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The Clues to Diagnosis

Chelsea Rice, for HealthLeaders Media, November 13, 2013
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This article appears in the November issue of HealthLeaders magazine.

In midtown Manhattan, Thomas Bolte, MD, an internist, comprehensivist, and medical mystery diagnostician, takes on each patient and his or her story like an intense a research project. Patients travel from around the world with medical mysteries, searching desperately for a diagnosis and treatment plan after other physicians leave them with no answers. Bolte is also available for local patients' urgent care needs seven days a week, and has a reputation for making house calls on inline skates. He answers all of his office phone calls and schedules his own appointments. He is fascinated in learning his patients' stories, and is about to finish a book on how to solve a medical mystery, which will highlight the extreme cases he's solved.

On getting to know your patients: I tune in with my patients and we bond pretty deeply. You get to know a person, the patients, their families, and that's an important part of cost containment, understanding the whole of a patient to know why they're sick. There's a saying in medicine that 90% of all diagnoses are made through a good medical history, not through the tests or even the physical exam. For me it's 99% of diagnoses.

On costs of doing business: I don't take insurance. If I did, I would totally go under. I have patients pay for time of service and then I have them file for the reimbursement. The whole structure of the insurance system irks me. Especially having a third party without a medical degree criticize your work. Even if I spent hours with a patient, insurance companies are only going to pay me for one hour because they feel that should be sufficient. For me it's not.

On accepting new patients: Patients have to write me in their own words and send it in the regular mail about what they've done to try to fix their condition, and why they think I can. The secret of it all is that if this patient is desperate enough or willing enough to write the essay, then they're on board, and I'll take them. I know they're proactive patients, and they're empowered. They're looking for my guidance and not just my knowledge.

Reprint HLR1113-12


This article appears in the November issue of HealthLeaders magazine.


Chelsea Rice is an associate editor for HealthLeaders Media.
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