There are No Ordinary Moments

And There are No Routine Office Visits

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

IMG_2379I 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.

IMG_2590
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.”

IMG_2592“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.IMG_2586

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

You Make Me Better

Our Team is Our Strength

My wife and I just returned from Wyoming for our anniversary trip.IMG_5416
27 years of marriage.
She tells me it feels like 27 minutes… underwater.
Who am I to argue?

Marriage is much like Primary Care.
It can be suffocating and elating, tearful and joyful.
Sometimes all in one day.

We left together and we returned together. Which is one answer to the question,
“How do you stay together for so long?”
Hang on and keep moving. Together.
The passion for marriage, much like for medicine, ebbs and flows.
So it is with tides, careers, hormones, and opinions.
Of course, the love is always there.
But at times, it’s less about love and more about holding on.
Primary care physicians are like my remarkable wife. They are very good at holding on.

Here’s another key:
(and you can forget everything else, if you just remember this)
Know that your partner makes you better.

When times are tough, when you’re tired, sad, or forgetful, turn to the ones around you.
Your team is your strength.IMG_5245

Some of the greatest people that I’ve ever known are physicians.
But this post is not about physicians.
It’s about the team that makes physicians better.

As our country struggles with ways to improve primary care,
we must be certain that our team is also rewarded.
We could not do what we do, as well as we do it, without these wonderful people.

IMG_5354Many of my patients are willing to put up with me because of the pleasant greetings that they receive from my front office staff.
My receptionist’s smile can make you feel better.

When my medical assistant reminded me about your drug allergy, she added it to your record. I looked like an attentive physician. I was attentive because she was.
It was my medical assistant that saved your life.

I am better because of my team.

I can remove your mole. Expertly. But you’ll want my assistant to draw your blood.
She has a gift. You’ll hardly feel it. She also gives much better shots than I ever could.

My nurse knew the moment she brought your husband into the exam room that he was really sick. I was with another patient, but she had the foresight to check his oxygen level. She’s very good at knowing when someone’s in trouble. She called the ambulance.
I gave her the flowers that you sent.

Oh… and about remembering the school that your son attends, which pharmacy you use, and the last time your mother in law visited you… yes, my medical assistant reminded me.

I am surrounded by dedicated and caring people. They make me better.

Our office is clean because of the delightful people that come in around 10 PM every night to clean it. Yes, I’m often here to see them. That’s a different post. You would notice if they didn’t show up. Doctors and nurses can be very messy.

Then there’s the business side of what we do. It’s called managing an office.
Somehow, a thousand times a day, our office manager does the impossible.
Orchestrating the moods and needs, complaints and requests, credits and debits
of a business wound tighter than a worn out pocket watch.
Every now and then someone says, “Thank you.”

Improving and rewarding primary care
means

improving and rewarding the people around us.

Independent primary care physiciansIMG_5374
must be rewarded for providing the
foundation of our nation’s healthcare.

And that reward must be sufficient
to share with our entire team.
Our partners make us better.

By the way, when my wife comes
up to gather air for another 27 years,
I’ll be telling her “thanks” too.
There’s nobody I’d rather be underwater with.

Guy L. Culpepper, MD