By Renée Loth | March 5, 2010
PRIMARY CARE medicine may be on the decline in prestige and pay, but the fancy surgical specialties can’t offer the same daily dose of satisfaction, heartbreak, and connection. Judy Paley, a primary care doctor with a two-person practice and a load of bills in Denver, has started a blog brimming with what she calls “close encounters of the life-saving kind.’’ Reading it is good for what ails you.
The 55-word dispatches are like medical haikus – fleeting glimpses of a particular moment in the doctor-patient relationship. Searing, sometimes funny, and invariably respectful, the postings (found at 55wordsfromanmd.blogspot.com) are the perfect antidote to the mysterious, dehumanizing interactions that pass for so much of medicine today.
“Eighty-something, on seven drugs, six supplements, and under the care of nine different doctors including four different orthopedists for as many body parts. She wanted to discuss simplifying her care.
“As she left the office, she caught her leg on the car door, peeling the fragile skin back like tissue paper. So much for simplification.’’
The entries have a wry flavor of everyday quirks and coincidences, but magnified because they are about life and death. They show how much of her patients’ anguish Paley takes on.
“Phone message at two a.m.: Quest Labs calling with ‘critical results.’ Oh no, Mr. G. has a white blood cell count over 100,000. Damn.
“No point ruining his sleep. Morning will come too soon enough. Meanwhile, I’ll lie wide awake for both of us, thinking of this family man whose shortened life has changed forever.’’
They also contain much joy: the patient who outlives the statistics, or whose hair grows in after chemo with a pretty new permanent wave. She gives a patient with bad arthritis the walnut cane that belonged to her own mother; stands crying in the rain over a diagnosis; gently confronts a woman getting Vicodin from three different doctors; laughs at her own diet missteps (“Eat as I say, not as I chew!’’).
In practice for 28 years, Paley started the blog in November to help find the universal in her patients’ particular conditions. “Everyone is shyly thinking they are the only ones,’’ she said. The blog posts “let them know that while they are unique, they are not alone.’’
She is particularly interested in those moments of “click’’ – where she is able to solve the puzzle of confusing symptoms, reach an understanding, or share a laugh. Working out of the same 1950s-style medical building for decades, she has relationships across generations with her patients. Some of them have no insurance.
She and her partner personally go out to the waiting room to call their patients to their appointments.
She tries to attend the funerals of every patient who dies.
“She overcame alcoholism, sepsis, and pancreatitis to become a gardener. I saw her in September; her boyfriend had ‘stolen’ her methadone. Her next appearance was in the October obits. I drove crosstown through sleet to the funeral, arrived, alas, 10 minutes late. The service was already over. What sort of send-off was that?’’
We can debate health care reform til Mitch McConnell comes home, but unless more people like Paley become general practitioners, expanding health care access will only stress the system more. Massachusetts, where insurance has been extended to nearly everyone, has the longest average wait times for medical appointments in the country – 63 days to see a family physician.
The primary care shortage is acute. About 70 percent of doctors work in the higher-paid specialties, and the Journal of the American Medical Association found only 2 percent of today’s students plan to go into internal medicine. Much of what drives these decisions is financial; the earnings gap between primary care doctors and specialists can add up to $3.5 million over a 40-year career.
Meanwhile, Paley is having trouble meeting her budget for the month. She worries that she and her partner may have to be absorbed in a larger practice. And yet: “I wouldn’t choose anything different,’’ she said. “I have an ability to get to the heart of a matter and make things better. And there’s nothing more rewarding than that.’’
Or more necessary.
Renée Loth’s column appears regularly in the Globe.
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