It’s a standard question Dr. Kate Long asks patients while they’re meeting one-on-one in her direct primary care office. Asking is like second nature now, but due to billing and time constraints in traditional health systems, it hasn’t always been. For one Charlotte patient, that critical question came at the right time and altered the course of her treatment.
A female patient came to Dr. Long’s clinic for her first routine physical. They met in Dr. Long’s personal office before the physical exam, giving them the chance to feel comfortable and cover all health history and concerns.
When Dr. Long asked about any additional concerns, the patient mentioned fatigue, shortness of breath and pressure in her chest.
“How she described it set off an alarm in my head,” says Dr. Long. “There was something that made me want to get into more detail about her history.”
Since the patient’s vital signs were normal, Dr. Long asked about family history, specifically regarding blood clots.
“Actually, I had one,” the patient responded.
Within 30 minutes of their conversation, Dr. Long had coordinated a same-day CT scan, which revealed two bilateral pulmonary embolisms and heart strain. Both lungs were almost completely blocked. The patient had been diagnosed with a pulmonary embolism ten years prior, but was not informed of future risks or precautions that could prevent a future one.
Untreated pulmonary embolisms can cause complete heart failure from a lack of blood into the lungs.
“Had I stopped there and gone into another exam, who knows what could have happened,” Dr. Long states.
Dr. Long coordinated with the patient’s radiologist and previous hematologist, and called the nearby emergency room to let them know that her patient was en route. Together, providers coordinated a direct admission, which saved hours of waiting in the emergency room. The patient was able to start treatment 5-6 hours after her physical, avoided surgery and was breathing easier within 24 hours, a result of provider coordination that’s not typical of the traditional system.
Dr. Long cites the unlimited appointment times in her direct primary care model as the reason she is able to uncover diagnoses. For most patients, any additional issues would have to be addressed at a future appointment or by a specialist. “In a regular physical, I would have never been able to ask her ‘is there anything else?’ ” Dr. Long says.
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