Primary Care Done Well in the Face of COVID-19
Exposing the Real Value of Relationship-based Medicine
It’s fair to say that most of us, doctors included, didn’t see the Coronavirus pandemic coming. But in an interesting wrinkle, it turns out that those physicians practicing in membership-based, concierge models of care may have been better prepared to deliver health care to their patients last year. In a recent episode of the ROAMD podcast, Dr. Scott Pope chats with Dr. Cari Dawson to explore how Covid-19 exposed some of the advantages of practicing relationship-based medicine.
As a co-founder of the Colorado Center of Medical Excellence in Denver, Colorado, Dr. Dawson spent the first 15 years of her career in a traditional practice. About five years ago, she decided to make a change into concierge medicine, both for her personal satisfaction and the well-being of her patients. Although she didn’t know it for the last five years, practicing in a concierge model helped to prepare her and her colleagues to provide optimal patient care as the pandemic unfolded in March 2020 in a variety of ways.
“Just having a smaller number of patients to take care of allows us to take care of each person. [With] a panel of 3000 patients, you simply can’t do that….I wish I could say that we were very well-prepared at the beginning, but we were so caught off guard, but none of us had experienced this before. None of us knew what to do and how to do it. Fortunately, those of us in concierge medicine had the time and space to figure that out very quickly.”
“[During lockdown] we moved our staff home, but we never closed our practice. We were an essential service. Our job was to make sure we were taking care of our patients during this time when everyone was at home. For instance I had one patient who called me, via telehealth, who had new onset AFib, it sounded like, and I said, ‘meet me at the office,’ my MA met us there, we got an EKG and got everything taken care of, to keep her out of the hospital at the beginning of this pandemic, which was really our job.”
Virtual 24/7 support? No Problem
While many traditional primary care offices were closed through the spring and into the summer, Dr. Dawson’s practice was able to lean on telehealth – in part, because this had already become a routine part of their offering.
“What was new for a lot of practices, we already have been doing for five years. Concierge docs are always available by email, by phone, by texting. We know how to take care of our patients outside the practice, whether they’re traveling, whether they’re busy at work and can’t get in, as long as it’s safe…we were already doing this on a regular basis to provide care for our patients. And our patients knew how to access us that way anyways.”
In addition to telephonic and Zoom visits, Dr. Dawson learned how to rely on patients’ in-home devices, such as pulse oximeters and blood pressure cuffs.
Opening Up: Safety in (small) Numbers
Around early May, as stay-at-home orders began to relax in some states, Dr. Dawson and her colleagues were preparing to get patients back in the office. She shares that one of the most invaluable resources in the run-up to this was the ROAMD network:
“I absolutely appreciated the Community Conversations with ROAMD on Monday nights. I don’t think I missed a single one. To have that network of concierge physicians around the country who are bright and experienced and all want to provide exceptional care…We all had different experiences, we all had different ideas on what’s the best way to do what. To have that collegiality and that network….to take all those pieces and add it to your practice, it made all of us more successful.”
With smaller patient panels, the concierge practices were already relatively safer than an ordinary outpatient clinic: “No patients sitting in the waiting room; we’re scheduled so patients aren’t overlapping and we’re not running 30 minutes late. [We have] enough staff to make sure everyone’s taken care of; There’s plenty of time to clean out the rooms, so they could be completely aired out and wiped down.”
Dr. Dawson points out that smaller panels also let her and her staff have the time they needed to read the literature and medical journal articles with the latest on the fast-developing science. Moreover, the personalized attention given to their members through a dedicated nutrition specialist in house, regular cardiac wellness monitoring, and other preventative care for the five years leading up to the pandemic may have had a cumulative effect on boosting patient well-being.”Our patients’ health was as well-controlled as it could be…You can’t do that for everyone when you’re practicing reactive medicine.”
The Power of Relationships: Patient Advocacy
“We were advocating for our patients – calling them at home, telling them we were here for them. Just simply checking on them, and really educating them about covid. We sent regular e-mails updating them, ‘Here’s how to protect yourself, what to do if you get sick, what you need at home, how to interact with the community.’ “
When it came to covid testing, “We waited a long time to get tests in our office. My staff worked endless hours to find tests and make sure people got tested. People were calling daily to join [the practice] – People realize what their doctors could do for them if they had a relationship with that person.“
Another major advantage of having a close relationship with your primary care doctor only recently revealed itself in the form of vaccine advocacy. “We’ve spent the last six weeks with our 70 and older [patients], finding them a vaccine, helping them to get on the portals, sending them links for the pharmacies when we get them. We worked with our hospital to get every patient over 70 in my practice vaccinated.”
She describes how with help from her colleagues, she was able to push their local hospital partner to provide vaccines for their eligible patients. Again, panel size becomes a massive advantage here: “We have a luxury of having a smaller number of people where we can advocate for each and every person. Our patients know that, and they expect it, and even when our hands are tied and we don’t have [a vaccine], we work hard to figure out where to get it. And we’ve worked tirelessly to make sure we have found the resources for our patients.”
Ongoing Learning, with One Clear Lesson
In discussing how she has been able to adapt to emerging best practices, from wearing masks to learning how to safely reopen for in-person visits, Dr. Dawson says she doesn’t have any regrets. She points to small things, such as potentially getting herself and her staff tested more than they may have needed to over the summer, but maintains that the biggest lesson is that “the pandemic taught us that this could happen; the other things we learned quickly, figured out the best way to do it and moved forward.”
She maintains that the biggest insight gleaned from the pandemic was that concierge care’s value proposition became much clearer for her and her patients. “The great thing about membership-based medicine is that there’s such a large spectrum of what that can look like. It doesn’t have to be thousands of dollars…it makes these models that can be quite affordable for patients, still profitable for physicians. I think people are starting to see the value of having a relationship with your doctor, and how difficult that is to find in a traditional setting.”
“People have really learned the importance of the relationship with their primary care doc during this pandemic. This pandemic shined the light on concierge medicine, hopefully it will improve longevity and growth of concierge medicine!”
To learn more about how concierge practices are supporting their members through the ongoing trials of the Covid-19 pandemic, feel free to visit ROAMD online to learn about membership-based medical practices.And as always, check out our other episodes online.
Dr. Cari Dawson is a co-founder and physician at Denver’s Colorado Center of Medical Excellence. As a Diplomate of the American Board of Internal Medicine and a Fellow of the American College of Physicians, she has been practicing internal medicine at Rose Hospital since 2001.
Dr. Dawson earned her degree in biology from the University of Colorado and completed her medical school and residency at the University of Colorado Health Sciences Center. There, she was elected into the national medical honor society Alpha Omega Alpha and received multiple awards for excellence in internal medicine, including Chief Resident. Dr. Dawson has a clinical faculty appointment at UCHSC, where she has mentored many medical students and residents.
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