header

Subscribe

Get Pulse via email every Friday


For Email Newsletters you can trust

Support Pulse

support us 2

Concierge Care

Deborah Pierce

I am a family physician. Like most of my colleagues, though, I must sometimes step out of the comfort of my clinical role to take on the role of patient or family caregiver.

Generally, these trips to the other side of the exam table inspire a fair amount of anxiety.

During visits to the doctor, I find myself noticing many details and comparing the quality of care to that in my own practice. I worry about how the doctor will relate to me--will I be viewed as a knowledgeable colleague, or as someone who knows relatively little? Will my background be treated with respect? Will my needs as a patient or caregiver be acknowledged? The uncertainty eases only when the physician wins my trust by showing both competence and caring.

My most recent such experience came via a family member, whom I'll call Henry.

He had noticed a lump in the skin of his lower abdomen. It was smooth, firm, mobile and ovoid. There was no history of trauma, and it wasn't bleeding or painful, but he kept noticing it, and over time, it grew.

When it reached more than one-half inch in size, Henry's primary-care physician, Dr. Tilman, removed it. To everyone's surprise, the growth turned out to be an exceedingly rare form of cancer.

Dr. Tilman referred Henry to the nearest specialty hospital, two hours' drive from home. I was to accompany Henry on his visits.

Soon afterwards, Henry made his first trip to the hospital for an appointment with the oncologist, Dr. Ricci. Beforehand, we received detailed instructions on what to expect and what preparations to make; when we arrived, we found that parking for patients was free and convenient.

Dr. Ricci carefully reviewed Henry's initial history, past history and preventive health measures. She had discussed his pathology findings with several other oncologists and had studied the literature on this rare form of cancer.

She ordered some tests for Henry, and he went to have them. The hospital staff gave me a list of nearby attractions and restaurants so I could explore the area meanwhile.

Later that same day, Henry and I met again with Dr. Ricci for a follow-up visit. She told us that she'd already contacted Dr. Tilman to discuss her recommendations and would send her a detailed consult note and copies of the relevant research literature.

I drove Henry back home, feeling pleased at how easily things had gone.

A week later, having reviewed Henry's pathology slides again, Dr. Ricci contacted us to go over the different treatment options--their risks and benefits, pros and cons. To save us travel time, she did this by phone.

She recommended a wider re-excision of the original cancer site, and we agreed that this made sense, so she arranged for Henry to consult the hospital's surgical team. To minimize travel time, the visit was scheduled for the day before the surgery.

The surgical team, Drs. Hendriks and Danner, indicated that they'd spoken to Dr. Ricci and reviewed the treatment options, the pathology slides and the recommended treatment plans. Dr. Danner again reviewed Henry's full chart, including preventive measures, then examined Henry carefully and admitted him to the hospital overnight.

The surgery took place the following morning. Before and afterwards, I received regular phone updates on Henry's progress; I could tell how attentively the team was dealing with his needs, and that they appreciated his individual quirks.

When I arrived to take him home, the receptionist said, "You've driven a long way to get here. If you'd like a cup of coffee while the resident prepares the discharge instructions, there's a pot in the waiting room."

After only a few minutes' wait Henry and I departed, equipped with complete discharge instructions and follow-up procedures.

Dr. Tilman got a faxed copy of the discharge summary and the follow-up plan. The plan, created by the surgeon and oncologist, empowered her to manage Henry's care unless complications occurred.

Our final contact with the hospital came five days later, when Dr. Danner called to tell us that the pathology findings on Henry's excision were negative. He's considered cured.

What and where is this excellent hospital, which features such smooth communication between specialists, primary-care doctors and patients?

It is the Cornell University Hospital for Animals, in Ithaca, New York. And "Henry" is Humphrey, my three-year-old black-and-white cat.

I had adopted him from the Humane Society six months previously, on the heels of losing two elderly cats to very prolonged illnesses. Humphrey is gregarious and affectionate, and I'd looked forward to several years of worry-free feline companionship, so I found his cancer diagnosis extremely frightening.

The hospital's entire team of veterinary professionals showed phenomenal skill, thought and dedication in their care for Humphrey--and for me. As a physician, I was extremely impressed; as Humphrey's family caregiver, I was tremendously relieved and grateful.

I found it deeply reassuring that the hospital scheduled consultations so that we could have closure with each one. There were no long delays in the diagnosis and treatment process; only a short time elapsed between the caregivers' recommending and getting approval for Humphrey's tests, administering the tests and responding to the results.

By scheduling Humphrey's exam and follow-up visit for the same day, by clearly communicating a follow-up plan for his primary veterinarian and by giving a phone consultation, Humphrey's caregivers acted in the spirit of a patient-centered medical home.

For this, I will be forever grateful. But my gratitude is tinged with sadness, because very often the efficient, patient-centered care Humphrey received is not available to human patients who face similar illnesses.

Most people's medical insurance will not reimburse medical providers for two visits on a single day; nor can you obtain ultrasounds or CT scans on the same day as a consultation. Delay is often the norm, not the exception.

Recently, for instance, a patient of mine who has lung cancer waited nine agonizing days before her insurer approved her CT scan; her work-up spanned three weeks and five separate appointments at the tertiary-care center. And for a human patient, a consultation like my phone conversation with Dr. Ricci would typically require another office visit.

My experience with Humphrey's caregivers showed me that veterinary medicine and human medicine, although very different branches of healing, hold similar values and priorities--the importance of efficient, patient-focused care; clear, timely communication between team members; the need to show kindness to the patient's whole family.

I cherish this knowledge.

And I wonder: what if we could set up the human healthcare system so that the communication, competence and kindness that made Humphrey's care so special--that made it so humane--were not only valued but also reimbursed?
 

About the author:

Deborah Pierce is a clinical associate professor of family medicine at the University of Rochester, NY. "I love the richness of primary care and write sporadically as a way to process the intensity of clinical medicine."

Story editor:

Diane Guernsey

 

Comments   

 
# Deborah Robbins 2014-01-09 19:18
And another thing. My veterinary discharge summary that I take home is terrific: cc, HPI, ROS, all histories, PE, labs, imaging, clinical course, A/P, follow-up. The human discharge papers for the patient to take home: take your meds, come to ER if you feel bad, see you in a few weeks. I wonder about this.
Reply | Reply with quote | Quote
 
 
# Dennis Leon, DVM 2014-01-06 01:00
a well-told story with a happy ending. glad my alma mater could serve as the example of how medicine (whether human or veterinary) should be practiced. we deserve and should expect this level of care from all of our doctors! ~Dennis Leon, DVM
Reply | Reply with quote | Quote
 
 
# William Aronstein MD 2013-12-26 10:50
Lovely article. Faith Fitzgerald described a similar encounter in "A Tale of Two Patients" in the Annals of Internal Medicine in 2004 (Ann Intern Med. 2004;140:929-93 0). She described taking her mother to a university internal medicine clinic, and contrasted that experience with the care her dog received at a private veterinarian's office. Quite a contrast.
Reply | Reply with quote | Quote
 
 
# Dr. Louis Verardo 2013-12-22 18:20
I read this piece and felt both chagrined and humbled. I thought back to incidents I have had with patients regarding delays in communication, or being unable to coordinate care in such a seamless way, and a piece like this gives me an opportunity to again look at my personal and professional environment and consider how I could do a better job at my craft. Frankly, the care outlined is how care should always be rendered to another living being, and I suspect that the fact it involved an animal, as opposed to a person, was not central to that point.
Reply | Reply with quote | Quote
 
 
# Claire Berian, D.V.M 2013-12-22 11:35
Part2
The importance of actually reading patients' charts, of timely and clear communication, intelligent and mindful consultation with colleagues, and skillful compassionate care for both patients and their people should not be underestimated. Being a good doctor, whether for people or animals, involves so much more than doing no harm! Your story is a gift to me and I will share it as a gift in service to others! Thank you! Very best wishes to you and your beloved Humphrey!
Reply | Reply with quote | Quote
 
 
# Claire Berian, D.V.M 2013-12-22 11:34
What a beautifully written, touching, and important story! I'm a Cornell-trained vet who does house calls. I have also been a caregiver for family members. Regularly, I meet people who are suffering with medical problems, who are frightened, and who have been through terrible experiences in the human health care system. I find myself wishing for them that they could find the kind of compassionate, intelligent, thoughtful, efficient and skillful care you experienced with Humphrey at Cornell University Hospital for Animals!
Reply | Reply with quote | Quote
 
 
# Paul Rousseau 2013-12-22 08:38
We'll written, and may I say I am glad Humphrey is now doing well. I cannot add any more than the other commenters have said, so I will say thank you for writing this piece.
Reply | Reply with quote | Quote
 
 
# April Baldwin 2013-12-21 22:25
Of course animals get better care in many cases. Doctors, nurses, techs, etc. get very jaded & I understand why, having been a R.N. for many yrs. Yet due to multiple complications from MRSA meningitis, sepsis, pnuemonia, etc. (truly the gift that keeps on giving) I am not taken seriously & treated liked a demented moron even though every test in the world shows the permanent damage done. Maybe we should all go to vets.
Reply | Reply with quote | Quote
 
 
# ann 2014-01-09 17:51
Heading to y vet immediately. I too am a Registered Nurse.
Reply | Reply with quote | Quote
 
 
# Margart Fleming 2013-12-21 21:20
Thank you for your very fresh take on this struggle for the best care - a struggle never finished. I have mentioned it in HEN BACKTALK in hopes some will find it still featured on line.
Margaret Fleming
Reply | Reply with quote | Quote
 
 
# Deborah Cornwell 2013-12-21 19:42
This article was forwarded to me by my best friend and I believe will prove to be my most memorable Christmas present this year. A few years ago, I donated money to the Cornell Feline Health center to be used to purchase a Bair Hugger,equipmen t used to warm cats as they come out of anesthesia. I did this in memory of my two beloved cats, each of whom had received the same type of tender care described in this article, from my local veterinarians. It was wonderful to realize that it was the Cornell University Hospital for Animal Care that Deborah was describing. Perhaps Humphrey experienced the warmth of a Bair Hugger ? The article, indeed, does an exceptional job providing comment on the current state of medical care for human beings. Merry Christmas, Humphrey. Many thanks, Deborah. Blessings, CUHAC.
Reply | Reply with quote | Quote
 
 
# Robin Gleed 2013-12-23 12:53
As one of the anesthesiologis ts at Cornell University Hospital for Animal, I can almost guarantee that Humphrey benefited from a Bair Hugger. Thanks for all the kind words about our practice.
Reply | Reply with quote | Quote
 
 
# Ron Banner MD 2013-12-21 17:26
Thanks, Deborah, for sharing this wonderful and inspiring story.

Isn't it a shame that it took an animal story to illustrate "humanistic" care.

Do Veterinarian Docs love the animals for whom they care more than we human Docs love the humans for whom we care?

Again, great teaching story. My guess is that the people who read this story are the ones who least need to learn the lessons it teaches. So, please send it to all Medical Schools to be included in the course (probably given early on) on "doctoring."
Reply | Reply with quote | Quote
 
 
# Andrew Gallan 2013-12-21 14:02
I love this comparison - we have a lot to learn about patient experience. Thanks for sharing.
Reply | Reply with quote | Quote
 
 
# Leslie Bank 2013-12-21 10:46
Wonderful!!
I address all new employees every other week about the patient experience. One entire session I devoted to the extraordinary care my cat and I received at the Oradell Animal Hospital. I couldn't believe the compassion, sensitivity, efficiencies and love shown to me and Big Boo. When she had to die, the vet got on his knees to be at eye level with her and me. In 47 years working in hospitals, I never saw anything like this. Then they sent me a card signed by all with Forget Me Not seeds, and they made a donation for care in her name. I asked who trains you? They had no answer. "This is how we are."
I'm not sure if the new employees heard me.
Reply | Reply with quote | Quote
 
 
# wendi cross 2013-12-21 10:26
Hi Deborah -- Great story! I was onto you-- in a way-- when you wrote that the Drs had conferred before the patient showed up... and then you kept referring to excellent communication behind the scenes. But I thought the story would turn out to be a dream. The fact it was a vet was a better 'ah ha' moment. thanks so much for the post.
Reply | Reply with quote | Quote
 
 
# Irwin Dannis, MD 2013-12-21 06:37
I am an internist actively involved with patient care and teaching. My daughter is a veterinarian caring for small animals. Dr. Pierce's article really hit home. I have seen multiple examples of suboptimal, or should I write poor, care of human patients resulting from factors beyond our control, including time limits for patient communication and third party reimbursement for procedures and not interaction or education. I have visited my daughter's practice and even brought medical students and house staff there. They observed telephone communication with pet owners as well as the compassion, understanding, and education involved in interpersonal communication with the pet owners. The compassion and empathy that I know most first and second year medical students possess is gradually contaminated and eventually decimated by the medical system imposed on us, which is now way out of control. I see no change in site. Dr. Pierce, you did a great job of enlightening the public!
Reply | Reply with quote | Quote
 
 
# Maureen Moran 2013-12-20 22:54
I was not surprised in the least. When you pay the bill in cash with no third party in the mix, you can get just about anything you want.
When the insurance companies call the tune, it is a different dance.
Reply | Reply with quote | Quote
 
 
# julia mckechnie 2013-12-20 22:18
As I read the article,I thought what great,client-ce ntred,personabl e & approachable services these are.My experiences of the health system,as told to me by my clients, tell me quite a different story.But I felt heartened to know that such services exist.
And then , you revealed the 'patient'.
I will show this to my colleagues, hoping that it will stimulate discussions about how to remain working in services & deliver professional,ca ring,compassion ate care. Thank you.
Reply | Reply with quote | Quote
 
 
# Deb Robbins, CRNP 2013-12-20 21:18
A lovely story, so well-told.
I could do a narrative comparison of shepherding my father through the medical system (Stage IV lung cancer) and my dog Freddie and my cat Monster (both with heart failure) through the veterinary health care system. All we seen at the University of Pennsylvania.
The caregivers for man and pet alike were kind, attentive, thorough and had great expertise. But the health insurance forces made every step of my father's care a torture and a trial. It would have been much worse had I not already been experienced in "working the system." In contradistincti on, there were no obstacles at all to Freddie and Monster's compassionate, personalized management.
I lost my dad. He became a mortality statistic.
Freddie and Monster are still enjoying great quality of life. Their cardiologist welcomes my updates, sharing care with the local veterinarian.
Food for thought, no?
Reply | Reply with quote | Quote
 
 
# Emily Theroux 2013-12-20 19:51
Dr. Deborah, what a wonderful story teller you are. Until you revealed it, I had absolutely no idea that the patient-family member would turn out to be your beloved cat.

As for the cat's medical care, well, only in my dreams would I experience the same.
Reply | Reply with quote | Quote
 
 
# Frank Baudino 2013-12-20 18:34
Thank you for a fine article. I, too, have found veterinary care for the canine members of my family much more humane and efficient than medical care for the rest of us.

High quality veterinary care also applies outside the US. During my visit to Mexico, my dog developed an ear infection. I made an appointment by phone, the vet's office picked up my dog at my residence in Mexico, and the vet actually accompanied my dog back to my house along with the appropriate medications and explained their use. Total charge: $40 USD.

That's what I call patient-centere d care!
Reply | Reply with quote | Quote
 
 
# Eric Gross 2013-12-20 18:24
Great story.
I will share with my cat loving patients.
I have one who sprung for a pacemaker for his cat.
The medical payors do not value our time spent with patients, or the time required for document, document, document.
Sadly this will only get worse.
Reply | Reply with quote | Quote
 
 
# Judith Murphy 2013-12-20 18:16
This is wonderful and important. Please submit it to NYTimes and other major newspapers or to a high subscription magazine. It definitely needs wider distribution.
Reply | Reply with quote | Quote
 
 
# Suzanne Zane 2013-12-20 17:44
(continued)
As I read this essay, I wondered at the level of humane care. But I was as surprised initially as any reader to come upon the surprise--that this care took place in veterinary medicine. I am a veterinarian, and I trained at Cornell. I can attest that the level of true, all-around care experienced by the author there are the standard, and that they would likely find the same at any other veterinary teaching hospital in the U.S. and Canada, and within many veterinary specialty practices as well. It is what we do. I took that same commitment to my own time in private practice, and I cannot count over the years how many of my clients told me how much they wished that I were their own doctor.
Thank you so much for this story.
Reply | Reply with quote | Quote
 
 
# Suzanne Zane 2013-12-20 17:43
I have been reading Pulse since I found it 2 years ago, and have been so heartened and touched by what is written in these stories and poems from the heart of medicine. Having this kind of creative outlet and inspiring it in others is a form of healing and presence that occasionally remind me of stories written to the magazine "The Sun". I share them with my colleagues who work in clinical reproductive health and my colleague who work in public health.
Reply | Reply with quote | Quote
 
 
# Amy Ellwood, MSW 2013-12-20 17:40
Dr. Pierce, thank you for writing this beautiful aritcle. I have had a similar experience with my feline's personal physician and the veterinary team at the referral specialty hosptial near my home. Veterinary medicine has alot to offer those in human medicine. I have forwarded this article to veterinary colleagues. I applaud them and you Dr. Pierce for writing this article.
Reply | Reply with quote | Quote
 
 
# maria leal 2013-12-20 17:26
lovely story :)
Reply | Reply with quote | Quote
 
 
# Laurence bauer 2013-12-20 13:56
Well done. Brilliant!
Reply | Reply with quote | Quote
 

Pulse Links