Internist's Practice Features a Unique Staff Member

JUNE 11, 2013
Ed Rabinowitz
Who’s that wandering down the hall with a piece of paper in her mouth? Oh, that’s Chloe, a hypoallergenic Maltese belonging to Ruth Rubin, MD, a board certified internist who maintains a hybrid concierge medical practice in Corte Madera, Calif. And Chloe is as much a part of the practice staff as anyone else.
 
“She has a fan club,” Rubin explains. “We get birthday cards and holiday cards for her. She received nearly as many Christmas presents as we did. Patients relate to her.”
 
And she has become an integral part of Rubin’s practice.
 
The whole person
Rubin was drawn to medicine because she wanted a career that was humanitarian, but was also based in the sciences. She found her niche in internal medicine during an orthopedic rotation in medical school. While the surgeons were busy in the operating room, Rubin had free reign to care for patients following surgical procedures.
 
“I love families, I love stories, and I love to treat the whole person,” Rubin says. “And I think that internal medicine gives people an opportunity to treat the whole person in a way that other specialties do not. The opportunity to do that was very attractive to me.”
 
It was also the driving force that prompted her to convert her practice to a hybrid concierge model five years ago.
 
“I’m an independent physician,” Rubin explains. “Insurance reimbursements and Medicare simply do not pay enough to keep independent practices open. I think that people come to independent practices because they want highly personalized care, and it’s too expensive to provide [that level of care] based off Medicare and insurance reimbursements.”
 
Rubin’s independent, hybrid concierge practice allows her to see patients according to a traditional insurance model yet still allocate additional time for concierge patients.
 
What you can do
Rubin takes a unique approach with her patients, many of whom are middle-aged and older women. According to Rubin, women in particular are very critical about their bodies, lamenting what they can’t do; but Rubin urges them to instead think of what they can do. They may not be able to run a marathon, but they can take care of a family, an aging parent or volunteer.
 
“I tell people that they’re born with perfect bodies,” Rubin says. “They can walk and hike and ski and play with their grandkids or their own children. It’s what your body can do that makes it a perfect body. I think there’s too much emphasis on what their bodies look like to them rather than all the wonderful things the body can do.”
 
As she speaks, Rubin is cognizant of people with disabilities, but she says the same advice applies.
 
“You should still focus on what your body can do, not so much on whether or not it’s the perfect size, weight or shape.”
 
Enriching life
Rubin met her spouse mid-life, and since neither of them had children, she decided that they needed a baby — a buddy, or a companion, for all the hours she spends in the office — never intending for the dog to become such an important part of her practice.
 
“I think it enriches life when we bring new life into it,” Rubin says. “And I think of that broadly, whether it’s kids, pets, plants or new recipes. Just bringing new life into our lives enriches the experience. I try to do that on as many fronts as I can. Chloe was part of that.”
 
Rubin was initially concerned that her patients might not like having a dog in the office, so she put up a sign saying that Chloe was going to become a therapy dog, even though she was only 12 weeks old. And if anybody had any objections, they should let her know. But it turned out that patients were completely enthusiastic.
 
Patients in hospice or hospitals wanted Rubin to bring Chloe whenever she visited. Rubin found that the patients wanted Chloe in the room and wouldn’t let Rubin take the dog out any time she offered.
 
“Even at work, she had her own room that was really cut off from everybody for quite a while,” Rubin recalls. “And then I realized that the patients were spending time back there, and staff were telling me that I was getting behind, and [patients] have to have their Chloe time after the appointment. So once she was potty trained and we could take her out, I took down the gate to her room, and now she just wanders around.”
 
A good citizen
All of this, of course, did not happen overnight. Chloe has passed the American Kennel Club Good Citizen Test, which mandates 12 things a dog has to be able to do in order to be considered a good citizen in public. For example, dogs learn sign language, so their master can simply put their hand in the down position and walk 30 feet away, and the dog has to remain in the seated position until summoned.
 
Chloe has also graduated from the Marin Humane Society SHARE program — a six-week course that trains dogs to volunteer in health care facilities. It’s an extensive program, says Rubin, for which dogs must audition.
 
During the program dogs learn how to navigate wheelchairs and walkers, as well as handle being surrounded by squealing children without getting skittish. They also have to walk through an auditorium, passing carts carrying food trays, without making an attempt to go after the food.
 
“The dogs in that course are like the Green Beret,” Rubin says. “They are so impressive.”
 
And Chloe, now two-and-one-half years old, is one of them.
 
“She has given so much life to our office,” Rubin says. “She has been a big stress reducer every place we go.”



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