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The “I Get It” Moment In Direct-Pay Primary Care

After seven years, my wife has finally stopped asking me for “The Power of DocTalker” story of the day. Now when I start with the details of the latest case report justifying the model, she stops me with “I get it, I get it! Go write the case report up and post it on your website for others to ‘get it,’ too.”

Case reports center on the mission of our medical practice, with points regarding care that include quality, accessibility, convenience, affordability, empowerment, trust, and price transparency. Because our patients pay us directly for the service and don’t necessarily expect any insurance “reimbursement,” we are a very unique practice. We adhere to the points in our mission and also outperform all our local competition — i.e. medical offices that accept insurance payment for service in order to survive as a business.

To the patient, our services cost a lot less than services available via the insurance model. About 40 percent of our clientele have no insurance, and the other 60 percent have insurance yet chose to use our services because they believe it’s worth paying directly in order to assume control of their care. (As a quick aside — my favorite clients in this group are health insurance executives and CEOs of large companies, who have the best health insurance in the country.) Read more »

The Canary And The Primary Care Physician

The vexing problem with “truth” when it comes to healthcare is to understand its limits. Let’s start with two  popular notions. The first: canaries are harbingers for detecting chemical leaks. The second: primary care specialists claim higher salaries for their work will prevent their extinction. Both claims sound plausible, but then come the conditions, the nuances, the variables and empirical testing and observation — the so called threads of truth.

Notion 1, The Canaries: In 1972 my brother passed through the military’s basic training and was Vietnam bound until a perfect score on a standardized test, his Phi Beta Kappa and a chemistry degree from college rerouted his destiny to a remote patch of the Utah desert. Instead of being a foot soldier, he gave back to his country in a chemical warfare lab. Read more »

The Win-Win Referral

One of my patients is an elderly woman who is completely bedbound due to osteoarthritis. Since she’s considered “too old,” she isn’t considered a surgical candidate for a knee replacement. Her son, George, is her caregiver.

George had been referred to our practice through word-of-mouth from a geriatric care consultant. When he called me for an initial visit, his mother had a spot on her left forearm that was growing rapidly. The nodule was red and tender. Both of them wanted a doctor to look at and remove it, and at the house if possible. Read more »

Medicine Vs. Religion: My Brother’s Keeper Revisited

A few weeks back, I had introduced a patient who was willing to let her religious beliefs stand in the way of receiving the proper medical treatment she needed to stay alive. I want to revisit with you this dying patient, who hadn’t known me or any doctor for over 30 years.

As the rest of the family, who were not as committed to a religious path, stood by her expectantly, I said to her: “I had a brother who was a true believer in the power of God and that faith could heal all things or be called God’s will. Like you, he was a competent adult in charge of his decisions. He wouldn’t listen to anyone else — not his wife, father, mother, children, brother — not even me, the doctor. He died two years ago, leaving behind 10 children and a wife who depended on him. We all believe he died unnecessarily.

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Musings From A Member Of The Medical Class Of 2010

As a medical student in his last year, I can attest that my classmates and I would like nothing less than a crystal ball. Always a daunting time in a future physician’s career path, the direction we point ourselves as we launch out of medical school this year seems as arbitrary as ever.

As we examine the rolling seas of medicine and try to determine our individual paths, there seem to be more clouds than blue skies, and certainly more shadows than light. This may or may not be a feeling many prospective physicians feel, but for the class of 2010 it comes as a tough pill to swallow. In a profession at the heart of a national policy debate and with a storied history to examine, it’s extremely disconcerting to be faced with so many question marks. Read more »

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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