When I entered the profession of being a family doctor, like many aspiring physicians, I had a more altruistic vision of what it would be like. However, the reality of that picture over the last 10-years has resulted in frustration, disappointment, and, above all, the realization that health care has changed for the worse. It has become unaffordable for the masses and institutionalized for the benefit of corporate America, not to mention a massive expansion of government involvement. Most educated people can appreciate the “spirit” of some of what is and has transpired, but there are still many ill-fated efforts afoot, and plenty of good old-fashioned greed in play.
Greed for excess upon excess is a sad statement on the human condition. I’m doubtful we’ll ever get around that entirely. That utopia will likely elude us indefinitely. However, I do believe we can make the overall process far more transparent by understanding some basic principals that are not being discussed as readily in the public forum as they should be. By understanding these issues, we can build better, more informed debate on the topic of access and costs of primary care and in the long run, produce a more professionally satisfying delivery apparatus for the docs, and a far greater experience for patients, at a fraction of the cost.
In my experience, the vast majority of family medicine physician residents entered that aspect of medicine for the purpose of taking care of and healing patients to the best of their ability. To do so effectively, requires time and access to affordable resources for the patients. Today, the institutional side of health care has taken over and “physician production” is the new name of the game. What does that mean? It means they are pressed to see as many patients in an 8-hour shift as possible. And yes, while the benefit to the doctor is that he or she gets to go home at the end of a normal day, the trade off was the meager 10-15 minutes they gave to each patient. While there are certainly common ailments that present with some patients, that can be addressed in a short, routine visit, most patients want more time to think about what they are hearing back from the doctor and ask more questions.
Granted, there are those individuals who want to get in and get out. But there are millions of patients that would like to be able to confide in their provider about other aspects of their life that may be contributing to their health state. My question is: Does 10-minutes with an individual physician, (who you may not see for a second and subsequent appointments), allow enough time for anyone to ascertain the whole person’s condition, evaluate external influencers, understand dietary and nutritional habits, drug and supplement interactions, lifestyle, etc.? The answer is, no. Doctors are becoming institutionalized, and autonomy is becoming a thing of the past. The one thing that allowed physicians time to care for patients long ago has now been replaced by production and outside influence by non-physicians.
Understand — physicians are highly trained and extremely competent. I have a lot of colleagues who have opted to work in this institutional dynamic because it works for them at that phase in their medical career. That’s not the question. The question is: Why are we as a society accepting this “new norm” and standard for the delivery of our most important asset, our health, and by extension, forcing our care providers into a reactive posture and treating patients like cattle?
Few physicians want to be told by any ethereal “system,” much less a non-physician lead bureaucracy how to manage patients, what drugs to prescribe, and how long is long enough to see a given patient, and what protocols are to be recommended. For most, this flies in the face of everything they worked for in medical school and residency regarding quality and individual patient care. Therein lies the tension: quality versus increasing pressure for quantity, so the institutional overhead can be paid for.
Doctors crave autonomy in managing their patients. Corporate medicine does not allow for that — not entirely. It’s become more of a process of moving patients through using protocol that addresses a wide range of patients generally, but not the individual specifically. Not to mention, the administrative component of each patient encounter is frankly, ridiculous and overkill. These processes are in line for the purposes of risk mitigation. Fine, but most docs will tell you, the administrative burden alone diminishes the very thing it claims to uphold – quality of care.
The beauty of simplicity and transparency:
Changing a system of health care is not for the faint of heart. However, when it is challenged and done successfully only good things come out of it. Like any good argument, it’s a purification process between competing points of view and interests. In this case, I firmly believe a deliberate refocus on a few key elements will position patients and doctors in a win-win state, and ultimately primary care becomes affordable and accessible again.
I firmly believe the path to making this work, however, involves giving the business of health care back to the ones that deliver it, and most importantly, transparency in regards to the true cost of health care. The amount of misinformation out there is astonishing.
Addressing these topics is a daunting proposition, as the corporations and the Federal overhaul and expansion have eclipsed more practical discussions and more practical solutions. But, there are reasonable alternatives to how your care is delivered. You have options that meet criteria for having health care coverage. I want to challenge you to think outside the box you’ve been sold and engage in the discussion of how we can make patient care better for all involved.
As a practice owner, not tied to any corporate or federal financial drivers or quantitative requirements, I am part of a doctor driven movement that is truly patient-centric. For starters, each of our patient encounters is one-hour in length, or less if less is needed. Regardless of the ailment, a patient is given this amount of time so that we may get to know the entire patient and as many variables as possible that may be influencing their overall health. You’d be amazed at what is revealed in the context of a conversation that is relaxed, and not rushed. This process is reminiscent of the home-visiting doctor where they could observe not just the patient, but their environment as well.
Next is available medications and labs — on site, and very inexpensive. As a doctor and business owner, we can purchase medications and lab services at wholesale prices and sell them directly to our patients. Since our business model does not rely on profit from either medications or labs, the savings are passed directly to our patients. For instance, a simple antibiotic like a Z-pak in your local pharmacy is about $20.00; our price is $2.75. A full blood panel to look at your kidney function, liver function, thyroid, cholesterol, and sugars cost $32.00 for our patients and up to several hundred dollars in other facilities.
Last and most importantly is access to your doctor 24/7 that eliminates co-pays, allows unlimited office visits, technology visits (via text, video, email etc.), and free services such as EKG’s, pulmonary function testing, urinalysis testing, pregnancy testing, strep throat, etc. We want to care for all patients, “cradle to grave as we like to say” and love pre-existing conditions. I mean that’s part of the reason you need a doctor in the first place.
Finally, on a very personal note, we are a group of doctors that have recognized that health care has lost its vision of basic, affordable and transparent health care. We have chosen to separate ourselves from seeing 30+ patients a day and allow the relationship between a doctor and a patient to be sacred and unadulterated from outside influence. We hope that through education, transparency, and good old fashion “doctoring” that we can recapture the confidence of our proud profession and give back to it rather than take away from it.
Mark Tomasulo is a family physician and can be reached at PeakMed Primary Care.