As a physician i have struggled for years on how to bring the compassion and enthusiasm back into the practice of medicine. I have watched as my colleagues, myself, and almost all other health care associates become more frustrated with the red tape and loss of control over our professions that we worked so hard to get. We all made huge sacrifices and continue to make sacrifices to get to engage in the practice of health care, no matter what level you yourself may be engaged in.
What is the payoff? Occasionally an opportunity to really help another human being with their medical problems and improve their quality of life or minimize their suffering from disease. But all to often it is internal frustration and even grief about what the quality of life is for health care providers in today's workplace.
Was there ever really a Marcus Welby environment to practice in? In talking to my older colleagues i truly believe there was. Was it perfect? Certainly not! The vision of sitting down with a patient and calmly listening to their problems or complaints, then examining them, then returning to a consult room or office to work together on a plan to treat an illness or work up the problem sounds pretty good to me. It would certainly sound good to me if i was the patient as well.
The one place i have personally been a patient that practices following this protocol is The Mayo Clinic in Rochester, Mn. That is there protocol and they send out a wonderful summary letter to the patient and the referring physician after the consult or continuing care to keep everyone updated on the recommendations or progress of the treatment. My point is that it does still exist. The real irony here is the bills from Mayo that i receive and my insurance company receive are much lower than equivalent treatment in my own major treatment center nearby. In spite of this Mayo Clinic is rated number one in many categories of medicine across the US.
What is their secret? Maybe they have endowment funds that other facilities don't that allow them to practice that way. But i know if you read about the founders of the Mayo Clinic they were primary care doctors who never wanted to compromise this caring empathetic bond with the patients they served and have never fallen short of this goal.
My point here is not to give kudos to Mayo Clinic alone as there are other treatment centers that are just as compassionate, i am sure, i just don't have personal experience with them.
How did things get so bad? It all started with the Medicare act in 1964 unfortunately. As soon as patients were no longer responsible for their bills and a government entity took over setting prices and imposing regulations it has gradually come down to where we are today. In the mid 1980'3 the DRG's started to curb run away hospital and doctor costs by limiting what Medicare would pay for a given diagnosis or procedure to a hospital. This is when all the other insurance companies started tying their reimbursement rates to a percentage of what medicare would pay. So as medicare payed less and restricted assess to certain procedures so do the insurance companies.
Then along came HMO'S to save money and make primary care doctors the gatekeepers of health care to protect their patients rights. The problem is they dictated to us what was medically necessary and what was not and also what they would pay for these services. The other major twist was that they didn't tell primary care doctors that they were NOT going to be paid for this added level of responsibility. In effect it put another wedge between the patient and the doctor. It made us look like the bad guy by requiring us to give them a referral to see a specialist and many times telling them they could not see the doctor they had seen for 10 years because he wasn't on their preferred provider list.
Little did they know that the preferred provider list had nothing to do with the quality of the care they gave, just the price they were willing to do a service for and bill the HMO accordingly.
The bottom line is this. We cannot look to government to fix whats wrong with medicine today. One of the simplest solutions is for the patient to take back control of how they spend their health care dollars in the free marketplace. One of the presidential candidates running for the Republican nomination has always been an advocate for this structure in health care insurance as I have for over 10 years. Its called a medical savings accounts where your employer or the government puts money into an account tax free for you to spend on whatever health care you decide to. If you didn't spend much money on health care for a few years the balances carry over year to year so you could end up with a larger account later when you might need the extra money.
You would need a policy to provide catastrophic coverage in the event you were ill with an injury or costly illness but it would put the free capitalistic market back to work in health care and take it out of the hands of the insurance companies and the federal government.
If you found a doctor that treated you like Marcus Welby and took exceptional care of you you would be willing to spend a little extra money for that i bet. This is no different than where you choose to shop for groceries or have your car worked on. If they consistently do a good job and are fair and honest and charge a fair price you will likely go back to them again.
Why do we think our medical care should be free or almost free? It is by far the most important thing you will ever spend your money on. Shouldn't you be willing to except that it is going to cost more than it has the last 10 years but have the quality improve 100%!! I dont know about you but the next time i need to go to the dr i dont wanr him/her to be rushed and to sit down and really talk with me and 'LISTEN' to what i have to say. Then explain what my treatment plan should be or what the next step might be and then make that descion together as a team.
Joke for today: Doctor Doctor I keep thinking i am a $10 bill!
( Thats ok go shopping the change will do you good!)
2 comments:
Primary care solutions to a complex medical system won't come from HSA types of reimbursement. HSA plans still use large commercial insurers as administrators to set doctor payments at arbitrarily low prices. They also direct enrolled patients to their in network providers/doctors.
Insurers and government payers still have a stranglehold on their doctor networks, and make it almost guaranteed financial suicide for a doctor not to contract with them, or for a patient to get reimbursed if they choose an out of network provider.
Retainer fee based primary care that is independent of insurance billing and discounted in network payment rates is the only currently feasible way to achieve high quality care for patient and doctor, especially those with multiple or more complex needs.
Unfortunately, this is only viable for doctors, and available for patients in wealthier communities at present.
Winslow Murdoch, M.D. Family Medicine Retainer Fee Doctor Philadelphia PA suburbs
What the kind Dr Murdoch does'nt understand is that the whole point of HSA is to break the tie with insurance companies as administrators for these accounts. This is a cash transaction, there is not set fee. It is based on the free marketplace. It will allow doctors to be paid on the spot like your local gas station instead of waiting up to 6 months as paper is shuffled back and forth to finalize a payment amount. WE are all not as fortunate as he is to practice in an area that can afford pay the yearly stipend of a concierge dr. I wish we could all practice that way. The problem would be solved very quickly.
Doctors will be able to charge whatever they want just like any other business. if its competitive and fair they will do well especially if their service is great and the care superb. If they charge too much for too little their business will suffer and they may find themselves out of business.
The uninsured patient will no longer be penalized by the fact that the dr must charge everyone the same or medicare will threaten to lower their reimbursement to that price. Where else in the modern day business world can a business not discount their products or services to increase traffic at certain times of the year.
It is ludicrius that physicians must try to run a business on these faulty and distorted market based principles. Is it any wonder that 87% of primary care doctors are now employed pyhsicians? Do you know what they gave up for the security of recieving a regular paycheck each month??? Their autonomy and many times their intergrity as they now have to practice under the guidelines and rules of the boss who may not have the patients best interest at heart.
Its time to step out of the box and take a stand and a risk or be swallowed into the abyss that is soon to follow with Obamacare. IMHO.
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