I dream of practicing free medicine

When I grow up, I want to practice “free medicine.”  You may be asking yourself, “What is free medicine?  Does he mean he wants to run a free clinic or give out free pills?”

Free medicine (FM) is a concept I just created in response to a comment from a reader on a recent blog post.  My reader is a brilliant doc, educator and writer who serves both as mentor and colleague.

Dr. M’s comment pointed out the fact that primary care docs are already a medical bargain.  While the world clamors over the ever rising cost of medical care, Dr. M reminded me that the cost of seeing a primary care doc is minuscule in comparison to the cost of chemotherapy, surgery or going to the emergency room.

FM is an old idea whose time has come.  FM means being able to practice medicine as it was meant to be practiced, unencumbered by governmental and insurer rules and regulations.  Yes, I dream of being able to provide the individualized care my patients both need and deserve without artificial constraints, prior authorizations, codes, etc.

FM means the ability to shelter my patients’ most private problems from the intrusion of modern day medicine’s fixation on sharing virtually everything with insurers, government workers and statisticians.  While their intent may be laudable, the information amassed in the “cloud” may be used to destroy the very health we are pledged to preserve (witness the anxiety and depression of those whose data was recently stolen from a large hospital chain).

FM opens a physician’s mind, allowing him/her to be creative in coming up with difficult to make diagnoses and treatment plans.  “Best practices” close the physicians mind, stressing compliance with established protocols.  Heed my warning: cookbook medicine, better known as evidenced based medicine, has infested my profession and stolen our freedom to think and act as highly educated professionals.

FM means being a doctor, not a provider, gatekeeper or service technician.  FM means working for you, my patient, not corporate America.  Yes, I dream of being free.  I also have nightmares.  In my nightmare, I am being sucked into a huge vortex, falling uncontrollably into the world of ACO bondage.  Finally, it’s there: the door to freedom opens.

What is cost of freedom?  What’s it worth to you?  Will you be sucked into a world where your healthcare is provided in accordance with protocols created by insurers and Medicare or will you break free?  Will I survive long enough to find my door to freedom?

My door to freedom lies in cutting the tether that binds me to the accursed computer and its EMR.  Breaking off from Medicare and insurers and starting a fee for service/cash only practice of medicine is freedom.  Once again, proudly hanging out my shingle and opening my door to all that would want to come in, all that cherish their freedom, is freedom.

Primary care accounts for a small amount of the cost of medicine in this country.  If we were free from filing insurance and Medicare claims and free from coding and accumulating meaningless reams of data, we primary care docs could  reduce our fees and do what we love best:  care for you, the patient, who places your life in our hands.

Yes, I dream of the day I am part of the free medicine movement.  The question is, will you join me?  I can’t do it unless you think freedom is worth paying for.  I cannot exit the vortex and leave all those souls I am currently responsible for to be sucked into the depths of illness without me.  I am truly torn. Captains are supposed to go down with their ship, aren’t they?

Stewart Segal is a family physician who blogs at Livewellthy.org.

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  • Deceased MD

    I have a dream. I have a dream that one day…

    Oh wrong speech. Never thought from 50 years ago that by now we ‘d have a black president but that physicians would be dreaming of their freedom.

  • Suzi Q 38

    I need a doctor that has a practice like yours.
    Problem is, I live in California.

    Keep up the good work.
    I have always said that doctors are free and have choices like the rest of us.

  • Deceased MD

    Couldn’t have said it better.

  • Tiredoc

    I think we’ll all be practicing for free next year. Does that count?

  • Michael Wasserman

    Of interest, one can actually see only Medicare patients, bill solely for face to face time spent, not worry about filling out all of the bullets, just document the time you spent and what you thought about, and make a reasonable living. You just need to spend more than 50% of each visit in education and counseling…which is what you’ll be doing if you’re not focused on bullets. If no one takes Medicare, who will care for our parents?

  • http://womanfoodshinyobjects.wordpress.com/ Brian Stephens MD

    Nice essay and well said.
    I think you are describing the new “Private practice.”

    as medicine barrels forward into inevitable mediocre government subsidized care, more and more physicians will choose the REAL private practice. The term concierge care no longer is relevant as Private practice itself now takes on a new meaning.

    the trick will be for primary doctors who are able to have a direct relationship with their patients to learn how to extend that relationship to the labs, xrays, and even their specialist colleagues to insure the same high level private health in all aspects of the patients care.

    I see Private health networks developing everywhere people can buy into not only primary care but also procedures, specialist and maybe even hospitals for ensure they have have truly “Free” medicine.