CVA – The Art of Collaboration by DAVID DAGEFORDE, MD
In April 1978, I interviewed with Cardiovascular Associates( CVA) and briefly met eight physicians. Having completed a residency in internal medicine at Baylor College of Medicine and a cardiology fellowship with Proctor Harvey at Georgetown, I was confident I was well-trained in the academics of cardiology. However, these eight physicians would teach me the art of medicine when I joined the group. They influenced my clinical practice and my personal life through their friendships.
During my interview, Dr. Ralph Denham, managing partner, asked me to examine five patients. Obviously, he chose them to see if I could diagnose each patient by physical exam. The examinations included mitral stenosis, coronary artery fistula, pulmonary insufficiency, a mitral valve prolapse click without a murmur and the toughest case of all, a normal patient with no abnormal cardiac findings. I was able to diagnose the first four patients without difficulty. But I took forever on the fifth patient, convinced I was missing something. Finally, I said,“ Dr. Denham, I do not hear any abnormal heart sounds or murmurs on the last patient.” To which he answered,“ You were not supposed to.”
“ Young man, we are glad you are joining our group,” Dr. Denham told me as he shook my hand during the November 1978 American Heart Association meeting in Washington, D. C. That handshake was my“ contract” with the group. There were no details about my specific duties other than I would be performing cardiac catheterization. While a handshake“ formal” agreement may seem short-sided or foolish, the man who extended his hand was known for his integrity, honesty and moral compass. Six months later, Emily and I flew to Louisville to purchase a house. The handshake was still in effect, but the details including salary, benefits, vacation schedule and most important of all, the call schedule, were specified. Dr. Denham’ s integrity was confirmed with no surprises in the contract.
On my first day of practice, I was told to round and learn the routines of each physician during my first three months. Quickly, I learned eight different approaches to build the patient-physician relationship. Specifically, I learned from Drs. Robert Goodin and Richard Allen that we would deliver continuity of care yet not assign specific hospital patients to be seen by specific doctors. They trusted me from the first day to implement the patient care plan by reading the note from the previous day and continuing, modifying or completely changing the plan based on whatever was best for the patient. No egos were involved if you changed treatment plans because the goal was the same – provide exceptional patient care.
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