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The Cost-Effectiveness of Family Physicians –Long-Term Continuous Relationships

August 18, 2013

Continuing my discussion of the findings in our recently published study on the ways family physicians deliver better care at a lower cost than a multi-ologist model, today I will talk about how family physicians believe in the power of their long-term continuous relationships with their patients.

The following story is a long one, but worth the read. This is an almost word-for-word transcript of an interview in our family medicine cost-effectiveness study. I took out a few uhs and ahs. The important thing to remember is that this story from our family physician subject was told without interruption. There was no break for her to go to her medical record to refresh her memory about this patient. Enjoy.

There’s a girl who was in my office in this past week. She’s 28 now, and I’ve known her since she was 8 years old. She came in because she’s having this intermittent funny numbness and inability to feel her foot.  It’s been going on for about 6 months.  She can’t really tell when it comes and goes, it’s just intermittent and when she first gets up sometimes she finds it difficult to get going, but otherwise she really functions OK.  Her past medical history is significant for the fact that she has very significant endometriosis and she was told she was never going to have a child and [had] many laparoscopies for her endometrial pain and her endometriosis and IVF, yada, yada.  She got pregnant.  Her baby is a year [old], she’d married. Family history, mother with systemic heart disease, two cardiac arrests at aged 48 and 50.  Father not present, thought to be healthy, she’s the only child. Mother also has a history of hypertension, hypo[thyroidism], obesity, and [the patient] herself probably has a BMI of 32 since her delivery, she’s obese. So she didn’t see me because she had been going to her OB and she didn’t think about it.

She saw her OB at her post-partum checkup – fine, she went for a Pap smear at 6 months and the OB, and the OB said well maybe you should see an orthopedic surgeon. She went to see an orthopedic surgeon who took a look at it and said she had some disc bulging on an MRI but not a true disc problem and that’s about it. Couldn’t come up with an explanation. It was getting worse to the point that now it was happening every day.  She had an EMG, [it was] negative. So now she sees the neurologist who tells her he doesn’t think it’s her disc. He wants to do multiple tests to [look] for B12 deficiency, whether she’s got syphilis, you name it, diabetes. He says well maybe you’re getting diabetes, maybe you have multiple sclerosis but we can’t find out now, but I don’t know what’s the matter with you. I don’t want to see you anymore unless you have some new symptoms. 

She calls our office crying, she’s really upset, because her mother said well why did you do all that?  You should go see Dr. [interview subject.]  So she comes in with her husband and they’re both freaked out. It started about 6 months but now it’s almost every day. So I examine her, there’s no real definite numbness on her exam. It’s totally normal except for the fact that she’s obese and she’s crying. Of course she’s crying, she’s got a one year old and somebody told her she might have multiple sclerosis. She’s terrified. The surgeons don’t want to see her, the orthopedic doctor doesn’t want to see her, and the neurology doctor doesn’t want to see her. So I say to her, [patient] I think I know what the cause of your numbness is. She says what is it? I said you sit like this and you put your baby on your side and you bounce him all the time and I bet you that’s how come your foot’s numb.  

The light went on. Her husband said you’re so right. She did that almost every day. It’s always after she plays with the baby, she can hardly get up. Okay? So she’s gone home, she’s going to try it out for 10 days. I’m going to see her in 10 days. Roughly a fortune could have been saved but the neurologist didn’t realize she had a baby, never thought that she would sit like that. Now why do I know that? Because when she was 8 or 9 years old she used to sit like this all the time in the office or she would sit in the W position when she was watching TV and we had that talk at her well child visit. Which I didn’t remember that I had told her [at first]. But it must have been filed somewhere in the back of my head.

10 days later, the symptoms were gone. And as for connecting the childhood observation with her symptoms 20 years later, I challenge your EMR to do that.

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2 Responses to The Cost-Effectiveness of Family Physicians –Long-Term Continuous Relationships

  1. NewMexicoRam on August 20, 2013 at 6:50 pm

    I love this!
    But we keep going to specialists anyway.
    I can’t tell you how many times a patient wants a referral to a specialist, I see the patient myself instead, and the problem is simply dealt with.

  2. Tracie Updike on August 21, 2013 at 6:37 pm

    Got to love

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