There are a few favorite stories we tell medical students during their rotations in our office as part of their curriculum. We believe these stories are of great educational value as an introduction to the world of "Outpatient Medicine".
The story of “Mr. D.” is always a good one. We saw Mr. D. as a new patient to our practice about 10-12 years ago. He didn’t stay for long. He moved to the west coast about 18 months after our first encounter, but he kept us busy before relocating.During his initial visit, as we obtained his medical history, Mr. D. admitted to smoking more than 3 packs of cigarettes per day, drinking “more than a pot of coffee” per day and knew that his last cholesterol was in excess of 800 mg/dl. Mr. D. had a bit of a haughty, and uncaring, disposition and seemed to be most proud of his football gambling prowess. Seeing this, I tried something I thought might catch his attention. I called the other members of the office staff, (nurse, receptionist and office manager) back to my office and had him repeat what he had just told me.
I then asked our office staff to make odds as to when Mr. D. would have his first heart attack. His response? “Oh, when that happens, they’ll bypass me and I’ll be good as new”. Well, we broke the news that approximately 1 in 3 persons do not survive that first heart attack ... and we guess it's no big deal to spend $50,000 to $100,000 to bypass an individual that makes no effort on their own.
Just recently, I had another discussion that supports my belief that many of our policies don't do much to foster a sense of responsibility in patients that might lead them to making some effort to reduce their health risks. A good example of the mindset in more than a few patients? We have been encouraging a 65 year old female (diabetes, high blood pressure, elevated cholesterol, arthritis), for more than two years, to consider bariatric surgery for her obesity (5’6” and 209 pounds). At her most recent visit, I noted we are waiting to hear the update regarding Medicare reimbursement for bariatric procedures as a treatment for Type 2 diabetes and other medical problems.
It's been suggested that Medicare reimbursement will be significantly better for patients having abody mass indexof 35 or greater. When informed that her current BMI (33.7) fell short of that cutoff, herresponse was, "How much do I have to gain? Gaining is a lot easier than losing".
..... and my family and friends, at first, thought I made this stuff up!