Comments on: "My primary-care physician decided to go boutique" http://www.kevinmd.com/blog/2008/11/my-primary-care-physician-decided-to-go.html medical blog Sun, 22 Nov 2009 19:59:44 -0500 http://wordpress.org/?v=2.8.4 hourly 1 By: Anonymous http://www.kevinmd.com/blog/2008/11/my-primary-care-physician-decided-to-go.html/comment-page-1#comment-88411 Anonymous Mon, 01 Dec 2008 18:41:00 +0000 http://clients.emmense.com/kevinmd/2008/11/my-primary-care-physician-decided-to-go-boutique.html#comment-88411 Sigh......for the bazillionth time. The Hippocratic Oath:<br/><br/>"......In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves....."<br/><br/>Of course I know the physicians here understand this. The Hippocratic Oath requires certain behaviors, and prohibits certain misbehaviors, in "every house" the physician enters.<br/><br/>It does not require the physician to enter "every house". The physician may choose not to enter. Sigh……for the bazillionth time. The Hippocratic Oath:

“……In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves…..”

Of course I know the physicians here understand this. The Hippocratic Oath requires certain behaviors, and prohibits certain misbehaviors, in “every house” the physician enters.

It does not require the physician to enter “every house”. The physician may choose not to enter.

]]> By: jb http://www.kevinmd.com/blog/2008/11/my-primary-care-physician-decided-to-go.html/comment-page-1#comment-88383 jb Thu, 27 Nov 2008 20:00:00 +0000 http://clients.emmense.com/kevinmd/2008/11/my-primary-care-physician-decided-to-go-boutique.html#comment-88383 Dr Mintz: "Not exactly" doesn't even come close to what we pledge to do. What we pledge to do is do our best to help each individual patient that we become associated with, either voluntarily, as part of a contract, or as part of on-call obligations. We don't "help people," we help one person, and then we help another. The collectivist assumption that underlies the "help people" concept applies only to public health physicians, epidemiologists, and other administrative physicians, not clinicians. I never pledged to ensure "equal access to all," and neither has any physician in clinical practice.<br/>When our once-proud and independent profession allowed itself to become an agent of the state, we and our patients lost a lot. No longer can we deal with each patient as an individual person with unique needs and resources. We have to fit each patient and each problem into a template so as to be able to assign appropriate codes, and do for the patient what the CPT book requires, not what our common sense, training, and experience dictates. The move to cash based practices is an attempt to get back to practice free of 3rd party interference, and we should all cheer the brave pioneers of our profession that are doing it. Believe it or not, the streets of America were not littered with the corpses of people who died for lack of "access" before Medicare and Medicaid were the law of the land. Our profession was able to provide care to just about everyone then, and we could do it today. Most of my colleagues estimate that they could do 30-50% more clinical work, and get home earlier, if they were freed of the 3rd party/govt/insurance burden. We need more steps in that direction. Dr Mintz: “Not exactly” doesn’t even come close to what we pledge to do. What we pledge to do is do our best to help each individual patient that we become associated with, either voluntarily, as part of a contract, or as part of on-call obligations. We don’t “help people,” we help one person, and then we help another. The collectivist assumption that underlies the “help people” concept applies only to public health physicians, epidemiologists, and other administrative physicians, not clinicians. I never pledged to ensure “equal access to all,” and neither has any physician in clinical practice.
When our once-proud and independent profession allowed itself to become an agent of the state, we and our patients lost a lot. No longer can we deal with each patient as an individual person with unique needs and resources. We have to fit each patient and each problem into a template so as to be able to assign appropriate codes, and do for the patient what the CPT book requires, not what our common sense, training, and experience dictates. The move to cash based practices is an attempt to get back to practice free of 3rd party interference, and we should all cheer the brave pioneers of our profession that are doing it. Believe it or not, the streets of America were not littered with the corpses of people who died for lack of “access” before Medicare and Medicaid were the law of the land. Our profession was able to provide care to just about everyone then, and we could do it today. Most of my colleagues estimate that they could do 30-50% more clinical work, and get home earlier, if they were freed of the 3rd party/govt/insurance burden. We need more steps in that direction.

]]> By: Dr. Matthew Mintz http://www.kevinmd.com/blog/2008/11/my-primary-care-physician-decided-to-go.html/comment-page-1#comment-88371 Dr. Matthew Mintz Thu, 27 Nov 2008 01:39:00 +0000 http://clients.emmense.com/kevinmd/2008/11/my-primary-care-physician-decided-to-go-boutique.html#comment-88371 "Doesn't boutique medicine go against what most doctors are pledged to do, help people while ensuring equal access for all?"<br/><br/>Not exactly. Physicians do take an oath to help people but not to provide access to all. In fact, they can not provide access to all. <br/>Think of other jobs that help people and provide access to all: teachers, fireman, police. The common theme is that they are all "socialized." Similarly, look at other professions where people train considerably and are valued for their knowledge and skill: lawyers, accountants, even plumbers. Would you expect a plubmber to come to your house and fix a leak without paying for it?<br/>Shouldn't Starbucks give out food and coffee for anyone who walks in regardless of their ability to pay? As preposterous as that might sound, you are asking the same exact thing of physicians. <br/>One of the problems has been that because physicians are generally altruistic, they have (and continue) to give away free care. However, since their reimbursement (especially in primary care) has diminished, costs have gone up, and those who are in need have increased; the ability for physicians to provide access for all is greatly diminished. <br/>As more and more physicians go to cash only and/or concierge models, we will have truly stratified health care into the "have's" and "have not's." <br/>The only solution is to provide all people with some type of insurance, and to dramatically improve compensation for cognitives services. “Doesn’t boutique medicine go against what most doctors are pledged to do, help people while ensuring equal access for all?”

Not exactly. Physicians do take an oath to help people but not to provide access to all. In fact, they can not provide access to all.
Think of other jobs that help people and provide access to all: teachers, fireman, police. The common theme is that they are all “socialized.” Similarly, look at other professions where people train considerably and are valued for their knowledge and skill: lawyers, accountants, even plumbers. Would you expect a plubmber to come to your house and fix a leak without paying for it?
Shouldn’t Starbucks give out food and coffee for anyone who walks in regardless of their ability to pay? As preposterous as that might sound, you are asking the same exact thing of physicians.
One of the problems has been that because physicians are generally altruistic, they have (and continue) to give away free care. However, since their reimbursement (especially in primary care) has diminished, costs have gone up, and those who are in need have increased; the ability for physicians to provide access for all is greatly diminished.
As more and more physicians go to cash only and/or concierge models, we will have truly stratified health care into the “have’s” and “have not’s.”
The only solution is to provide all people with some type of insurance, and to dramatically improve compensation for cognitives services.

]]> By: Philippa Kennealy MD MPH CPCC PCC http://www.kevinmd.com/blog/2008/11/my-primary-care-physician-decided-to-go.html/comment-page-1#comment-88367 Philippa Kennealy MD MPH CPCC PCC Wed, 26 Nov 2008 19:13:00 +0000 http://clients.emmense.com/kevinmd/2008/11/my-primary-care-physician-decided-to-go-boutique.html#comment-88367 As a primary care physician who left practice over 10 years ago because of my frustration and lack of joy with the adminstrivia, I wish I had been gifted with the smarts to figure out a "concierge" or retainer fee option to stay happily in practice. <br/> <br/>When you consider that most concierge fees equate to a latte and biscotti daily (see "Is Concierge Medicine too expensive?" at http://www.entrepreneurialmd.com/index/2008/10/28/is-concierge-medicine-too-expensive.html), and what people actually spend their money on, doesn't it make sense to invest a little in a relationship in which the physician loves what he or she does, has time to spend understanding you and your situation and think about what might be wrong with you, and is able to keep up to date with medical advances because he or she has time to read and learn? <br/><br/>Remember, if you expect to pay peanuts, don't be surprised if you get monkeys! As a primary care physician who left practice over 10 years ago because of my frustration and lack of joy with the adminstrivia, I wish I had been gifted with the smarts to figure out a “concierge” or retainer fee option to stay happily in practice.

When you consider that most concierge fees equate to a latte and biscotti daily (see “Is Concierge Medicine too expensive?” at http://www.entrepreneurialmd.com/index/2008/10/28/is-concierge-medicine-too-expensive.html), and what people actually spend their money on, doesn’t it make sense to invest a little in a relationship in which the physician loves what he or she does, has time to spend understanding you and your situation and think about what might be wrong with you, and is able to keep up to date with medical advances because he or she has time to read and learn?

Remember, if you expect to pay peanuts, don’t be surprised if you get monkeys!

]]> By: Anonymous http://www.kevinmd.com/blog/2008/11/my-primary-care-physician-decided-to-go.html/comment-page-1#comment-88366 Anonymous Wed, 26 Nov 2008 18:08:00 +0000 http://clients.emmense.com/kevinmd/2008/11/my-primary-care-physician-decided-to-go-boutique.html#comment-88366 Not all cash only practices have a retainer fee, "boutique" is not synonymous with cash only. <br/><br/>Cash only is becoming an important way to keep some of us in clinical medicine. If our new government overloads block that option to try to keep us trapped in a miserable specialty, then expect even more retirements and career changes from primary care docs. Not all cash only practices have a retainer fee, “boutique” is not synonymous with cash only.

Cash only is becoming an important way to keep some of us in clinical medicine. If our new government overloads block that option to try to keep us trapped in a miserable specialty, then expect even more retirements and career changes from primary care docs.

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