The Complete Patient

I’ve been in Sarasota, FL, the last week tending to my mother, who is 84, trying to help her decide whether or not she needs to move from her apartment in a senior citizen community into an assisted living facility. She’s had what seems to be a rapidly accumulating number of health problems, primary among them dizziness and edema in her legs that renders her nearly unable to walk. Still, she is understandably resisting the move. 

Part of my intention in coming down to Sarasota, aside from helping my mom assess a specific assisted living facility, was to help her explore switching doctors. Her existing physician of twenty years has told her that he can find no cause of her dizziness (which has sent her to the hospital a couple of times after actual fainting), and that her edema really isn’t getting worse, that it’s just something that can’t be treated and that she needs to learn to live with. I actually was with her on one visit to this doctor a couple years back, so I knew my mother’s reports of his detached approach haven’t been an exaggeration He’s had her on three or four different prescription medications designed to thin her blood and help correct possible heart beat irregularities.

My feeling has been that there may be some non-drug tactics she can apply to her problems (perhaps herbs or supplements) and that she may benefit from the insights of another physician. So, with help from my sister, who lives in the Sarasota area, I checked around and found a doctor trained in so-called functional medicine, which emphasizes prevention and comprehensive management of complex and chronic conditions. I arranged an appointment about a month before coming down, and last week my mother and I went in to visit the doctor.

We were both impressed. In listening to my mother’s heart, she thought she detected problems with her aorta. In examining her legs, she found fluid in her knees, and in her questioning figured out that there is likely a genetic factor contributing to the edema. None of these matters had ever been explored or raised by her previous doctor.

It turns out the new doctor has what’s known as a “concierge” practice—a new trend among doctors who want to increase the amount of time they can devote to each patient, and reduce their overall patient load by charging an annual fee above and beyond regular office charges. I had known about this in advance, and encouraged my mother to consider it, since it seemed as if she needed additional care, assuming the doctor was knowledgeable and appropriate to her. The $1,500 annual “membership” fee, as this new doctor called it, seemed okay—perhaps beneficial, since my mother tends not to take great care of herself in terms of diet, and she resists exercise. So if she’s paying, I thought, she might be incentivized to follow through on this doctor’s recommendations.

Before leaving the office, my mother signed a form requesting that her previous doctor send along her medical records to the new doctor.

An hour-and-a-half later, a call came in to my mother’s apartment from the old physician’s office. I answered the phone, since my mother was lying down, and the physician’s office manager said it was his practice to call any patients who were leaving his practice to find out why they were leaving.

I explained that my mother was concerned that some of her conditions continued to deteriorate, and Dr. XX had said there was nothing he could do. She wanted to get another physician’s input.

“If she wants to consult with another physician, Dr. XX can send her to a specialist—maybe a vascular specialist for her legs,” she said

I explained that my mother wanted to avoid being sent to specialists—that she wanted her primary-care physician to do as much as possible to oversee any treatment.

In that case, the assistant told me, if she leaves his practice, “she can never come back.”

I said she hadn’t made the decision to leave, but in any event, that sounded like a strange approach. Just because she was consulting with another physician, she was being kicked out of his practice forever?

. “Yes, since she is going to another internist, he won’t take her back.”

“Why is that?” I asked.

“It says to him that she has lost faith in him.”

“Hmmm, “ I said. I then explained that my mother hadn’t made any final decisions (since she hadn’t and, even though the decision seemed clear to me at this point, she had the final say). The office manager she she’d call back the next day to speak with my mother.

When I explained the situation to my mother, she was upset. She had heard stories that a number of doctors in the Sarasota area had closed their practices to new patients. “What if I don’t like the new doctor. Then I won’t have a doctor.”

The intimidation was working. I tried to reassure my mother that she would always be able to find a new doctor. In any event, any doctor who was using such scare tactics probably wasn’t worth being with. While I thought the new doctor offered some possibilities for more effectively understanding and treating her conditions, the final decision was hers, I said.

She was troubled, and rightfully so.

The next day, when I called her at mid-day, I asked her if her old doctor had telephoned. Yes, the office manager had called at 9 a.m., and confirmed my report that if she left his practice, she was out for good.

So what did you say, I asked.

“I told her I was changing doctors,” she said, with more force than I’ve heard her say anything of late.