January 27th, 2010 by AlanDappenMD in Primary Care Wednesdays
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Health and wellness go hand in hand; there is little question of this. I therefore ask why isn’t primary care at the heart of the health and wellness movement? This, I feel, would make outstanding economic sense for all involved.
In an effort to survive these sour economic times, more and more companies are trying to stave off the escalating cost of healthcare by pushing for wellness. There is good reason for this. According to Buck Consultant’s third annual global wellness survey which was cited on the Society of Human Resources Management web site those U.S. companies who measured financial outcomes of their wellness programs reported a 43% reduction in healthcare costs or about two to five percentage points per year. Read more »
January 20th, 2010 by AlanDappenMD in Primary Care Wednesdays
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I bristle when my patient-driven, fee-for-service primary practice, DocTalker Family Medicine, gets lumped into the “concierge” movement, as it frequently does. First, veterinarians, accountants, mechanics lawyers and all other service providers in everyday life who work directly for their clients and not as “preferred providers” for the insurance companies are not labeled “concierge.” Secondly, the label “concierge” implies exclusivity, membership, high yearly retainers, and capped patient enrollment. Each of these labels we too reject.
A practice like ours out-competes the traditional model and the “concierge idea” in almost every measurable way: access, convenience, patient control, speed to treatment, quality and finally and maybe most importantly for the sake of the health care debate, price. Our boss is each patient one at a time, and our goal is to provide the most cost effective delivery model achievable. We strive for nothing less than making primary care immediate, high quality, patient controlled and affordable to every American. We deliver a concierge-level service at a price that is much less than even the price-fixing controlled by the insurance-driven model to date. Read more »
January 6th, 2010 by AlanDappenMD in Primary Care Wednesdays
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About a year ago I made a house call to an elderly widow which has left a lasting impact on me.
Our “trusting relationship” began twelve years earlier while I attended to her dying husband at home. She couldn’t find another doctor to come in to help. Now it was her turn to need help, and like her husband insisted that she stay at home. The woman was being cared for by her middle-aged granddaughter who remained her daily companion.
Both granddaughter and grandmother distrusted the health care industry and had formed many conspiracy theories. They believed in the power of healing through “the Lord” and natural remedies, especially vitamins. I admired their fierce independence while holding my tongue on the magical and, in my opinion, misinformed views of the science of medicine. Both tried, in vain, to convince me that I should use the vitamins and other products they endorsed for my patients. I smiled obligingly, yet made no move to implement these ideas while pondering the paradox and danger of being invited into the “trusting circle” of such divergent world views. Read more »
December 30th, 2009 by AlanDappenMD in Primary Care Wednesdays
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A Case Report: Even a Doctor Needs to Talk to His Doctor
I love the following battery of questions I hear from doctors and patients alike regarding telemedicine: “Don’t you think it might be dangerous to answer a patient’s medical questions by phone or email?” and “Shouldn’t you handle all issues in the office with a face-to-face visits like most other primary care physicians (PCPs)?” and then “Isn’t medical care by phone or email impersonal, shoddy, and second rate?
I however argue that everyone with these assumptions is wrong, Wrong, WRONG!
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December 16th, 2009 by AlanDappenMD in Primary Care Wednesdays
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Over the past few weeks, I’ve presented a parody of family medicine, whereby each character (Mrs. Doctor, Mr. Insurance, Patients) represent the current triad of the most dysfunctional of all American families: that of primary care practice. This week, Mrs. Doctor airs her grievances to her counselor about her evermore demanding and unreasonable spouse, Mr. Insurance).
A week after Mrs. Doctor’s visit to her PCP’s office, she sits in a waiting room, awaiting her first visit with the therapist.
Unlike the chaotic, tense reception at her primary care physician’s office, the therapist’s waiting room is everything but: it boasts relaxing designs and colors, is not crowded, and no noise save the soft bubbling from a Zen water fountain can be heard. A feeling of calm invites Mrs. Doctor to sit and reflect.
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