Curbside consults can't replace a personal physician

Commentary. By Michael Greenberg, MD, amednews contributor. May 8, 2000.

COMMENTARY

Observations on the state of medical practice and medical life

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My physician, Richard, quit his practice a few years ago. Since then, I've been a doctor without a physician of my own.

I miss Richard. I became his patient after eating some stir-fry vegetables that had been diced by the same knife that had just cut through bacterially infected chicken. I wound up in a hospital room, an ice mattress chilling my blood, and it was a nervous Richard (who was a timely referral by my cousin, also a physician) who refused to leave until my fever broke.

Since Richard stopped practicing, I've done only a lackadaisical search for a replacement. I've gone so far as to promise one candidate that I would call his office and schedule a physical. I didn't follow through.

But I'm not alone. An informal survey of physicians with whom I eat lunch suggests that doctors who have personal physicians are the exception, not the rule. And, considering what many of my colleagues eat, it's a sure bet they're going to need a doctor sooner or later. We doctors, however, are smart. We've created the curbside consult as a way to obtain our own nonacute health care.

Curbside consults are held in the doctors' dining room, the parking lot or (my favorite place) the corridor immediately outside the physicians' lounge. I'm asked to diagnose my fellow staff members' skin diseases so often in that particular patch of hallway that I live in fear of the hospital administration adding the square footage of that area to my office lease.

It's time to end my cavalier personal health habits. I'm already pretty careful about what I eat (as long as I get enough chocolate) and I exercise daily. But my colleagues and I have the same rights to quality health care as our patients. It makes sense for me, as a doctor, to have a personal physician. And as politically tricky as it might be, I'm going to avoid the dangerous practice of curbside consults.

The curbside consult probably was born because doctors are chronically short on time. But as busy as we are, none of us examines our patients in the parking lot. Why should we treat each other al fresco? While I've always welcomed colleagues to my office, I'm going to be more insistent they see me there -- for their own good (and, as always, at no charge). I'll ask doctors to call when they have a free moment. My staff can hold an exam room open and usher them into it without waiting.

Obtaining excellent care can be, for a doctor, a political minefield. Do we choose a personal physician from our own medical staff? When I needed surgery last year, I got opinions from two colleagues. The tricky part was choosing one without bruising the other's ego. But I would advise my patients to seek a second opinion. And, having known them for years, I trusted the two physicians I consulted.

Do we use our own hospitals and hope for discretion about personal information? In my case, I didn't care if anyone knew about my vein stripping. I felt I would receive excellent care in my own hospital. But what if the nature of my illness was more personal?

I've promised to find a personal physician within the next few months and schedule a physical. But it's not that I've been without any care since losing Richard. A cardiologist has thoroughly checked my heart. The rheumatologist across the hall has injected my shoulder bursitis, and I know that my PSA is normal -- I sneaked the test in with my cardiology lab work.

But it's good medicine to have a primary care doctor who looks at the big picture. We doctors should set examples by our own behavior. As Richard once responded when I asked him why he smoked: "I'm a doctor, not a saint." All of us doctors, saints or not, should take a look at our own health practices and make ourselves examples of excellence.

Dr. Greenberg is a dermatologist in Elk Grove Village, Ill. and author of the novel A Man of Sorrows (http://www.anovelvision.com/). You can contact him by email (offped@aol.com).