January 2009

Talk To Me

Author: Paul deVere | Photographer: photography by anne

Dr. Patrick Jordan likes to listen. “History taking, spending time with patients—it’s my blessing and my downfall. Spending too much time slows things up. People don’t like to wait,” Jordan said. Two years ago, when he opened his own practice, the Comprehensive Family Care clinic just off Sea Pines Circle, he was determined to take that time.

“Spending time with the patient is where the diagnosis is made versus all these fancy tests and MRI scans that make everybody feel more comfortable. But that’s what they taught us at Georgetown (Medical School); 85 percent of the diagnosis comes from the patient’s history,” Jordan said.

This philosophy was a little tough to follow in the specialty Jordan first chose: emergency medicine. “Being an emergency room doctor was very satisfying to me. I was always one of the athletes (at school), but mostly on the bench. The emergency room allowed me to be the quarterback, the star pitcher. I was the person who would run the code. You put the chest tubes in, you saved lives, and it was truly exhilarating.” But he also admitted that being in the ER for 10 years was very unhealthy. “Twelve hours a night wouldn’t bother us, at age 32. The endurance was there. But after you crack so many chests and treat gunshot wounds, you don’t need to see much more. There’s no learning curve then. And there is definitely no fulfilling patient interaction.” At age 42, it was time to move on.

“My wife, as always, was right. The job was really affecting my health. My sleep was totally screwed up. It took me one year to get back to sleeping six hours in a row without interruption. I was 42 years old and sleeping like a 72-year-old,” Jordan said. Even more importantly, it was stressing family life. “The kids were not seeing their father. My wife said, ‘You’ve got to address this issue. Couldn’t you get a daytime job?’” Jordan remembered the conversation and smiled. Today, his family can have dinner together—most of the time.

In 1998, he did get a new job. That year, the Jordan family moved to the Lowcountry. “It was divine intervention. A friend told me about an opening here. The timing was perfect,” Jordan said. But it was still in urgent care.

“I’ve always prided myself that I brought family practice to the ER in terms of how I handled patients. They appreciated that, but it was not appreciated by staff or by the patients who had to wait because I had to take more time. Well, guess what? The next person in line was sicker than the first one, so you had to move them along, for the safety of the patients,” he explained.

That all changed two years ago when Jordan opened his own practice, the Comprehensive Family Care clinic. He practices both primary and urgent care, along with Physician Assistant, Stephanie Lovato. “Hiring Stephanie was one of the smartest things I’ve ever done,” Jordan said. As part of her responsibilities, Lovato conducts physical exams, makes diagnoses and treats illnesses, orders and interprets tests, counsels on preventive healthcare, and writes prescriptions.

When Lovato joined the practice in June 2008, it allowed both Jordan and Lovato to focus more on patient interaction. Jordan said he was not only impressed with Lovato’s medical skills, but also with her involvement in Hilton Head Island’s athletic community, where she has been a competitive runner and triathlete. Prior to obtaining her master’s degree, Lovato worked for the popular Go Tri Sports company in various capacities. She often performed running evaluations, foot strike analysis, and is familiar with various aspects of athletic training and conditioning. “That kind of experience and local knowledge is very important to us,” Jordan said.

“For the tourists, we’re not just a walk-in clinic; I’m actually going to take care of them. They appreciate that kind of security, knowing they’ve got someone watching over them as well as someone back home. We make the initial evaluation and management decisions and contact the doctor back home and conference, making sure everyone is confident in our evaluation. The doctors and patients are very responsive and appreciative,” said Jordan.

Whether they are primary care patients or walk-ins, Jordan said, “I feel so comfortable on how to approach people and their conditions. I do medicine, that’s all I can do. We don’t do defensive medicine here. We don’t tell them to rush out and get a chest x-ray or blood test unless there is some great need. We don’t do labs; we don’t do x-rays here. You can make the diagnosis listening to the history and through the exam,” Jordan explained. “Listening to the patient, that will never change, that is truly the essence of medicine. But, unfortunately, what has supplanted that are the dollars needed to provide the other realms of medical and legal intervention,” Jordan said.

He is very concerned about the spiraling cost of healthcare and its effect on his patients and the medical profession as a whole. When Jordan was in medical school in the early 1980s, the total health expenditure in the U.S. was a bit over $1,000 per person. Today, that number is close to $8,000. “Now what everyone is concerned about is getting the ‘right’ diagnosis, getting the ‘right’ treatment, and avoiding malpractice litigation. Sadly, there is the fear factor and financial factor,” said Jordan.

He gave routine ordering of MRI and CT scans as examples of the defensive mode medicine has come to and the financial “juggernaut” the medical profession is being virtually forced to respond to in the U.S. He made the comparison that in Canada, in 2006, there were 4.6 MRI scanners per million people. In the U.S. there were five times as many. “In the town of Bluffton, there are four MRI scanners in a 12-mile radius,” Jordan said. It is not that there is anything wrong with MRIs or CT scans as a diagnostic tool. “Far from it,” explained Jordan. “It is that physicians, faced with such a litigious environment, feel they must protect themselves. In a sense, MRIs and CT scans have become a second opinion—a very expensive second opinion.”

Jordan said his training and experience in emergency medicine, along with Lovato’s support, are the perfect combination for his practice—and location. Comprehensive Family Care is minutes from bicycle paths and the beach. As an example, they can stitch people up (suture) from falls on bicycles and take care of burns (i.e., bad sunburns).

“As an ER doctor,” he said, “you get very proactive in treating the disease. When you parlay that into a family practice, you have more time with people. Then it becomes much easier to do certain things. As opposed to saying ‘you have a blood pressure issue; come back in three or four months we’ll check it again,’ the ER doctor is conditioned to say your blood pressure is high; you get back here in two weeks. Get the issue, get the problem controlled. That’s the mentality of the emergency doctor. Problem solving. There is nothing you cannot solve. You have to face the issue and help these people along. Of course, if they need a second level of intervention, we have our colleagues to do that. With primary care and urgent care, for both islanders and tourists, they’re looking for someone to help them right now. And that’s what we do.”

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