The benefits of group practice

One day in my first year, the most senior doc in our group of then 9 men asked me to listen to his patient’s heart.  She was in her early 20s.  As I listened, I noticed a widely split S2 that didn’t seem to vary with respiration.  This is the point when a 29 year old should be thanking his training and teachers, but this 71 year old has enormous gratitude for my medical school, CWRU, and my residency at MUSC.  The findings, using only a stethoscope, indicated she had an ASD, atrial septal defect, a congenital anomaly, and had been living with it as my partner’s patient since he delivered her.  I told him, for it was his job to deal with it with her.  He told me, “I’ve been listening to this heart for 20 years wondering if it was OK and worried it wasn’t.”  

The same man taught me the right way to remove a foreign object from a child’s nose, using pepper.  Having an old experienced guy taught me a lot.  Having a young, well-trained colleague taught him!

Synergy!

One day I looked at a rash and I thought I was pretty sure what it was, and when I told the patient, she didn’t like it one bit.  Being told it’s probably a virus, but no one knows which one, and there’s no treatment except for itching, and it could last for 12 weeks, and by the way, sunburn could trigger permanent pigment changes….well, not happy!!  So I offered a second opinion, free, right now.  Magic of group practice!  I left the room, found two of my colleagues conversing in the hall, and invited them to look at a rash.  We did this all the time.  Usually one at a time, but I found two this time!  Both entered and I introduced them to the patient.  They both looked at her, looked at each other, and both said, “PR!”  I nodded, they left.  “Well, that makes 3 of us who believe your rash is pityriasis rosea.  No more objections from my patient.

My dad had it when I was a kid.  He came home from the doctor, and my mother asked what the doctor had said about his rash.  “I didn’t understand him,” said my Dad.  “He said, ‘pity my ass, it’s rosy.’”

Best to explain medical terms in standard English….something primary care doctors do for patients all the time….

Where else can a patient get seen promptly,  and get three opinions for the price of one?  Today, I’m not sure it can be done even in my own practice, now that the culture has become part of the larger owner, as good as they are.  In a small town with a three or four doctor practice it is probably still like this.  Elsewhere in urban areas?  You tell me!