Medicine: Have You Hugged Your Doctor Today?

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.