Welcome to “Ask Dr. Mike,” Our New Series With a Beloved Philly Doc

Meet internal medicine physician Michael Cirigliano, affectionately known as “Dr. Mike” to not only his 2,000 patients, who love his unfussy brilliance, tenacity, humor, and warmth (he’s a hugger!), but also to viewers of FOX 29’s Good Day Philadelphia, where he’s been a long-time contributor. For 32 years, he’s been on the faculty at Penn, where he trained, and he’s been named a Philadelphia magazine Top Doc every year since 2008. Starting today, he’s our in-house doc for the questions you’ve been itching (perhaps literally) to ask a medical expert who’ll answer in words you actually understand. Got a doozy for him? Ask Dr. Mike at lbrzyski@phillymag.com.

Hey, Dr. Mike! My doctor just shifted into concierge medicine — I’m not doing that — and now I have no GP to call my own. How in the world do I begin to find a new one?
Great question! I believe the most important person in your life, after yourself and your significant other, is your healthcare provider — someone who cares, is willing to take time with you, doesn’t blow off your concerns, and takes you seriously. This person is your advocate, guiding you through the shark-infested waters of healthcare. There’s an old saying, “He or she who treats themself, treats a fool.” You need to have someone you trust, who you believe has your best interest at heart, and actually gives a damn about you.

Why? Because medicine is not an algorithm. It’s a combination of love, caring, science, and being there for the person, no matter what they’ve come to you for. William Osler, one of the fathers of modern medicine, used to say, “You listen to the patient, and they will tell you the diagnosis.” That has saved me and many patients over the years, and is the framework of what doctoring — of being a healer — has been about since the beginning of time. The sacrosanct relationship between a healthcare provider and their patient is almost on the level of a priest or rabbi. This is at odds with what I was taught as a medical student — which was, “you shouldn’t be friends with your patients.” Well, too bad! The people I take care of are an extension of my family. We deal with their health as a family — that bond, that trust, is critical.

So how do I find an amazing provider like that?
Tap into your community. Word of mouth can be immensely helpful, and is one of the more legitimate ways to get information about a provider. Ask your friends, your co-workers, anyone you trust who they like or have tried … and who they’ve maybe steered away from. A lot of my referrals are patients that have mentioned their experience with me.

I’m a big fan of large teaching hospitals — that’s nothing against smaller hospitals in the community. But when you need a primary-care provider, those large health systems can provide a list of doctors who are accepting new patients or have availability right now. Also, most hospitals are now affiliated with a larger system, which is great because your primary will have access to all the subspecialists in that particular system. So you’ll have a lot of backup.

Then, just as you would with a potential spouse, you’ll want to “date” a potential practitioner a bit to see if they’re going to work out as your longterm healthcare partner.

So, wait, I should … doctor shop?
Yes! Well, I support that, at least. It’s like getting married: You want to find someone you connect with and who is right for you. Otherwise, you’re headed for divorce! If you meet with a primary but don’t click, go back to square one and start again — and do this until you connect with somebody who aligns with you. And then, give them a fair chance. It comes down to: Does this person communicate with me? Do they listen and validate my concerns? Are they willing to explore every path to getting me the care I need? Your internal radar will tell you yay or nay.

Okay, so I’ve done my homework, found a few primary docs I’d like to “date” — only to find that they’re not even accepting new patients. What’s with the shortage of available primaries?
There’s a tremendous shortage of primary care providers in this country — getting an appointment is like trying to meet the Pope! — partly because we emphasize surgical specialties because they offer more remuneration and opportunities for growth. That means we don’t have enough of a frontline “iron dome” of primary-care docs like me who are looking out for the enemy — the Grim Reaper — on behalf of patients and who will squeeze you in when you have an acute problem instead of your having to wait months to be seen. I think the field needs to entice more young people to go into primary care so we can have more advocates for patients and be that frontline.

Of all the qualities of a good doc, what’s the biggest non-negotiable?
You want your doctor to have a high level of “resolution,” which is a term I learned early on from one of my mentors, Dr. Lou Dinon, a revered Penn cardiologist and an extraordinary clinician. It’s a commitment to actually resolve the problem you go to your doctor to address. It’s a willingness, if they don’t know the answer to something regarding your health, to not “guess” at it but to reach out to other experts for consultation. That takes time and commitment — and there is no substitute for it.

Can you give me an example of what you mean?
Here’s one that comes up all the time. I’ll have a patient who I think needs a specialist. But when they call the specialist’s office, they’re given an appointment that’s four months away! I tell my patients, if that happens, call me. I swear, I spend multiple hours a day on the phone, trying to get an imaging study booked or a pre-authorization on a medication. Half of what I do is act as an advocate. No one should have to wait four months for something that’s acute and troubling.

It’s amazing that you’ll do that for your patients! Still, are there things we patients can do, ourselves, to get an appointment sooner with a specialist? Got any good workarounds?
Have you ever seen The Shawshank Redemption, the prison movie? Remember how the main character — Andy Dufresne, an inmate — forced the state penal system to finally get some books for the prison library? He sent a request to them once a week for six years — and the state finally sent the books. I tell my patients all the time: Call the specialist’s office every day! The people answering the phone won’t like it, but you know what? That’s going to get you in the door quicker — there’s always a cancellation. Also, just say your specialist is totally booked at the Center City site where you’d like to be seen. That may not be the case if the practice has other sites and you’re willing to travel a little. They may have an opening for you sooner.

You’ve been in practice for 32 years, but when you talk about medicine, you sound as enthused as a brand-new doctor. What keeps you so motivated?
I still feel honored every time someone trusts me enough to walk through my door. People talk about burnout in medicine and, yes, it’s real. But if you chose medicine for the right reasons — to heal, to care — it’s the best job in the world.

This interview has been edited for length and clarity.