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.”