Friday, February 15, 2013

Why I Quit

     I quit being a doctor because the government raided my clinic.  The effect on my local reputation was such that I couldn't hire physicians and mid-level providers to help me take care of patients in the medical facility I had established, in the way I had envisioned.
     Colasante Clinic was housed in a 4,000 square-foot space with a lease I kept down to $4,000 per month--but it was scheduled to increase.  I opened in February 2010 and furnished it with a wide range of medical equipment, fully intending to employ thirty to fifty employees working two or three shifts, so patients would have access to medical services at their primary care physician's office every day of the year, twenty-four hours a day.  I had sixteen years of clinic management experience when I opened this office.
     The clinic was overflowing with patients right from the start, so I hired three mid-levels and another physician to help me take proper care of them.  We expanded the hours of operation soon after opening, to fourteen hours a day, seven days a week.  I was looking for several more physicians, so that I'd have time to manage the business of the clinic, rather than seeing patients all day.  I needed to do teaching inservices for employees, establish protocols for handling patient and employee problems, review insurance contracts, keep abreast of medical research, and make additions to clinic services to give people in this new neighborhood exactly what they needed.  There were Spanish-speaking patients, for instance, so we needed translator services.  Many people had a history of abuse and trauma, and would have appreciated counseling on-site. 
     We were focused on preventive care, mostly, but had an urgent care component.  My thinking was that if we could get patients to come in for their urgent needs--stitches, fractures, infections, pain, headaches--we could persuade them to return for preventive care, or even have some of it done on the spot.  So, if a patient came in with bronchitis but was due for a Pap test, we'd suggest doing it on the spot.  If a teenager sprained his ankle, we would take the opportunity to address subjects like safe sex, drug use, alcohol, seat belts, peer pressure, gun safety, immunizations, and depression.  A 52-year-old patient with gastroenteritis would be treated for her symptoms, but might also get a referral for a mammogram and colonoscopy, as well as a chest x-ray for the nagging cough we heard, and smoking cessation counseling, and a flu shot.  An 80-year-old with trouble sleeping might be in need of outside help with meals and housecleaning, a bone density test, a cane, or treatment for depression.
     The mission of the clinic was to take care of the whole person, whatever that required.  Every employee was focused on preventing disease, or catching problems in their early stages so that patients wouldn't end up in an ambulance one day, surprised by pancreatitis, an infected gallbladder, or lung cancer.  And, in fact, we found lots of medical conditions that warranted treatment, thereby preventing catastrophes, or at least keeping patients from having heart attacks in the middle of the night, or having to spend ten times more for a medical problem that had been allowed to fester, because no one found it.
     This turned out to be a very popular model for a medical practice.  Patients appreciated what we did and how much we cared about them, and they referred their neighbors, friends and families.  We were very busy, late into the night.  If a woman wanted a gynecologic exam at 10 pm, that was fine with me.  If a college student was up at 2 am and had urinary symptoms, our clinic would have been the place to go.  Local residents began to figure this out, and expressed their gratitude by coming back.  They believed in preventive medicine, but hadn't known doctors who practiced it.  This kind of care takes time, persuasion, and sensitive counseling--but it pays off for society, in the long run, and costs less than emergency care at the last minute.
     I enjoyed teaching new physicians and mid-level providers how to read bone density and x-ray films, when to order ultrasounds and how to address the findings, how to do stress tests and echocardiograms, which patients would benefit from corticosteroid or Synvisc injections, how to apply splints and casts, when to do trigger point and carpal tunnel injections, how to read allergy skin tests and gram stains, and when to recommend the Hako-Med pain machine instead of prescribing narcotics.
     I liked thinking about what new services we might be able to provide under the same roof:  psychological counseling, acupuncture, nasopharyngoscopy, sleep studies, play therapy, group visits for diabetes and hypertension, massage treatments, Weight Watchers meetings, cooking lessons, herb and vitamin classes, jogging groups, and a colonoscopy suite were some of the services we were considering.
     Being raided by the government, whether there might be cause or not, casts a professional person's reputation into ignominy.  Even though most Americans doubt the government's actions (a recent poll has shown that 75% of Americans "don't trust the government'), that didn't mean doctors and nurse-practitioners wanted to join a clinic that was under investigation by federal agents.  After all, I could be indicted at any moment.  Then what would happen to the clinic, and their jobs?
     My clinic was too big for me to run alone.  I couldn't see patients all day, and manage the inevitable problems that arise in any business--and do both things well.  I might have scaled down the operation, which I did do, but then the large space I was leasing seemed unnecessary.   I could have moved to a smaller location, and continued to practice in a more limited way, but that wasn't my mission.  The only way to have a full-service medical facility is to employ many specialized people.  After the raid, I lost key employees in billing, ultrasound, x-ray, and nursing.  Only the bravest souls stuck with me, knowing there was nothing the federal agents would be able to find, to justify an indictment.  I ran a clean, upright operation, and the employees knew it.  But a government with money and guns is scary.  It scared people away from me and the jobs I offered.
     Thomas Jefferson is famous for having said, "When the government is afraid of the people, we have liberty;  but when the people are afraid of the government, we have tyranny."
     People are afraid of the government these days, and they hate being afraid, but they don't know what to do about it.  I guess I should be afraid of the government, too.  But I'm too sad and disgusted to feel fear.
     I quit medicine two weeks ago, for good.  I have regrets, but they aren't about the decision to close my clinic.  My regrets are broader than that, and have to do with the tendency people have to act automatically, without thinking, and out of fear, to preserve themselves, personally.
     Not everyone--not by a long shot.  But it's going to take a lot more people willing to stand up to an unjust system before our government is forced to work for us, as it was intended by the framers of the Constitution, not against us.  It's probably going to take a lot more people getting raided, and arrested, and robbed, and attacked, in the name of the government, for us to gather enough force to do something about it.  

1 comment:

  1. I regret very much that Colasante Clinic has closed. Here's why.

    Number one, how many family physicians offer to do so many medical procedures on site? Usually doctors tell you to, 'go here' or 'go there.' So you have to make another appointment, drive somewhere else, fill out more insurance forms, make more co-pays, etc. And hope they know what they are doing. It's easier to just forget the recommendation or referral at the cost of your health.

    Not so at the Colasante clinic where so much is done right there.

    In addition, they routinely give you tests that might seem to a layman 'unnecessary' but are in fact very important for your health.

    For example, I went there not long ago to have pre-cancer skin lesions removed from my face. While I was waiting for this procedure, which of course was done there, not at a dermatologist-specialist, as my regular doctor had recommended, the Colasante clinic gave me a blood pressure test.

    I was annoyed with this. What does my blood pressure have to do with skin cancer? I have always had low pressure. "Test, test, test," I thought. Just another expense to protect the doctor from malpractice risk and charge me more money.

    I was so wrong.

    It turns out I am starting to have high blood pressure. Dr. Colasante recommended I put on a 24 hour blood pressure monitor which her staff would put on in the clinic. While this would cost me and/or my insurance company more in the short run it could save me from a heart attack or stroke in the long run. Here is an example of how spending more at a clinic like Colasante saves us all money in the wrong run. It's called preventive care.

    When I told my regular doctor my readings, he told me to get a home blood pressure monitor, do readings for a month, and send him the results. I will. But why didn't my regular doctor find this out? I saw him not long before I went to the Colasante clinic, but he didn't give me this easy, cheap, routine test.