Woody Allen said, “80 percent of success is just showing up.” I am realizing a similar truth in my office practice. 80 percent of success is just letting the patient show up. You can’t help patients who can’t get into your office. We have experienced the benefit of showing up in dramatic fashion over the last few months.
In the middle of the busiest flu week of the year a young man called our office. He had complaints similar to so many other patients seen during that time, high fever, occasional chills, loose stools and abdominal pain. Our office policy is to see anyone who wants to be seen for anything at any time, so the receptionist worked him into the schedule of our Physician Assistant. She walked into the room expecting to see her umpteenth influenza victim of the day.
He didn’t look like the other flu sufferers, though. He was paler, covered in sweat, and his abdomen was extremely tender. Concerned, she called me into the room for a second opinion. I took one look at him and had him lie down for a repeat abdominal exam. His abdomen was rock hard and he felt pain with the lightest touch. Minimal movement made the pain worse, as even tapping the soles of his feet was agonizing. I knew something was wrong.
“It could be flu,” I said, “but your symptoms are consistent with a surgical abdomen, what we see with a ruptured appendix for example.” I told him that because there was a possibility that he was seriously ill I wanted him to go straight to the emergency room.
The next day his mother updated us on his condition by sending us a message. “Thank you for saving my son’s life,” she said. Tests had shown that not only had his appendix ruptured but that he was septic, with life-threatening bacteria found in his blood stream. Has my receptionist made him wait a day longer, the delay could have been fatal. We all breathed sighs of relief. We knew that his life had not saved by brilliant medical acumen. He was saved because he was allowed to show up.
We had another close call a few weeks later. A man in his 60’s called saying he did not feel well. He was unable to give the receptionist more specific information. He just felt weak and sick. She told him to come on in to the office. As luck would have it, he was also seen by our PA. Although his blood pressure, heart rate and oxygen levels were all normal, she did not like the way he looked. It was my day off, so she called me at home to discuss the case. It was immediately apparent to me that she was unusually worried about him.
“Do you want me to come take a look at him?” I asked, “I am not doing anything and I can be there in 5 minutes.” She did not require convincing. She definitely wanted me to take a look. Attired in jeans and a t-shirt I went in to see him. When I entered the room I instantly understood why she was worried. He just looked wrong. He was pale, and his face was covered with glistening sweat. He looked like someone who was sick, even though his vital signs were normal.
“I am worried about you,” I said, “and in order to make sure you are okay I need some answers, answers I can’t get fast enough outside of the hospital. You need to go the emergency room, because they can get the results quickly.”
I had no idea how quickly the answers were needed. A little over an hour later in the emergency room he on the verge of dying. He went into respiratory failure and needed to be put on a ventilator. Further tests showed the cause, he had blood clots in his legs that were traveling to his lungs. Only the grace of God and the skill of the critical care team saved his life.
The next day in the office the topic of conversation was what would have happened it we hadn’t had him come in right away, or if I hadn’t come to the office, or if we hadn’t sent him to the emergency room. We shared the draining realization that we came so close to losing him. It was clear to all of us that his life was saved because we allowed him to show up.
I wish I could say that this was always the way I practiced medicine, that same day access without explanation or questioning has always been our response. A little over 7 years ago we started offering same day access to sick patients who called before noon. We only began guaranteeing the service to all callers regardless the time they called in 2015.
It is the best thing I have ever done in medicine. I have realized that while I can’t always be right, I can always be available.
Somehow, I think there is a lesson here for all of us. Showing up is important.
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