Medicine: Have You Hugged Your Doctor Today?

by Jenna Bergen | May 28, 2010 6:00 am

It’s a Tuesday afternoon, and like all afternoons in Michael Cirigliano’s life, this one is running like an exercise in organized chaos. “Yo, what’s up, man? I’m comin’, I’m comin’!” Cirigliano booms through the open door of an exam room where a middle-aged man is patiently awaiting his turn from the high perch of a paper-covered table. The doctor is running late; my shadowing for this story has slowed him down. But I’m here to see how this joke-telling, dark-haired Penn physician — known to patients and colleagues simply as “Dr. Mike,” and resembling a shorter, slightly stockier Stephen Colbert — could be changing the way primary-care doctors practice medicine.

“You’re up next,” Cirigliano, 50, says, shooting the patient a quick -finger-snap point before hurrying back to his office to scribble down notes on the patient he just left.

The four walls that hold his working possessions at 3701 Market Street are unassuming. A few cans of used paint are stacked in the corner behind the door; a microwave and a mini fridge tucked under his desk are sure signs of a man who has little time to break for lunch. Yes, there’s a bookshelf filled with the medical tomes one would expect to see in any doctor’s office, but above them sits an autographed hockey stick — a gift from Ed Snider, just one of the city’s many big names who are Dr. Mike’s patients. The cell phone attached to his belt, poised to field incoming calls from patients who can’t get through at the front desk, is the badge of a man who’s given up waiting for a health-care reform bill that works and has figured out a way to practice medicine on his own terms.

“All right,” he says quickly, turning toward me so fast that the papers on his desk flutter. “Let’s get on with this tour.” And then he hugs me. For the second time. Because that’s just part of who Dr. Mike is. He’s a hugger.

He’s also an innovator. Four years ago, like many primary-care doctors across America, Cirigliano found himself so frustrated by the practice of modern medicine — insurance pre-authorizations, patients unable to get through on the phones, 15 minutes or less to spend on each exam — that he was ready to throw in the towel. “I just couldn’t do the job I needed to do,” he says. “I was getting to the point where I was thinking, There’s gotta be a better way to do this.” The obvious choice? Join the waves of primary-care doctors moving into concierge or VIP services, for which patients are charged a yearly base rate that buys them unlimited personal access to a physician, allowing the doctor to maintain a much smaller patient load.

But that didn’t sit well with Cirigliano, who believes those services should be part of the basic package, not extras. Besides, he had hundreds of patients who depended on him — many of whom lived in West Philly and could never afford the annual fee for a concierge practice. “I wanted all of my patients to get the same level of care, whether they had money or not,” he says.

So he decided to do something no doctor had ever done before: ask his affluent patients, a group who made up only two percent of his patient roster, to donate funds to help him build a practice that would outfit him with the space and staff necessary to do his job well for all his patients. In turn, he promised to make their medical experiences as pleasant as possible.

And because of who Cirigliano is, they bought it.

CIRIGLIANO’S DAYS START EARLY and go long. In addition to his full workload, he answers calls from patients at any hour of the day or night and does his best to transfer his love for primary care to the Penn medical students who shadow him regularly. Twice a week, he drags himself out of bed before 4:30 a.m. and makes the drive from his house in Glen Mills to Fox 29’s Market Street studio. There, he’ll discuss everything from the latest medical breakthroughs to the pitfalls of smoking, so into whatever it is he’s talking about that you’d think he skipped the cup and siphoned his morning coffee into his bloodstream.

Cirigliano also calls in weekly to 610 WIP’s Middays with Anthony Gargano and Glen Macnow sports radio show to offer his loud, boisterous opinions on sports injuries and men’s health issues. “He’s the energy doctor. That’s what makes him good for TV and radio,” says Gargano, who feels Cirigliano is to his show what Dr. Oz is to Oprah. “The audience says, ‘I buy him. I believe him. I want him as my doctor!’”

But even after he switches from his TV-doctor hat to the real thing, Cirigliano’s bedside manner is a mix of stand-up comic, OCD dad and skillful physician. “He is always on. Always energized,” says Vesna Todorovic Sacks, a Serbian artist who lives in Symphony House and has been a patient of Cirigliano’s for the past five years. “Zipping everywhere. Working, like, 37 hours a day, calling you at 11 o’clock at night. And then you turn on the TV and there he is, still going. … But I finally figured him out.” She pauses. “He’s a virtuoso. And this,” she says, sweeping her hand across the small office, “is his stage.”

Performing was Cirigliano’s first love. He’s the only son of a barber and a high-school secretary, and his fingers teased notes from a trumpet long before they ever tore off a prescription. His father, raised in an orphanage, didn’t really have a family until he created his own. So when the Vietnam war broke out, he pressed the shiny instrument into his son’s hands, in the hope that if his only child was ever called to serve, it would be by entertaining his fellow soldiers rather than by fighting.

As with most everything, Cirigliano was good at the trumpet. School performances and halftime shows at Sun Valley High School in Aston eventually led him to pursue an undergraduate degree in music at West Chester; he was certain he’d build a career on the stage. A steady flow of band gigs like 82nd Airborne reunions fulfilled his need to perform, but they also kept him from having the kind of social life he coveted. “I felt as if I had served in World War II,” he quips. “There were no young people to be seen. So I complained to my dad that I wasn’t meeting women, and he said, ‘Go to a hospital and meet people with real problems.’” Cirigliano began volunteering a few hours a week at Riddle Memorial Hospital’s ER in Media.

The fast-paced, electric atmosphere of the hospital quickly drew him in. “Back then, they had these docs moonlighting from different teaching hospitals — Penn, Temple, Jefferson — and I got to see all kinds of wild stuff. They’d say stuff like” — he pauses, and his eyes grow an inch wider as he leans forward to re-enact the scene — “‘GO TO THE CLOSET AND GET A CATHETER!’ And I would run and get a catheter. And that was it.”

Cirigliano was hooked on medicine. He eventually landed in med school at Penn, where, hungry to connect with patients, he gravitated toward primary care. In the decade that followed, he built a strong practice at Penn Internal Medicine Associates, with patients mesmerized by his attitude and bedside manner.

“I go into the office and I hug him — I mean, how many people hug their doctor?” says Ken Zekavat, president of New Jersey’s Zekavat Investment Group, who used to wait up to an hour and half to see Cirigliano. “I was willing to wait because he’s at the top of his game, he has great bedside manner, and he really cares.”

Still, after 13 years of dealing with the day-to-day roadblocks that come with being a PCP and one of seven doctors sharing the same office, Cirigliano was increasingly frustrated. If there was a tipping point for him, it was the day four years ago when he was told the practice’s dictation service, something Cirigliano used religiously to send patients personalized, detailed follow-ups after appointments, was being eliminated in favor of automated, less expensive form letters. Now he was losing control of the one thing he had left: how he interacted with his patients. Cirigliano was so bothered by this that one day, one of his patients, Steven Dandrea, of Vineland’s Dandrea Produce, noticed it while getting an exam. “What’s goin’ on, Doc?” Dandrea asked. “Everything okay?”

“I’m getting chest pains,” Cirigliano joked, before telling Dandrea about the dictation service — and parroting his boss’s crackerjack suggestion for fixing the problem: ask his patients for the money.

Dandrea shook his head, upset that a doctor so dedicated had this kind of stress. “How much do ya need?” he asked.

Surprised, Cirigliano realized Dandrea was serious. “Whatever you can give,” he said, sure whatever it was would be a small drop in a very large, leaky bucket.

But a few weeks later, a check for $25,000 showed up in the mail. Cirigliano was shocked — it would pay for his dictation and then some. And then, a tiny glimmer of hope shot through him. Why stop with just the dictation service? What if he could find a way to get the support staff and space he needed to practice medicine the right way, where the patient comes first? Even though the idea of a partially patient-funded practice was new to Penn, Cirigliano’s enthusiasm was contagious, and in August 2007, the Cirigliano Clinical Care Excellence Fund was set up for the practice. Any costs that Cirigliano couldn’t pay from regular patient income would be covered by patient donations.

Whenever his wealthier patients came to see him, Cirigliano began laying out his vision of the perfect practice. All it would take was for them to write a check to help fund it. Among the first he asked was Zekavat. “It was an easy sale,” Zekavat admits. “Not only was I making a small investment in Dr. Mike that certainly benefited me, but it would also allow him to create a game-changer in medicine.”

“The guy is pure dedication, he’s pure doctor,” says Ed Snider, another of Cirigliano’s major patient backers. “So when he came up with this idea, I was really excited. I felt that he needed to have a better support staff and a better setup, so I offered to help him in any way I could.” Eventually, Snider donated $500,000 to the cause.

In two years, Cirigliano raised nearly $2 million. “I have patients who have donated artwork and magazine subscriptions, and I have patients who have donated thousands of dollars,” he says. He insists both groups get the exact same care: “The goal is not only to give people the highest quality medical care, but also to treat them like human beings. I want people to walk out of here and say, ‘Holy shit! What just happened? That was the best medical experience I ever had!’”

THE FIRST THING YOU NOTICE when you walk into the waiting room of Cirigliano’s office is that the usual cacophony of a family doctor’s office is missing. Instead, it’s startlingly quiet. The receptionists look up and smile the moment you arrive at their desk, and address you as Sir or Ma’am as they efficiently handle the scheduling of appointments, referrals, and any other insurance issues you might have. There’s freshly brewed coffee, and a mesmerizing display of brightly colored fish swimming lazily across a flat-screen TV. Though one would expect to find only high-profile business professionals and Main Line moms checking BlackBerrys or e-mailing on iPhones in a place like this, the intimate waiting room is dotted with patients of lesser means. A silver plaque adorns one wall, etched with the names of those who’ve made all this possible. Steven Dandrea and his wife are there, and so are Snider and Zekavat, along with more than 25 others, including Linda and Tom Knox, -Wendy and Derek Pew, and Aileen and Brian Roberts.

Of course, when you realize what they’re getting, it’s easy to see why so many of Dr. Mike’s patients have generously opened their checkbooks.

“Feel this. This is like a medical Snuggie,” says Cirigliano, holding out a cloth exam gown as we continue the show-and-tell of his practice. “The highest thread count you can buy, not that horrible paper that has your butt hanging out and makes you feel like you can see everything.” I brush my hand across the material — he’s right, it’s softer than my PJs at home. Cirigliano adjusts a switch, and the lights above my head dim. “Typical lighting in doctors’ offices is terrible. If you come in here with a migraine or you just lost a loved one, you don’t want those frickin’ lights. And this,” he says, pointing above us, “is a heating element that keeps the patient warm when it’s really cold out. It’s just a little thing, but again — it’s for patient care.”

Patient care is also why Cirigliano calls his patients on Sundays with lab results, and spends more than half an hour peppering them with questions during even a common physical. It’s why he answers texts from patients, and it’s the reason he took his staff on a trip to the service-centric Four Seasons, so they could get a feel for the consumer-driven experience he was looking to create. It’s why he insisted there be a lab at his office, so patients wouldn’t have to deal with the hassle of going elsewhere for blood work.

Thirty minutes of face time and all the plush little extras that make up the Cirigliano experience may seem frivolous at a time when our country is grappling with how to provide even basic coverage to all Americans, but Cirigliano insists it allows something to grow that rarely takes root nowadays: trust between doctor and patient.

“Look at this,” he says passionately, pointing to a painting on the exam room wall. It’s a plain, simple scene of Norman Rockwell visiting the country doctor. Rockwell’s wife sits in a chair holding their infant; Norman stands behind them. Their doctor sits quietly across from them, leaning forward in concern. “There’s love and caring between them. There’s no bullshit. There’s no Maserati in the driveway. This doesn’t look like some fancy Fifth Avenue office. It’s all about love, and that’s what this is all about. People want high-quality medical care, but they also want somebody who cares.”

Of course, not everyone approves of Cirigliano’s level of patient care. Though no one has publicly denounced his efforts, he hears rumblings from time to time from envious colleagues, and his track record for being overly cautious and prone to call for one test after another has been known to raise an eyebrow or two. Tests are pricey, and the government is hoping to curb them under the nation’s new health-care plan. “The government is interested because of cost. They’re paying for about half of health-care costs right now, and with health reform, they might have to pay up to 65 percent,” says Arthur Caplan, director of Penn’s Center for Bioethics. “In primary care, it can be good to find things early, but a lot of testing is done because doctors worry that if they miss something, they’ll get sued.”

However, to Cirigliano, being overly cautious isn’t just the ethical way to practice medicine; it’s also the most cost-efficient, since screening early often catches problems when they can be treated with something as simple as medication or a change in diet. “I won’t rest until I find it,” he says, talking about his diagnostic skills. “I’ve saved the asses of a busload of people because I just did a little extra. And I found something.”

Among the many patients Cirigliano’s obsessive-compulsive tendencies have saved is Ken Costello. Four years ago, Costello was coaching his son’s Harrison Township soccer team when he noticed it was getting harder and harder to keep up with the kids during practices. Always an athlete, he was in good shape at 45, and brushed away any fleeting concerns until he was sitting across from Cirigliano for a routine physical. An offhanded joke about his lack of energy caused the doctor to pause. Though everything else appeared fine, Costello found himself strapped up for a stress test a few days later, followed by a cardiac catheterization. The findings: An aortic aneurism — the same condition that killed John Ritter — was quietly biding its time in Costello’s chest. “If he hadn’t caught it, I wouldn’t be here today,” Costello says matter-of-factly. “I owe him my life.”

NOW THAT CIRIGLIANO IS calling the shots, the stresses are still there, but they’re the stresses of a full patient roster — he’s no longer accepting new patients (at least not officially) — and his on-camera commitments, not those of a medical system gone awry. And with the 32 million patients covered under Obama’s new health-care plan, Cirigliano hopes more PCPs find ways to make the job enjoyable again — otherwise, there won’t be anyone available to see those patients. “I think the idea could be replicated in other areas where patients come from a mixed range of incomes,” he says. But this would require doctors with the same level of passion and ability to bond with patients — something all of us with less-than-stellar PCPs wish for, but aren’t betting on anytime soon.

Of course, developing relationships and saving lives takes time. Cirigliano’s trumpet is now tucked away in a closet, and the uninterrupted hours with his-family — wife Elisabeth and two-year-old son Nicholas — are much enjoyed, but few. His unfulfilled passion for assembling radio-controlled model planes is made evident by the more than 200 boxes housed in his basement; he’s bought them on eBay, but has yet to find the time to put them together. But even on less than six hours of sleep a night, Cirigliano wouldn’t change a thing. “You have to love being a doctor for the right reasons,” he stresses. “You have to love it not only for science, but because you love the human organism. You love people. And if you love people, then it’s the neatest job in the world — even when it’s a pain in the ass.”

Source URL: http://www.phillymag.com/articles/2010/05/28/medicine-have-you-hugged-your-doctor-today/