I snaked my way between the crowded tables of Friday evening revelers, late again. Despite continuous tweaking and re-tweaking of our schedules, we still manage to run late at least 25% of the time. If your goal is to never be too busy, you'll never be busy enough to pay the bills.
“Hey, Willis, how many lives did you save today?” The familiar voice told me I was nearing our table of regulars. I mulled over the perfunctory greeting I had received.
How many lives had I saved today? None! In fact I couldn't remember the last time I had actually saved a life. Sure, every time I give an immunization I am protecting the herd. And two or three times every year I have to jump start a newborn who had had a particularly harrowing obstetrical adventure.
But I don't consider that saving lives, certainly not like in the gold old days when Haemophilus influenzae stalked the infants and toddlers and new diabetics stayed in town instead of being shipped to the big city before the urine dipstick had dried. So who or what am I saving?
I thought back over the high points of the day I had just completed. Late in the morning I had seen a 6-year-old who had fallen on the playground and gotten a big goose egg on his forehead. Luckily his mother arrived at the school just before the ambulance did, and she had the good sense to call our office. The 15-minute visit did not include a head CT. In addition to saving him the radiation dose, I saved someone a $2,000 emergency room bill.
Just after lunch I saw a child whose left arm was hanging limply at his side. Within 2 minutes he was using it to reach eagerly for a sticker held over his head. I know that half of my partners would have ordered an x-ray before attempting a reduction, and I am sure that, had he been seen in an emergency room, he would have had the x-ray and maybe an orthopedic consult. Savings for this child were somewhere between $150 and $1,000.
At 3:15 p.m., I saw a new mother with a 2-week-old who was finally doing well at the breast and gaining weight. It had been a struggle over several visits that nearly exhausted my bag of tricks. Now the mom was confident and ready to nurse for at least 6 months. Savings to that family would be at least $600 in formula costs alone.
The last patient of the afternoon was an 18-month-old I had never seen before. His record documented several ear infections. He had a new cold and had been a bit fussy. His parents were convinced that he had another ear infection or that the last one was still bothering him. They had already been on the Internet and found an ear, nose, and throat specialist in Boston and were planning on having him insert pressure equalization tubes. The child's tympanic membranes were transparent and moved briskly on insufflation, a procedure the parents had never seen before.
Although it was late on a Friday afternoon, I decided to share with the family what I knew about the natural history of otitis media and the role of surgical management in its management. It's too early to tell, but I think I may have saved them a trip to Boston. Cost of travel, parking, and lost time at work could easily have run to $250.
So as my pint of ale arrived I did a little quick math. I had saved these four families at least $3,000. So, I guess when it comes to saving these days, at least for the primary care physician it's all about the money. For a pediatrician, though, the bulk of the rewards comes from intangibles like watching parents relax and seeing children grow into happy, productive adults.