(Note: As always, all personal and clinical details have been disguised beyond recognition.)
I spent today volunteering for the Dr. Oz 15-minute Philly Physical down at Temple University School of Medicine. Although not previously a huge Dr. Oz fan, I do have a pulse, therefore I know who he is. I found out about the event from the folks who run my EMR, Practice Fusion. Seems they were going to be there setting up the event as a one huge practice just for the day, and were inviting local PF users to come down and help teach the Temple folks how to use PF. This EMR is so ridiculously easy, though, that I ended up helping see patients as well.
Dr. Oz, the great and powerful himself, was there almost the entire day. He began with a heartfelt address to all the volunteers, which included more than 100 medical students, probably 30 attendings total (both Temple faculty and Practice Fusion users from the community), plus a dozen more folks from PF and from Alere, the company providing the point-of-care desktop blood analyzers that produced the lab screenings. There were also cameras, sound people, production crew and various hangers-on from both the Dr. Oz show and the local news affiliate, Fox 29. You could always tell where the good doctor was as he meandered around the room, festooned in his signature dark blue scrubs, because the cloud of people and hardware hovered and moved around with him like a swarm of mechanical bees.
Both he and his staff were gracious, accommodating, and professional, which spoke very well of Dr. Oz as genuine. I’m always struck by how many doctors fail to recognize the degree to which their staff represents them. I’d brought along an autographed copy of my book and although I was prepared to leave it with his publicity manager, Tim Sullivan, he insisted that I give it to Dr. Oz myself. Eventually I got my 15 seconds of face time, which was actually quite a feat given that each and every other person there wanted his attention as well. What was cool was how many managed to get it. Granted he was multitasking the whole time — generating film for an episode of his show featuring the event, likely to be aired in the Fall. Additionally, the announcement was made at the beginning of the day that everyone who wanted a picture with Dr. Oz would get it. It was a promise on which he made good. I think I shocked both Dr. Oz and Tim when I demurred. I hadn’t brought a camera and didn’t feel like digging my phone out of my pocket, because I don’t feel that every experience in life needs to be recorded. Besides, I was there more for the patients.
Each participant received several screenings — height/weight/BMI, blood pressure, waist and neck circumferences, and a fingerstick blood test for glucose and a cholesterol panel — followed by a personalized consultation with a physician to review the results. Calling it a “physical” was a little grandiose; still, there was great value in the event for a lot of people.
We had been asked to keep an eye out for patients with “interesting stories” to be featured on the Dr. Oz episode of this event. It’s fair to say that the vast majority of the patients were hoping for exactly that. The local news clip linked at the very top of this post includes Dr. Oz proudly describing a patient with a severe anemia (“Blood like gingerale”) who was sent to the hospital across the street and admitted. (I’m sure the admission was appropriate, but the characterization “might not have walked out of here later” was a bit of hyperbole. If you were in an auto accident and acutely bled out two thirds of your blood volume, you would indeed be at death’s door. But for someone to walk in with a hemoglobin of 5 (or however low it was), it had clearly taken them a long time — months or even years — to gradually lose that much blood. Very slow blood losses allow the body to compensate and equilibrate, allowing people with ridiculously low blood counts to walk around just fine. Yes, they need to be worked up, but Dr. Oz was taking a bit of poetic license there.)
“Two human beings walked in here today who may not have walked out of here later today,” he announced.
He was not correct.
There were many more than two.
I saw a woman who knew she had diabetes and high blood pressure but had been out of work, and hadn’t had any meds for four months. I got her hooked up with one of Temple’s clinics.
I saw a man whose doctor had given him pills for blood pressure and cholesterol, but he didn’t want to take them anymore, and figured he could control them himself. His blood pressure was 160/100, and his cholesterol was over 350. I convinced him to go back and talk to his doctor again, by helping him understand why it was important.
Then I saw a man who smoked and whose blood pressure was 176/114. He had run out of the blood thinners, blood pressure pills, and nitro his doctor had prescribed previously. He told me about the chest pains he got that made him short of breath, and when I asked if they were worse when he ran up the stairs, he said, “I don’t run upstairs anymore, because I get this terrible pressure in my chest and I can’t breathe.” This was angina; the history of pain at rest defined it as unstable. He needed to be in a hospital, preferably on a treadmill and/or on a gurney racing to the cath lab. I tried to get him to go across the street to the Emergency room, but he was here on his lunch hour and said he couldn’t miss work. This is what happens in the real world: just because we tell people they need to go to the ER does not necessarily mean they go.
Here is how I conveyed my level of concern, balanced precariously between emphasizing the potential gravity of his symptoms but not scaring him into just running away: “Put it this way: if someone told me later this afternoon that you had a heart attack, I wouldn’t be surprised.” He nodded, eventually agreeing to go to the ER right after his work shift. I took his hands in mine, looked him straight in the eye and told him how glad I was that he had come here today, and how much it meant to me that he was going to seek the care he needed. He squeezed my hands back as he thanked me, clearly fighting back tears.
One of the roving camera crews, noting the intensity of our interaction, moved to get us on tape. The patient turned his head and hid his face. “No, please,” he said frantically. I waved the camera away; they complied politely.
Of this and all the other similar interactions I — and I’m sure many of my colleagues — had today, Dr. Oz never knew. Nor will he. It doesn’t matter. A tree falling in the woods does make noise; an intervention not filmed still happens.
Dr. Oz is the name, the face, the brand that got people in the door today. Once inside, it was the Temple University medical students who stabbed their fingers, measured their necks and waists, and recorded their heights and weights. Then it fell to me and my colleagues to instantly form a bond, instilling trust, creating a doctor-patient relationship between two strangers facing each other in comfy blue chairs. Practicing the art of medicine, defined as human beings applying and explaining the science of medicine, to empower other human beings to take charge of improving their health.
There was a press conference at 3:00, where Dr. Oz presented the day’s findings to Philadelphia mayor Michael Nutter. I missed it. As I was finishing up with my last counseling session (persuading yet another hypertensive diabetic to stop smoking) some of the students called me over to where their patient was trying to faint. I helped her lie down on the floor, and mopped her forehead with cool water while hanging onto her wrist, willing her thready pulse to both slow down and become stronger. It did. Color gradually returned to her lips. She said she felt better; we sat her up; she stayed conscious. All was well. Some people aren’t good with the sight of blood.
Unsurprisingly, Philadelphians on average are roughly 40% obese, hypertensive, and pre- or floridly diabetic. Dr. Oz, Mayor Nutter, their staffs and camera crews then left the building. My new-found friends from San Francisco, whose names I knew only from my Practice Fusion Request-a-Feature forums, and I exchanged cards and farewells. Next I took my leave of a handful of new friends from Temple University Medical School.
Finally I said good bye to the stragglers among the medical students; studs in the best sense of the word. It was really great watching every last one of them morph from tentative novices, clumsily sticking fingers, struggling to collect a whopping 40 microliters of blood in a two-part capillary tube (NOT as easy as it sounds), awkwardly interacting with strangers — AKA patients — to a group of poised, skilled young professionals, confidently handling technology that changed from hour to hour (there were some software glitches through the day; they handled them all with aplomb.) Shout out to all of you for a job very well done. It’s wonderful to know that the future of our shared profession is in such good hands.
It was a very good day.