Part of a series. A common criticism of direct primary care (DPC, membership/retainer/concierge practices) is the added expense: “Isn’t it too expensive?” Ways to think about the cost are to prioritize expenditures and to consider potential savings that make it cost effective. I gave examples of three direct primary care practices in an earlier post. Here is a recap of costs. AtlasMD’s annual fee is $600 for a young adult and ...

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Part of a series. In earlier posts, I have described direct primary care (DPC) in its various forms called membership, retainer and concierge. There are some concerns with DPC. Does more doctor-patient time really mean better quality care? Does it really mean lower total costs? It seems logical that closer care means better care, fewer referrals to specialists and fewer hospitalizations. Most DPC physicians will tell you this is the case ...

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Part of a series. Primary care need not be expensive and until the past few decades it was paid for out of pocket. Heretical perhaps, but it would be very useful to go back again to paying the PCP out of pocket directly by the patient, preferably with a tax-advantaged health savings account (HSA). A County Doctor wrote on his blog:

I can freeze a couple of warts in less than a ...

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Part of a series. Is concierge medicine for everyone or is it just for the rich, the 1%? Most people assume it is for the elite and cannot be afforded by the common man, the masses. That is unfortunate because in many cases it can be quite affordable. Here are three examples. AtlasMD in Kansas City and others like it think of themselves as “blue collar” concierge practices. According to ...

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Next in a series. The fundamental problem in health care delivery today is a highly dysfunctional payment system that leads to higher costs, lesser quality and reduced satisfaction. It also means less time between doctor and patient with the loss of “relationship medicine.” The core problem? Price controls and regulations that reduce the trust and core interactions between doctor and patient. The patient is no one’s customer and visit times ...

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Next in a series. What are some of the characteristics of healers? They listen and do so nonjudgmentally. They respond on the patient’s terms. They are humble. They are truthful. The healer communicates on the patient’s (and family’s) own terms. The healer always explains his or her reasoning. The healer tries to diminish the information gap. Despite all of medicine’s sophisticated technology and providers’ skills, the patient still needs the doctor ...

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Next in a series. Years ago while in oncology training, I was on night duty when a patient of one of my colleagues was having severe penile pain. He had received a new investigational chemotherapy and it turned out to have an unexpected property of damaging the lining of the bladder and urethra. It gave him a strong uncontrollable urge to urinate yet each time the burning was excruciating. Oral ...

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Next in a series. The art of healing is very important in medicine. There is a difference between being a modern day physician and being a healer. All societies have healers -- wise men and women, shamans, medicine men and people of other names. The “old time practitioner” was almost always a healer but many physicians today are not. It is an issue of interest, training, time and prioritization. Most ...

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Next in a series. As a patient, you have probably had the experience of meeting a physician for the first time and very quickly becoming comfortable that he or she has your very best interests utmost in mind. The sense comes quickly; you become comfortable, less anxious. Unfortunately you may have had the opposite experience of encountering a well-educated, well-trained physician who, although technically an expert, left you cold. As a ...

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Next in a series. How many patients can a primary care physician (PCP) reasonably care for? I have been interviewing PCPs: Here are some of their thoughts when asked this question.   Responses were widely divergent  ranging from about 300 to 3,000 or even more. Yet many are clearly conflicted. Some say they can manage about 2,000 with little difficulty -- but then observe elsewhere in the conversation that they have no ...

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