It was 10 AM and the unmarked glass door was locked. A woman in a brightly colored dress with a big smile on her face waved from inside, disappeared for a brief moment and returned with a key, unlocked the door and welcomed us to Dr. Elliott’s brand new solo practice. The small rooms were brightly lit, sparsely furnished and smelled of fresh paint. There were two elderly patients in the waiting room and one empty chair. In the next room there was a desk with a big monitor, a new printer and lots of framed pictures of happy people holding little children in their arms. Unpacked boxes and crates were stacked up in one corner and across from it the exam room door was closed. Dr. Elliott was with a patient. Mrs. Elliott, the lady with the brightly colored dress, produced a couple of extra chairs from thin air and told us all about the happy people and the little children in the framed photos, while answering phones, making appointments, checking authorizations, printing all sorts of papers, preparing charts and arranging for referrals, all at once. It was 10:30 AM and the exam room door was still closed. I was beginning to understand why Dr. Elliott’s finances were less than stellar. The door finally opened a few minutes later and a tall and gaunt gentleman with a thin colorless ponytail sticking out the back of his green baseball cap walked out of the exam room holding some papers in his hands. Dr. Elliott walked right behind him finishing an unfinished conversation with his patient and starting a brand new one with us. The patient decided to hang around and participate and somehow this looked and felt just right.
Dr. Elliott is a bubbly fidgety man in his mid-forties, and this little practice was his desperately brave response to rejection after rejection from organized medicine. Dr. Elliott was either invited to leave, or quit on his own, several health systems due to his inability to meet productivity quotas. Somehow I was not surprised, and the patient with the thinning ponytail had a toothless grin on his face. Turns out Doc wants to know everything, even what he had for breakfast today and maybe Doc should pay him for doing most of the talking. He slowly pulled a $10 bill from his stiff jeans pocket and handed it to Mrs. Elliott who thanked him and handed him a receipt which he stuffed back in the same pocket, shook hands with everybody in the room and left escorted by Mrs. Elliott who unlocked the door for him and locked it behind him. I just had to ask…
“I take insurance, but if they don’t have insurance, they still need a doctor, so they pay what they can”. My partner mumbled something about chickens. Dr. Elliott walked back into the exam room and closed the door behind him. Mrs. Elliott, still doing five things at once, told us about the new EMR they just bought and how they are working on becoming a medical home, and maybe soon she’ll be able to get a good phone system so she doesn’t have to forward calls to her personal cell phone. There was someone knocking at the door. Two teenage girls came in and one wasn’t feeling well. Can she see the doctor? Sure. The girl who wasn’t feeling well had no insurance either. Another half hour went by and Dr. Elliott walked out from the exam room behind a perky little old lady with huge glasses and cropped white hair. Miss. Sally also decided to stay and chat with us for a bit.
Miss. Sally was suffering from congestive heart failure and was in and out of hospitals for most of last year. She was pretty sure her time has come until she found Dr. Elliott, and he found a cardiologist for Miss. Sally and together they worked things out for her. She is as good as new, or so she tells us. No more hospitals for her. Instead she visits with Doc once a month and sometimes he sends her to see the cardiologist. Miss. Sally was having a grand time being the center of attention. Doc saved her life.
The teenage girl who wasn’t feeling well looked up from her cell phone for a brief moment and agreed to wait a few more minutes so Dr. Elliott can complete his oration on evidence based medicine, the importance of primary care and his great expectations from his soon to be installed state of the art EMR system. He gave Miss. Sally some education materials she will never read, and walked us to the locked door. This time I didn’t have to ask. There were some “incidents” close by and “once they walk through that door, they are my patients, and I am responsible for their safety”, said Dr. Elliott as he unlocked the glass door. As we said our goodbyes I caught a glimpse of the office hours painted on the glass in a soft gray font. The last line read Saturday 9 am – 7 pm.
The rain stopped and a hot Alabama sun was baking the dusty row of little storefronts. A distraught woman walked by looking for a bathroom. We drove back to the city passing by a cinderblock hospital with fat pipes sticking out in every direction, and I wondered how many little old ladies with congestive heart failure are in the process of dying there now. It was getting dark outside.
Note: In order to protect their privacy, the names of all people mentioned in this post have been changed, as have certain physical characteristics, quotations and other descriptive details.
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