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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