A Medical Story

The Principal Undergardener is taking a week off from essays about weeding to offer a tale of an encounter with modern medicine. If you’re rolling your eyes with an expectation of another lament about things going horribly wrong in the world of Big Medicine, be advised this story has a happy ending.

DMA's offices

When a career opportunity first brought us to Boston back in 1980, Betty and I asked neighbors and co-workers about where we might go to find a family doctor and dentist. The recurring name we heard was that of Dedham Medical Associates, which was housed in its own building roughly 15 minutes from our new home in Medfield. We went there, felt comfortable, and made it our medical home.

Ten years later, we left Massachusetts for yet another career opportunity but, in 1999, we returned to Medfield and picked up where we left off with the same doctors and dentists. In 2004, DMA joined with two other medical groups to become Atrius Health; adding medical specialties not previously available in-house (but, alas, shedding dentistry). Through all this, we kept the primary care physicians we had known for decades. When Betty and I became eligible for Medicare, we chose a ‘Part C’ plan that specifically included DMA.

Aging, though, brings a need for specialists you never contemplated in your 30s and 40s and, for Betty, osteoporosis reared its unwelcome head while she was still in her 50s. Atrius Health provided superb care. In 2020, she underwent spinal surgery to address continuing pain associated with collapsing vertebrae, receiving an injection of the medical equivalent of cement into two areas of her back.

Few things last forever, though, and this year, the back pain returned. Betty bore it well and insisted no intervention was necessary. Then, two evenings ago, Betty got up in the middle of the night and tripped, wrenching her back in the process. We both knew this wasn’t going away with ibuprofen. I also knew, from experience, that short of a true medical emergency, going to a hospital’s emergency room is an invitation to wait hours for indifferent care.

That’s when I discovered just how good medical care can be. At 6:30 a.m., I wrote a note to Betty’s primary care physician of almost three decades to let her know what had happened. At 7 a.m., I called DMA and got their ‘after-hours referral service’. I explained what had happened and, 30 seconds later, Betty had an 8:30 a.m. appointment at Atrius Health’s ‘Urgent Care’ center at their Norwood location.

There, Betty was taken in immediately. An RN named Megan called up Betty’s medical history, did a series of ‘touch your toes’-type tests, and sent her across the hall to radiology for a spinal x-ray. Fifteen minutes later, that image showed a fresh injury to a vertebrae that had been slowly collapsing. Megan put in a request for an appointment with Physiatry, the folks that deal with spinal and skeletal issues. She also issued a prescription for a drug to help alleviate the pain. Elapsed time from arrival to departure: less than 90 minutes.

We picked up Betty’s prescription - already waiting for us at our local pharmacy - on our way home. There, I called the Physiatry Department at DMA. After first cautioning me that appointments dates were made weeks or even months in advance, the scheduler paused and asked, “Could you be in Dedham at 3:30 today?”

Of course we could be, and at exactly 3:30 p.m., we were ushered into an examination room. A few moments later, we met Dr. Srdjan Nideljkovak.

Over the past several years, enormous sums of money have been devoted to facilitate the integration and digitizing of medical records - $36 billion according to consulting firm PwC. More than a few times, I wondered if the project was simply a government boondoggle doomed to deliver 10% of its promise. I officially admit my suspicions were misplaced.

In less than a minute, Dr. Nideljkovak had in front of him Betty’s complete medical history. He highlighted the multiple osteoporosis treatments Betty had undergone and their dates. He compared x-rays and MRI scans over two decades. In ten minutes, he isolated the likely source of Betty’s pain and confirmed it with a quick examination.

We spoke about treatments and settled on one that should offer long-term relief without further surgical intervention. I marveled that it was not yet 4 p.m.; Betty’s fall had been just 15 hours earlier and her arrival at urgent care was fewer than eight hours ago. And the out-of-pocket cost for all of this was $26 – ten dollars for urgent care, a dollar for the Tramadol tablets, and $15 for Dr. Nideljkovak’s time (seeing a specialist costs more).

All is not perfect. We have an appointment for the treatment in September. But Dr. Nideljkovak also told us about the workaround of calling on specific days to check for last-minute cancellations.

Perhaps our luck was exactly that, and the next person with a nighttime fall will spend days or weeks in medical purgatory. Perhaps it is just our good fortune to live in a region with a fabled wealth of medical practitioners. I like to think, though, that this is the way the system works for everyone who is willing to be flexible, to be persistent, and to have had the common sense to take advantage of Medicare’s Part C option.