrictures, she could only offer me a sigmoid but thinks I should have a colonoscopy. She suggested that I go through you. She wants you to be fully involved in everything and so do I."
"That's good, thank you. I think the colonoscopy is a good idea. I'll have the office make the arrangements and get in touch with you."
"You know, Dan, I really appreciate your following up on this so quickly. Thank you so much."
"Not at all. My pleasure."
The next day I got a call from Dan's office manager explaining that she had made arrangements for the colonoscopy and I could pick up the information at the office or have it mailed to me. Not in any hurry, I asked that the info be mailed to me.
You must understand that what's going on here is something almost unheard of in health care today. A doctor in private practice, Dr. Dan Marelli (not his real name, out of respect for his privacy) calling a patient at home the very same day that he receives lab results and recommendations from a VA provider? When it's not an emergency?
What gives? Am I some kind of VIP? Do I have some kind of sweetheart deal -- you know, wink, wink -- with Dr. Marelli? No and no. In fact, as far as I know, Dr. Marelli did not make a dime from our unhurried 15-minute conversation. And he was not the one who wound down the conversation; I did, because I know how valuable his time is.
Believe it or not, what we have here is a young, early forties, doctor who practices old-fashioned, patient-centered medicine. He didn't have to respond so quickly. He didn't have to call me at home. He did so primarily because he cares about me as a patient and to hell with the insurance companies and all the other complications that come between doctors and patients today.
I have been seeing Dr. Marelli for about ten years and he knows me and I know him. We are a team. But it is all about me all the time. He goes over the latest lab results and health developments and explains options.
Unlike many doctors who do all the talking, Dr. Marelli wants to know what I think. He listens intently. In the end, I am the decider. I decided when it was time for me to have two total knee replacements. This time I decided that, after two years of talking about it, it was time for me to go on a statin. Once I decide, Dr. Marelli makes it happen.
There is something else unusual here. We also have two health-care providers, one from the VA and one in private practice, working as a team. I have been going to the VA for nearly twenty years and it consider it an essential component of my health care.
Despite what you read about the neglect of wounded veterans at Walter Reed in Washington, D.C, patient care throughout the VA system is excellent. (Walter Reed is run by the Defense Department; the VA System is entirely different). My provider at the VA, Dana (also not her real name) offers me preventive care, something that Dr. Marelli cannot always offer.
She is not a medical doctor but a nurse practitioner, though I want to call her "Doctor." As far as I am concerned, she is a superb doctor. But when it comes to the big things, such as total knee replacements, Dr. Marelli is the go-to guy. With him, I can choose my hospital and surgeon. At the VA, I cannot.
Now it so happens, that Dr. Marelli and Dr. Dana know each other. They know each other very well. Dr. Dana worked in Dr. Morelli's office for ten years as a medical assistant. He was the one who encouraged her to go for further medical training and to become a nurse practitioner. He was and is her mentor.
Yet their respect is clearly mutual. She is taking the lead in getting me on Zukor and getting me a colonoscopy and Dr. Marelli readily approves. They both want the other to know everything that is going on with me. For me, the patient, what that amounts to is a built-in second opinion and superb ongoing care.
I only recently starting going to Dr. Dana after going to the same VA doctor (an M.D.) for seven years. When this long-term provider left, she called me at home to tell me the news. I was shocked. I put down the phone and cried. This was a doctor who knew me -- she had read my novel and read posts on this blog -- and cared about me as a person.
The first time I walked into Dr. Dana's office, I told her I was in deep mourning for her predecessor. "Oh, I know, isn't she wonderful!" And I proceeded to talk about what a wonderful doctor she is. Dr. Morelli's name came up and we both sang his praises.
To me, Dr. Dana was a question mark. I was skeptical. How could she ever fill those big shoes of my longtime doctor that I still desperately missed?
A year later, at this most recent meeting with Dr. Dana, I left her office feeling that here was a nurse practitioner who was a doctor in every way that matters to a patient, and one who knew and cared about me as a person. I can never forget my old VA doctor, but by some miracle her big shoes had indeed been filled.
At the door, I paused and said, "You know, you are absolutely wonderful."
She smiled, warmly. "Thank you. Make sure Dr. Marelli gets everything."
Given the state of health care today, how lucky can one guy be?
So long and keep moving.