Although I’m never as pessimistic as my sister is, I agree entirely with her sharp comments about the current state of medicine.
What provoked all this was a notice I received from my internist saying she was going exclusively into a “concierge practice.” Since then — only a few weeks ago — she has become my ex-internist.
I’m going to quote directly from the “concierge practice” communication I received. I’m sure my doctor did not write this. There’s a company name at the bottom. The name suggests the company specializes in “concierge-ing” medical practices, i.e., writes all these things and presents official-looking applications. I assume the company takes a percentage, i.e., sucks money out of “their” physicians’ income for this great service they’re offering to medicine.
Here’s what the “concierge practice” promises to deliver to patients for $3000 a year,* with my comments.
More than 10 years ago, we began offering a limited-membership concierge program while, at the same time, continuing to care for our traditional patients. Since then, there have been many changes in the healthcare marketplace that have placed an enormous amount of stress of Manhattan practices like ours.
“… traditional patients.” That means people who have medical insurance policies, i.e., most of the patients in the city. I guess “traditional” also means patients who are not necessarily wealthy, but nevertheless do expect good, thorough medical care from a doctor in Manhattan. (“Traditional.” What a word to use in this context!)
… “healthcare marketplace.” Here’s where rockets go up. Medicine is not a “marketplace;” Citarella, where I buy most of my fine foods, is a marketplace. I don’t consider us patients to be “medical shoppers.” This crapola is the language of Big Business, in this case insurance companies, Big Pharma and such.
Then the communication goes on to tell us “traditional” patients what New Look Medicine will be giving us:
Members in the program report high satisfaction with the level of service and attention they receive. It’s the return of old fashioned medicine…
“Old fashioned medicine…”? Wait a sec; didn’t they just call us “traditional” patients? Doesn’t that mean “old fashioned medicine”? But let’s go on…
…where it was easy to secure an appointment, and your doctor could take as much time as necessary with you.
Blinking red lights!!! Re getting an appointment: once, when I was sick with a weird throat infection, my internist saw me immediately. Because, you know, that’s what doctors do.
And I got regular appointments easily. Here’s how: as with all my physicians, I made the next appointment while I was in the office, having finished my check-up. I never viewed standing at the administrative desk with my Filofax and pen at the ready as a difficulty.
If my doctor was not taking “as much time as necessary” with me, then what the fuck was she doing? A spurious job?
No, she wasn’t. She may have been rather crisp and brusque when she saw me, but she was giving me the attention I needed. She has an assistant do the basics — weighing, measuring, temperature-taking, drawing blood — and then she came in to listen to my heart, press any body parts which needed to be pressed, and asked me important questions. She also brought me up to date with vaccines I should be getting for a full range of unpleasant possibilities, like pneumonia, shingles, flu.
First, she sat at the computer and reviewed my chart, where all the blood test results (many, many of them) were displayed for her contemplation and mine — I have easy computer access at home to my full medical chart. No secrets here. And after my visit, she’d contact me via the on-line patient chart email to give her assessment of the new bloods, whether I needed any medication.
There was time for me to ask her questions, if I had any. That’s the care I’ve always received from my physicians.
So what does the “as much time as necessary” mean, given that I had as much time as necessary?
I’m presuming it means I’m rich enough to pay $3000* a year for unlimited kvetch time. That’s the thing, though: even if I could afford it, I haven’t anything to kvetch about. I’m a low-maintenance patient because I’m well informed, trust science and only get outraged over outrageous things.
But let’s go on further with what this “concierge practice” would offer me:
Our concierge program allows us to put you first, with unhurried, comprehensive and compassionate care and the level of service and attention you deserve.
Yeah, well, the “traditional” program did all of that and did this, too:
…more time and convenience with relaxed, same-day or next-day appointments, convenient ways to reach us by cell phone or email, and enhanced care coordination with all of your other health providers. Most importantly, you will have confidence knowing the physician you know and trust is just a phone call away.
And my internist referred me to excellent specialists when I needed them.
*On Monday, when I saw my internist for the last time, we talked a bit about this “concierge” practice. She told me that patients had said she was charging too low a fee. So her annual fee for her service is soon going up from $3000 to $5000.
I told her the communications letter did not do her any service, since it suggested she had not given the care she would now be giving, at a big fee — and that my experience was the opposite. In my perception, she’d been an excellent physician.
Then, aside from continuing to pitch the value of concierge service, she said a couple of interesting things. First, she was going all concierge because she was tired of seeing 20 patients a day. I just did the calculation: that would mean seeing each patient for no more than 20 minutes. Although that may serve some patients, it certainly would be exhausting for a physician.
And she had to see 20 patients a day. It wasn’t so much Medicare or insurance reimbursements that determined the number of patients she had to see to keep her practice going; it was the medical center within which she maintained her practice. The medical center reimbursed her practice on a quantity, not quality mode.
Well, that’s not good either.
Still, it seems clear to me that concierge practice is an undoubted advantage for doctors — they’ll make more money with less hassle — while being sold as an advantage for patients.
So “concierge medicine” is merely another more expensive “advantage” plan, for which the “advantage” is not to us patients.
You know, as I wrote this, I got angrier and angrier.