And There are No Routine Office Visits

“Oh, and one more thing Dr. Culpepper…”

I hear those words frequently, just as we’re leaving the exam room.
It’s often the most important part of an office visit. That moment when both the physician and the patient have let their guard down. It’s a safe moment. And sometimes it’s the
real reason a person came to see me.

“My father loved you.”
I looked at the middle aged mom putting her over-stuffed purse back on her shoulder. Claire hasn’t changed much in twenty years. Her kids have worn her out a little, but she still grins the same way that she did as a college student. I remember her dad. Funny thing is that while I can hardly remember where I put my car keys this morning, I can still remember most of my patients quite clearly. Her dad was tough. An oil man.
He didn’t grin so much.

“How long’s it been?”
“Two years.” She stood with the heavy purse hanging on her shoulder. Obviously she’d grown accustomed to its weight.
“He was a good man,” I said. Not much more to say, so I gave her a doctorly pat on the back. Sometimes being quiet is the best medicine.

Claire had come to see me for a “routine” visit. CPT code 99213.
A level 3 office visit, defined as the evaluation and management of an established patient with a problem of minimal complexity.
The most common code used in primary care billing.
It doesn’t pay much, but it’s the foundation of our industry.
The truth is that there’s absolutely nothing routine about it.

I thought our visit was done. And as you might guess, I was behind. I’m often behind.
“He said you saved his life.”
That comment surprised me. After all, we were just acknowledging his passing.
Not much life saving there.
I must have looked confused because she clarified. “You changed his life.”

Now I’ve been doing this long enough not to take credit for the big stuff.
That’s in other hands. Much bigger hands. But it is polite to say “thank you” and listen. Besides, I really like compliments. So I kept listening.

“Mom said that he came home after a visit with you, I think it was for a blood pressure check…” She paused as if I would fill in the blank, but HIPAA held my tongue.
“He said he’d been waiting for a doctor to tell him when it was time to quit drinking.
He emptied out the cabinet and didn’t touch a drop in last three years of his life.”

“I’m glad he took my advice.”

“It was a wonderful three years. Mom had her husband back,
my son got to know his grandfather…” She adjusted the heavy purse and moved it away from her shoulder. I was a little bit afraid that she’d sit back down. My nurse is used to apologizing to our patients about their wait. So I put my hand on the doorknob to silently steer the situation.

Mom’s are smart. She read my body language.
“I know you’ve got to go, Dr. Culpepper,”
she said, “you always have so many people waiting. But I just wanted you to know that by taking that extra moment, by stopping on the way out,
you gave my father much more than a minute of your time.”

“Thank you,” I said. Her words made me feel warm. In that moment, the rushing and the stress of primary care was far away. The kind of moment that keeps family doctors doing what we do. A reminder that no office visit is ever routine.
Then I remembered… this was her office visit.

I took my hand off the doorknob and placed it firmly on her shoulder, to the spot where her heavy purse had tugged just moments before.
“Claire, you know the real reason he changed? Because he loved you.”

There are no ordinary moments.

Guy L. Culpepper, MD