Lamplight glints off the stainless-steel coffee machine, one of
those high-tech models that make a mug at a time. Beside it sits a
basket of bagels and muffins, each tucked in a plastic bag tied with a
silver bow. A bowl of organic pears and apples, perfect as a Renoir
still life, snuggles up to the baked goods. Across the room are
unruffled copies of today's New York Times, Wall Street Journal and
USA Today. A Bose Wave Radio murmurs nearby. A door at the back swings
open, and Bobbie Wingate-Fisher presents herself. She's wearing a
clingy pink sweater and matching pumps. Her knee-length skirt reveals
shapely calves. Flashing a toothpaste-ad smile, the brunette appraises
the two 40-something guys slouched in soft chairs. Her gaze, friendly
but firm, settles on one. She wiggles her fingers in a come-hither wave,
says hi and beckons him to follow. "This is not good," he
thinks. "She's come to take my vital signs, and my
heart's already racing."
Yes, this is a doctor's office, but, no, not a typical one.
Duke Executive Health Program, a division of the university's
nationally esteemed hospital, offers a level of convenience and coddling
rare in today's healthcare industry. The waiting room, like nearly
everything about the program, underscores a message that's
straightforward but, in medicine, startling: We care about your
business, and we're here to serve you. In a typical doctor's
office, that notion would be shocking enough to send you into cardiac
arrest. If it does so here, the folks at Executive Health want you to
know you'll be whisked up the hill to Duke University Hospital,
ranked eighth in the nation in cardiac care by U.S. News & World
Report (see pages 61 and 62). "It's a way for them to practice
concierge medicine," says Curtis McLaughlin, an expert in the
business of medicine and emeritus professor at UNC Chapel Hill.
"It's a way of maintaining relationships with a well-heeled
population who'll pay a premium to see a physician who gives them
lots of time."
Programs like this once were common, with the Mayo Clinic leading
the way. "When my father-in-law was with Arthur Andersen, it used
to be a big perk to send somebody to Mayo for a day at company
expense," McLaughlin says. They lost popularity as
employer-provided health insurance expanded, but now with medical
centers scrapping for every dollar in their ongoing smack down with
managed-care insurers, they're resurging. "If you bring in
executives and they've got a leaky heart valve, where do they send
them? Chances are to Duke. Imaging, orthopedic replacements and heart
surgery are the most profitable things in health care. So this is
another way of capturing and servicing profitable market segments."
With a full-time staff of nine, the Executive Health Program operates
profitably, an unusual enough distinction in a major academic medical
center, but its contribution is a pittance to an enormous operation such
as Duke University Health System, with its $1.8 billion annual revenue
and more than 20,000 employees.
The program's other benefits might outweigh its financial
contribution, says Charles Sanders, former CEO of Glaxo Wellcome and a
cardiologist by training. Sanders, who has used the service himself,
points out that clients may become donors. "That's been proven
at Duke with Roger Milliken and Dave Thomas." The chairman of
Spartanburg, S.C.-based Milliken & Co. provided one of the
testimonials on the Executive Health Web site and contributed to Duke
Eye Center. The late founder of the Wendy's fast-food chain's
name is found on the R. David Thomas Executive Conference Center.
I've come to Durham to learn firsthand what could make a tough
textile baron like Milliken go gaga over Duke doctors. I'm the guy
Wingate-Fisher summoned from the waiting room, and I'm here to find
out what executives get for their money. The typical client--a man
between the ages of 45 and 60--pays $2,765 for his visit. The program
doesn't take insurance, though some who come submit the bill on
their own and often see some reimbursement. Others have the fee paid by
their companies as a fringe benefit. Each typically gets a physical,
separate diet, fitness and stress assessments and a raft of chemical and
digital evaluations, including an electrocardiogram, body-fat scan,
chest X-ray and multiple blood and urine tests. Like the executives,
I'll devote a full day to meeting with a retinue of specialists who
will assess everything from the rhythms of my heart to the soundness of
my psyche. (Unlike some of them, I won't spend the night at the
luxurious Washington Duke Inn, just up the road, nor squeeze in a round
of golf at its Robert Trent Jones-designed course.) I'll be poked,
prodded, measured and scoped to create the most complete picture of my
health and physique I've ever had.
I've already had seven vials of blood drawn, and as
Wingate-Fisher and I pad down the hall to the nursing station, a courier
is shuttling them to a Duke lab so that I'll get the results by
that afternoon. Later, he and the program's shiny silver SUV will
be available in case I need a lift to the hospital to see a specialist.
Even at the main hospital, Executive Health customers get VIP treatment.
They often get to jump to the front of the line, instead of camping out
with the common folk amid the blaring TVs and dog-eared copies of Car
and Driver and Good Housekeeping. After Wingate-Fisher checks my vitals,
she drops me off for an introductory chat with Kevin Waters, the
program's director and one of two physicians on its staff. He gives
me the rundown of the day ahead and a piece of advice: "Don't
try to beat the treadmill," he says, referring to the stress test.
"We get a lot of competitive guys here, and sometimes they overdo
it. The treadmill always wins."
A few minutes later, I'm facing the treadmill and its imposing
operator, exercise physiologist Rob Gray, who sports a nearly shaved
head and the thick shoulders and broad back of a football player, which
he once was. After explaining the test, he tells me to remove my shirt
because he's going to shave patches of hair off my legs, stomach
and chest to attach the leads for the EKG's wires. Soon my torso
looks like a crazy quilt of farmland and forest as seen from an
airplane. "A stress test can get you with incline or get you with
speed," Gray says as he does my resting EKG. "We choose to get
you with incline. This thing tilts up to 23 degrees." A smile
flickers across his face, and I can't help but think that he's
going to enjoy humbling me. He fires up the machine. Its wide belt
starts to whir. Soon enough, I'm panting and he declares my test
done. I say, sheepishly, that I believe that I could've gone
longer. "Don't worry," he responds. "Everybody
thinks that."
Wingate-Fisher ushers me into an examination room. She pauses for a
little friendly banter, then tells me that the doctor will be with me in
a couple of minutes. He soon arrives, settles into a chair and starts to
quiz me on my medical and family history. I regale him with the whole
sorry tale--the litany of clogged arteries, weak hearts and remorseless
cancers. I'm relieved when he skips the mental-health
questions--one side of the family alone could keep a psychiatrist busy
for months. Lanky and loquacious, Waters has a bartender's knack
for knowing when to talk and when to listen. A natural storyteller, he
riffs at length--about his stint as an Air Force medic, about his former
life as a primary-care physician in New Mexico, about his family's
history of esophageal cancer. But he also waits patiently as I answer
his questions. Seldom have I met with a doctor who seemed so unrushed.
"If you ask all the doctors what would make their lives
better, they'll say, 'If I could spend more time with my
patients,'" he says. "And if you ask the consumers,
they'll say, 'If I could spend more time with my
doctor.'" Working at Executive Health, he says, gives him the
professional satisfaction of spending that time and really getting to
know his patients. He even hands out his phone number and e-mail
address. If his clients become patients of other medical departments at
Duke, he coordinates their care, checking in with them and their
specialists.
As the physical exam begins, he mentions that Wingate-Fisher had
noted a slightly higher blood pressure--130 over 70--than is ideal for
my age. He gets the same reading. "You look pretty healthy--your
weight's good. We'll talk about this later, once I've
seen all your test results. Meantime, talk about it with Gene, our
nutritionist. He can tell you about the DASH diet." DASH stands for
Dietary Approaches to Stopping Hypertension. Next come the usual body
thumping and stethoscope listening. Waters checks my reflexes, eyes and
ears, then he tells me to drop my drawers. "Do you know where your
prostate is?" Unfortunately, I do. "They put it in a weird
place," he says. "I didn't pick where they put it."
I hear his rubber glove snap into place and wonder if he's pulled
it on with just a tad too much glee. I know how many folks feel about
journalists.
COPYRIGHT 2008 Business North
Carolina Reproduced with permission of the copyright holder. Further reproduction or distribution is prohibited without permission.
Copyright 2008 Gale, Cengage Learning. All rights
reserved. Gale Group is a Thomson Corporation Company.
NOTE: All illustrations and photos have been removed from this article.