28/10/2019
As I have talked to potential new patients I've found myself repeating a few thoughts about the concierge practice-- here are some of them:
1. I think medical care SHOULD be a right (like education) and not a privilege-- thus, on a global level, I'm sorry that social pressures have accumulated that make me be able to exist. As an individual, I'm very grateful that I'm getting to practice medicine this way because it's so GREAT for me, and I hope, the patients. I also want medicine to change and feel that the retainer strategy is a small rebellion-- I'm not going to do it the same broken way we've evolved to.
2. Most medical practices exist on a productivity business model (AKA factory medicine)-- you have to see X many patients in a day to pay all the bills. The concierge practice-- the way I think about it/ do it is totally different-- the money aspect is neutralized. It's not on my radar. You can come in as much or as little as you want/ need. No bills. It's so freeing! You pay once a year.
3. Somewhere along the line, medicine totally forgot that really, it is a customer service profession-- typically everything is the office or hospital's way (there are a few exceptions) without much concern for patient needs/ preferences.
3.a. I think that's partly because of social/ professional expectations that doctors are always right/ smart/ you shouldn't "talk back to them"-- i.e. doctors created this phenomenon/ it evolved from respect for doctors.
3.b. when you're running a factory, you have to create rules/ tactics-- "we always get a urine sample at every appointment", "if you're 10 minutes late we have to reschedule you", etc...
4. There's so much medical science doesn't know. The factory model has made visits so short that there's no space to discuss options-- see also 3.a. so generally discussion is eliminated-- this is so unfortunate! In the retainer practice there's room to consider several strategies, AND, reconnect to make sure that the first plan is working OK.
4.a. I LOVE patient's with internet information! Since when is more knowledge bad?? Not in my world! Plus I love referral center higher level care-- sometimes a real authority on a subject is needed!
5. It's crazy that such an expensive service doesn't tell consumers what the service will cost! (my form of retainer practice doesn't have this problem-- you pay only once a year, no other bills).
6. Insurance companies-- a complex web to earn the most amount of money and keep it for themselves-- good luck figuring out what they cover-- that'll be 4 hours on the phone please, and even then, they won't tell you what the final price will be. They tell doctors what they pay-- Doctors do not get to tell insurance companies what payment they require.
7. All doctors are not the same, nor are all NP, PA. Doctors come in all shapes of intelligence, compassion, knowledge and motivators. Those pieces are very difficult to figure out until the middle of the night during an emergency when everyone's tired. We all have biases. I think the factory model depersonalizes medicine for all involved.
8. more medicine is not always better (pills/ treatments).
There-- maybe more to follow-- that's my editorial philosophical rant. For what it's worth, I regularly read the big journals, go to all three cottage hospitals, and I try to be PRESENT while with patients. I feel my care needs to spring from love and compassion.
Please help me and give feedback to this pretty candid post-- if it's too much-- please let me know!
