The Patient Was…

The patient was a 45-year-old male who had been seriously injured in an accident and was on medical disability leave from his job. Although I had never previously heard of, talked with, or seen him, I made a house call, and it was a life-changer  —  for me!

House calls, while perhaps never frequent, were certainly more common in years past. General practitioners and family physicians did call on patients in their homes when it seemed necessary. Specialists rarely did so. And as medicine became more specialized and physicians relied more and more on technology, house calls became a less frequent feature of patient care.

I did make occasional house calls in situations where patients would have to go to unusual effort and expense, such as summoning an ambulance, to simply come to my office for routine examinations. Parenthetically, I don’t recall any colleagues of mine doing so, but they may well have done it.

I recall once leaving my office during office hours and making an emergency home visit to a patient who had an acute ophthalmologic problem, but whose ophthalmologist refused to leave his office because “he was busy.” The delay in getting appropriate care for the patient cost her her vision. I never referred a patient to that doctor again.

Remember, the injured patient on medical leave discussed in the current encounter was not my patient.  He was a middle-level executive for a major, multinational pharmaceutical company that had its headquarters in a foreign country. The company planned to market a new drug for treating heart disease. The patient was the leader of the medical – marketing team in the United States. (Most pharmaceutical companies have separate medical and marketing teams that work closely together, but this organization actually combined the two disciplines under one umbrella).

At the time of this encounter, I had been in medical practice as a cardiologist for over twenty years.  The pride and pleasure I took in my work is unquantifiable. The combination of science and human behavior in the face of illness was incalculably fulfilling. And I was constantly moved by the sober realization of the privilege afforded me as a physician: to have patients and their families place trust in me to care for them, to literally put their lives in my hands.

But my professional life was not confined solely to clinical medicine. Quite by accident, in the early years of my practice when I still had spare time, I had become involved in pharmaceutical advertising (that’s a whole other story that may be related sometime in the blog). As a result of that “non-clinical” work, I had become the Medical Director of a prominent pharmaceutical advertising agency, a large medical education company, and a science and medicine public relations agency. These activities occupied no more than ten percent of my time, the rest being devoted to caring for patients.

One day, during office hours, I received a telephone call from an Executive Recruiter, a so-called “headhunter.” He wanted to discuss an opportunity for me to join a pharmaceutical company as its Medical Director. It was time between patients, and I thought I would accept the call and quickly dismiss the caller. When he explained the reason for contacting me, I asked how he had come upon my name in the context of this employment opportunity.

“Oh,” he said, “you’re high in our database of advertising and marketing doctors.”

“I’m a practicing physician,” I replied, “not an advertising doctor.”

“Wow, we love advertising doctors who also have clinical experience,” he said.

“I also teach at the medical school,” I countered. “I’m not an advertising or marketing guy, and I’m not interested in working for a company.”

“Fantastic,” he said. “Clinical and teaching experience. You’d be ideal for this job.”

“Look,” I explained, “this is not for me. I also do clinical research, and my professional plate is full.”

He was over the moon!

“Clinical, teaching, and research experience. It’s the perfect trifecta,” he said. “You’ve got to hear me out.”

Since it was time for me to focus on my next patient I agreed, wisely or not, to speak with him again.

At this point in my life, I had been in medical practice, and doing all the other activities I mentioned, for over twenty years. And three thoughts had begun to periodically percolate in my mind. (My wife recalls me occasionally giving voice to these ideas.)

First, although every patient brought with them a unique set of values, concerns, and behaviors, their actual medical and scientific problems were basically the same: I wasn’t seeing anything new to challenge my scientific and medical training.

Second, I recognized that while my advertising, education and public relations activities occupied only a small fraction of my time, they represented the most fun and enjoyable parts of my week.

Third, in clinical practice, your full energy and focus is on one individual at a time. The person sitting across from your desk or lying on your examination table is your sole concern; and the benefits of your knowledge, experience and attention accrue to only that one person. Imagine, instead, if your work could benefit hundreds, perhaps thousands, of people at the same time. Maybe entire an population could be helped.

With those thoughts in mind, I reconnected with the recruiter. He outlined the opportunity to join the company as Medical Director, help complete the development of their new cardiac drug, and then participate in its marketing across the globe. He suggested simply that I spend a day at the company’s headquarters in the U.S., meet some of the people working on the project, and reserve any decision until after that experience.

It made sense and, frankly, it sounded like fun. So, I drove to New Jersey where the company was located. (New Jersey is probably home to more major pharmaceutical companies than any other state.) The day went swimmingly. I met medical and marketing folks involved with the new cardiac drug and sat in on a couple of meetings. When I got home, I debriefed with the recruiter.

“The day was fine,” I told him. “The people are smart, interested, collegial, and it was really fun.”

Not surprisingly, he wasn’t entirely satisfied. “It sounds like there is a ‘but’ in there.”

“The ‘but’ is that they don’t know anything about marketing to cardiologists,” I said.

“Well, think of the opportunity,” he said. “Think of what you could bring to the table.”

I said, “If I were interested in pursuing this, what is the next step?”

“That’s a problem,” he said. “Everybody who met you there really liked you and said they would love to work with you. But the person who runs the Team is out on medical leave and won’t be back for a few weeks. And you have to meet him before anything further can happen.”

“I’m not going to be in limbo,” I said. “There are so many steps to take to close down a medical practice. It’s going to be now or forget it.”

“Well, the problem is the man is home on disability. There’s nothng I can do.”

“Where does he live?” I asked.

“In New York. Why?”

“I’m a doctor,” I said, I’ll make a house call.”

“What? What do you mean you’ll make a house call?”

“If he wants to interview me,” I said, “I’ll visit him at home. And I won’t even charge him for the visit!”

The recruiter chuckled, said he had never heard of a potential new employee interviewing at an executive’s home,. But this was an unusual circumstance. He floated the idea to the company and everybody liked it and thought it was a creative use of everybody’s time.

We met, we hit it off really well, and the upshot was that they offered me the position.

All from a doctor’s house call.