I’ve been reflecting about why I opened my DPC clinic and why I continue to support and advocate for this model. In the next few posts, I want to share some patient stories and how DPC has helped them as well as helped me in the physician/patient relationship.
Mark (name changed to protect patient privacy) followed me from my previous office because he stated that he had never felt listened to by a physician, and that I was different. I was surprised to hear this since I rarely had the time I needed to spend with each patient. Mark has had diabetes mellitus which has been somewhat controlled for a couple of years. My approach to a patient with diabetes was usually to get lab work to determine if we were meeting our health maintenance goals. “Health Maintenance goals” are a measure that is used by insurance companies and Quality Management by hospitals to report the percentage of a doctor’s patient panel that are at goal. These reports would measure my performance based on certain items charted, such as a yearly or biyearly eye exam, foot exam, and hemoglobin A1c (blood sugar levels) below a certain threshold. These are the same quality goals for every patient that has a diagnosis of diabetes based on the code used to bill the patient’s insurance. While I agree that using these goals is a good guideline to follow, it meant that personalizing each person’s care was secondary to meeting the parameters of these goals (often times tied to reimbursement and overall performance).
So, for Mark, I would adjust his medications based on his lab work, dutifully refer for eye exams, and discuss diet and lifestyle changes at his appointments. If I thought that some education on a diabetic diet would be helpful, then I referred him to our Diabetes Educator who was excellent, and had an hour to discuss eating habits and carbohydrate content of foods. Mark was doing well according to all of my reports and checked all the boxes indicating that he and I were managing his diabetes well.
In DPC, not only do I know a lot more of Mark’s personal story, but I also have learned his personal goals for medication management. He texted me on a weekend about a very high blood glucose level and was concerned about what he could do about it. I brought him into the office the next week to discuss further. We were able to download an App to his phone that he could input all his meals and snacks. I went through a typical day of what he ate and we found some key foods that were very high in carbohydrates that he was eating almost daily, thus making management of his disease more difficult and causing him to have to increase medication dosage or add on medications as time went on. Apparently, he had an appointment with our Diabetes Educator for a diet and lifestyle consultation, but either our office or Mark had to reschedule and the follow up appointment never happened.
I texted Mark the following week, in part for encouragement, and also to check to see how it was going with the low carbohydrate diet. His response was, “I haven’t felt this good in years”. He is starting to meet his quality goals by taking control of his diet instead of adding more and more medications to his regimen. Not only does he feel better, but he is getting high quality care because I have the time to devote to education and personalizing his appointments to figure out what his barriers were for meeting his goals. Even though we were both doing our part in the insurance/hospital based system, we were both underachieving. He feels better and I feel better knowing I’m helping him prevent retinopathy (eye damage), nephropathy (kidney damage), and neuropathy (nerve damage) that years of untreated diabetes can cause. This is one of the reasons WHY I choose Direct Primary Care.