After the HMO experience, Bolte longed to open a practice that was relatively free from the influence of insurance and pharmaceutical companies. Today he literally runs his own office. No secretaries. No partners. No insurance forms. (Many patients submit his invoice to their insurance companies for reimbursement.) If you call the number listed on his Web site, it rings his cell phone. “Doctor’s office,” he says. “What’s the problem you’re having?” Then, if you agree to his terms—no insurance, $125 for a 25-minute urgent care visit, $290 for a major 60-minute consult, he’ll enter your appointment into his Palm Treo. When you arrive at the office a few blocks south of Bloomingdale’s, he answers the door himself, unless he’s with a patient. It’s like this all day, all week. When it comes time to pay, he runs your debit or credit card through the machine under his desk, prints out an invoice, and asks, “Want me to staple that?”
Although unusual investigations are his specialty, urgent care cases help pay the rent. Hotel concierges near his office know to call him if an out-of-town guest takes sick. He’s the official on-call doctor for MTV Networks, and if someone there calls, he skates over to the studios on his Rollerblades with a knapsack of medical supplies strapped to his back. A number of celebrities—an Oscar-winning actress, the widow of a famous rock star—regard him as their official New York physician. But you don’t have to be famous to get him to your bedside. He’s one of the last Manhattan physicians who makes house calls. He unhesitatingly gives his number to every patient who visits, even if he knows it could later wreak havoc with his social life, dinners out with his fiancée, or an ongoing home renovation project back on the Island. “Please,” he reminded a recent flu patient who was leaving, “I’m completely at your disposal. If you get worse or it doesn’t clear up, call me at 3 a.m. I don’t care.”
He goes to such lengths to stress this because so many patients have been trained by the medical industry to behave deferentially, as if their doctors are always too busy to bother with them. Yet some of his most fascinating cases were solved precisely because he gave patients the time that their primary care physician could not.
“The first time I met him I thought he was a quack,” says Dustin Palmer, a 29-year-old sales representative. “I hate saying that because I feel I owe my life to him.” Palmer’s teens had been hell, punctuated by crippling abdominal pain and alternating bouts of diarrhea and vomiting. Doctors diagnosed him with irritable bowel syndrome. (“A lazy diagnosis,” quips Bolte.) Palmer lost so many days of school that it took him five years to graduate from college. By then, he had lost his faith in doctors and was depressed. “I couldn’t see any future for myself,” he recalls. Dragged to Bolte’s office by his mother, Palmer—then a kid with unkempt dreadlocks—rocked back in his chair and uttered profanities at Bolte, who just chuckled.
“Whaddaya laughing at?” Palmer demanded.
“I’m laughing because I know I’m going to get you well,” said Bolte.
Oh, the kid thought, you met me an hour ago and you know what’s wrong with me? Sure you do, buddy.
Bolte’s rambling interrogatory style threw the kid off. “I think he’s a genius,” says Palmer, “but kind of like an idiot savant. He sits there and he’s nonchalant, but he’s got a lot more knowledge up there than I first expected. You would not expect it.” For Bolte, the key was hearing specifically what foods Palmer had eaten prior to his attacks. Over time Bolte demonstrated that the young man was suffering from celiac disease, a genetic disorder that meant he could not digest gluten, a protein found in most grains and commercial food products. As many as 2 million Americans have the disease, which attacks the intestines, but doctors routinely misdiagnose it. Over the course of several visits, Bolte studied Palmer’s food diaries and helped him nail down which foods were most likely to trigger the painful autoimmune response.
Many of the patients Bolte sees have been misdiagnosed, overmedicated to the point of sickness, or given treatment inappropriate to their conditions
Another patient, an art gallery owner, arrived one day complaining of chronic headaches that he’d had for 40 years. His primary care physician had him on six different medications, some prescribed for migraines, others for depression, and still others for the side effects from the migraine meds. The suffering was so severe that the patient took to bed for days at a time, tracking his headaches on a calendar, hoping to divine a pattern to the pain. Some days the meds worked, some days they didn’t. But no pattern emerged. Every doctor he saw seemed to be grasping at straws: One prescribed an antifungal medication; another, allergy shots. Bizarrely, Bolte seized upon a single symptom: The man casually mentioned an intolerance to egg yolks. If true, this seemingly innocuous point could narrow his problem down to only one or two possible diagnoses, one of them being heavy metal poisoning. Sifting through the file, Bolte found a hair analysis that the desperate patient had commissioned at an alternative pharmacy: The results showed elevated levels of mercury. Yes, the patient said, he had shared that result with his original doctor, who pooh-poohed the test and told him that if he was concerned about it, he might want to reduce his fish intake. Bolte ordered a DMSA challenge test, in which a drug is taken orally that extracts heavy metals—if they exist—from tissues and excretes them in urine. The urinalysis revealed extremely high levels of mercury. The man responded well to medication and a new diet that flushed much of the dangerous toxin out of his body. Two years later, he celebrated his first headache-free month.
