When was the last time your PCP accompanied you to a specialist visit? Never? Same here. That’s actually not entirely surprising in today’s healthcare environment, given the demands placed on healthcare providers and primary care physicians in particular. But last week, I had the opportunity to be a part of such a visit.

I’m a medical student on my family medicine clerkship with Dr. Gold, and on his schedule this day was a cardiology visit for one of our 78 year-old patients. In the afternoon, we drove to meet her at the cardiologist’s office. She had recently had an episode of atrial fibrillation picked up by her pacemaker, and at this appointment, we would discuss the possibility of starting her on blood thinners. The cardiologist thoroughly explained the algorithms that guide decision-making for the treatment of new a-fib, along with the risks and benefits of blood thinners. He concluded by saying that, while he slightly favored starting the medication, he would leave the decision to our patient. As she took a moment to take in this information, her eyes began to well up. Amidst her tears, she explained that having to add yet another medication to her regimen or the thought of a stroke or going into a-fib again or bleeding from a fall was all too overwhelming to process.

The situation was complicated further by our patient’s chronic pain, which she experiences as a burning sensation across her lower chest. It has been treated with varying success for many years, and she was soon visiting a pain clinic for further assessment. So how was she to decide given these circumstances? The cardiologist offered expertise focused on giving her the best possible care for her cardiovascular health and went on to reassure her that the pain was not cardiac in origin. The presence of her primary care physician in addition, however, proved essential in helping her feel comfortable with her options. Primary care physicians are charged with taking care of the whole patient, a-fib, pain, tears and all. So when it became Dr. Gold’s turn to offer his input, he took a step back and considered her quality of life and her priorities. He helped her to sort through the risk calculators, EKG results and medication side effects to reveal what was really causing her the most distress each day and keeping her up at night. It was not her cardiac issues. It was her pain. Perhaps, he advised, we should address this issue first and then reconsider starting blood thinners in the future.

I would argue that any primary care physician would want this opportunity, the chance to sit down with his or her patient and another member of the healthcare team for one hour and determine what is really best for the patient at a given point in time. The problem is finding that hour amidst the multitude of patient visits, phone calls, notes, prior authorizations and EMR notifications. This time is what Dr. Gold offers his patients, and I believe that this single visit demonstrates how essential that time can be.

Tufts 3rd Year Medical Student

Have you ever been frustrated as a patient with the time it takes to see a specialist? ….The cost of seeing a specialist? Or maybe you are frustrated that your primary care doc refers out many of your medical issues without taking enough time to get to the root of them? Having worked in the insurance-based system for ten years, I can honestly tell you that many of the referrals I made were medically unnecessary. Although I hate admitting this, it is a fact. Required to see 20-25 patients a day for 15 minutes at a time (if lucky), I did not have adequate time to think and/or treat even if it was an issue that was in my scope of care. This is one major reason I switched to a Direct Primary Care practice. I wanted more time with my patients to think, to treat, and as a result decrease the number of specialty referrals I make. And when you eliminate the restrictions of third-party payment many other great opportunities open up to you- both as a patient and a physician. One of the incredible services that I offer to my patients is called RubiconMD.

RubiconMD is a company built for Direct Primary Care practices, but in my opinion it could also be used effectively by any primary care practice. They have created a network of specialists from all fields of medicine from some of the top hospitals in the nation. For a very affordable monthly fee that I pay them (with no extra cost to patients), I have access to online consults with any of these specialists. You have a rash that I can’t figure out? I can send pictures to them and get a response from a dermatologist in less than 24 hours. You have concerns about a complicated insulin regimen? I can email an endocrinologist for unbiased medical advice. All communications are secure, and all-in-all it is an amazing tool that saves time and money and facilitates much better medical care and patient satisfaction. It is one of the many great services we offer at our Direct Primary Care practice.