The Argument Against Partial Person Care

Holy moly. I just actually just saved someone’s life.

I know, I know—I’m a family doc. That’s what we’re supposed to do every once in a while, at least in theory. I’ve always practiced within a large university health system and have additionally had a large proportion of my job allocated to ‘teaching and administrative duties’. As such, I’ve come to view life-saving through a long-term lens. Of course, I help decrease cardiovascular risk over time. I save lives by providing needed mental health services and decrease barriers to care for those unlikely to access it otherwise. I recognize potentially life-threatening situations and then refer to the appropriate specialist, subspecialist or physician who actually cares for only a singular cell layer–albeit an important single cell layer—the retina.

I was on the phone with a medical director of a large local HMO. This physician is someone I’ve known and respected for years: She’s been willing to appreciate the complexity involved in caring for humans, she was willing to advocate for ethically just care—like covering care for transgender individuals—before it was legally mandated.

It had been over a year since I resigned from the only job I’d had after training. I was now applying for HMO privileges as a solo family physician who literally practices in the basement of what used to be a Taco Bell [TM]. This medical director showed me the courtesy to let me know that they would be extending a contract to me as an addiction medicine physician, but not as a primary care physician. I responded with authentic confusion and some familiar righteous indignation.

“So… if I am seeing a young woman and she’s taking buprenorphine, and she needs and wants contraception, I’m not allowed to slip in an IUD at that visit? I don’t know—I’m not really into partial person care. Still—right now I’m not exactly in a position to turn away business, so let me think about it.”

One of my very first patients as a solo family physician was a 33 year old father of four. Like so many in his community, he struggled with heroin. He drove from over an hour away, his wife and small children accompanying him for his buprenorphine induction. As a standard part of initiating buprenorphine, I evaluated his level of withdrawal. Out of habit, I laid a stethoscope on his chest. His diastolic heart murmur was alarmingly loud and obviously pathologic.

“Anyone told you anything about a heart murmur?” I mumbled with the left earpiece removed from my stethoscope.

“Yeah—they said it was nothing to worry about.”

He had no stigmata of infectious endocarditis nor track marks to contradict his history of only using heroin intranasally.

“Let’s get an ultrasound of your heart—just to make sure,” I uttered, habitually.

The cardiologist called me from the echo lab: ‘Moderate to severe aortic regurgitation…and an active aortic dissection.” A remarkably timely CT scan and cardiothoracic surgery consultation later, the young man called me on my cell phone: he was being prepped for the operating room in the nearby tertiary care medical center. He was having open-thoracotomy valve replacement and aortic repair. He wanted me to know he would miss his appointment with me next week. He and wife were mostly calling, though, to express their gratitude.

I offer this story not because I am any better a family physician than most, but exactly because—first and foremost—I am a family physician.

No matter what the immediate care need is, I remain committed to the care of each individual human in the context of their unique life, within the context of their family and community. As any experienced physician knows well, it’s not the glory of a ‘great call’ or diagnostic prowess that feeds us long term. It is the humbling experience of ‘bearing witness’ as individuals struggle and rejoice. I continue to be honored by those who call me ‘their doctor’ and entrust me with their health, their vulnerability, and those they love.