In general, I find primary care to be a rather noble specialty to go into. While the hours are fairly lax, the pay isn’t particularly good and the procedures aren’t particularly sexy (probably because they consist of the physical exam and blood draws). The physicians who enter primary care aren’t always the noblest of people either: some people are forced into it because of less competitive scores or because of financial incentives (debt forgiveness for setting up practice in a rural area). But my heart is warmed whenever I see a physician practicing primary care because he believes in long-lasting relationships with patients, preventive medicine, and public health measures. Sometimes it is their faith and dedication to what they believe is the heart of medicine that makes their behavior so inspiring.
Dr. Vaccaro and I recently saw a patient named Jessica Rose. She was a young woman who presented with paresthesias along her hands and feet. She had been worked up by her prior primary care doctor and had been brushed off as crazy, meaning there was no physiologic reason he could find to explain her symptoms. She decided to find a new primary care doctor; she searched on Yelp and found Dr. Vaccaro. Before her appointment, she went to see a neurologist at Northwestern and had a few more blood tests that showed low vitamin B12. While B12 deficiency can cause a neuropathy, the neurologist wasn’t sure that it explained her symptoms. Regardless, he started her on B12 supplementation.
When Dr. Vaccaro and I saw her, she came off as genuinely concerned with her symptoms. But at the same time she did seem to exhibit some hypochondriasis (she was extremely precise in describing what was going on and had searched on WebMD for possible diagnoses). It was unclear how to interpret the patient’s actions and behavior. After performing some physical exam techniques, Dr. Vaccaro was also not convinced that the low B12 was causing her symptoms. He ran some blood to check on her B12 and her copper and iron as well. Since it would take a day or two to get the results back, he had to go back in and talk to Jessica about what he thought she should do in the meantime.
He decided to tell her that there was a high probability that the symptoms she was experiencing were not physiological. He believed there was a 50% chance she would blow up and scream about not being taken seriously, threaten to find another doctor, and storm off to write a negative review on Yelp. He was willing to take that chance because he believed she really needed to know what his medical opinion was on the situation. So he went in and said exactly that. Jessica was actually relieved. She told us that she just wanted to make sure there was nothing that could hurt or kill her that she was missing. She said she was okay with her symptoms being a result of anxiety, because that would be easier to manage than some unknown and undiagnosed disease. (As it turns out, her blood work came back with some concerning copper and iron levels, but that’s a story for another time.)
While it turned out to be a (relatively) happy ending, Dr. Vaccaro took a risk that could have damaged his reputation and relationship with patients. He did it for the same noble reason he entered primary care: he believed it was the right thing to do for the patient.
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