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Leaving The Organization But Not The Practice Of Medicine

I confess ignorance. I know nothing about interviews with vampires. However, last week on my drive to a house call to see a sick patient, I experienced a sudden respect for author Anne Rice. I listened to a stranger completely off my radar screen being interviewed on NPR saying and making me feel the meaning of the phrase “Evil needs but one thing to grow. It is for good people to do nothing,” and reminding me that throughout history there have been numerous times where groups, organizations, and governments have acted even in ways that don’t represent our values or feel wrong minded or appear short sighted.

This statement was her simple explanation for a recent blog posting announcing she was resigning from Christianity. She remained a believer in God and in Christ, but no longer would listen to the Church tell her what to think, when and how to believe, or define truth while trying to control belief and the process.

For years and in a not too dissimilar parallel universe exists the American Health Care Church, where it too, like the Church that Rice is leaving:

  • Has brought much good, reduced suffering, restored health, made people whole again.
  • Has a group of priests, the health care professional, to tend to the masses, and infirm to work as the public face and work force of “the church.”
  • Has become a colossal bureaucracy, an industrial complex, of  (in Anne Rice’s words) “quarrelsome, hostile, disputatious and deservedly infamous” splintered voices quarreling over the largest and richest sector in the wealthiest economy of the world  and consistently doubling in price every 10 years.
  • Has a deepening divide of haves and have-nots.
  • Faces the predictable conundrum of power amongst its practitioners with the inevitable conflict: “Is the Church of Health about health or has it become obsessed by wealth?”

Anne Rice’s resignation from organized religion is a message that ripples into the parallel universe of health care, heard or not. In the corridors of primary care, for instance, its legions of doctors are abandoning and retiring from the field of primary care medicine for greener or different pastures. The message of the despair is written up by their organizations, reflected by their dwindling numbers, and observed by the next generation to not follow. The soothsayers predict extinction. Who will rescue the primary care physician?

Yet I find optimism in Ms. Rice’s position in that she refuses to abandon her beliefs and faith. Instead she will defend her personal God and faith from the very church that says they represent truth and her best interest … but doesn’t. So too should primary care physicians find optimism and resolve in defending their belief, purpose and worth even if it means resigning from those institutions that bring us under their umbrella but work to undermine the integrity of the doctor patient relationship and the sustainability of high quality primary care.

Ten years ago, I too made a similar decision as Anne Rice in regards to my profession as a family physician.  I gradually was being confronted with either changing or quitting the very job that I so dearly loved. Would I continue to do wrong to my patient and do the bidding of the rule makers (insurance and government) so that I can make a living? Would I play games inside of games gleaned from medical practice management magazines and meeting upon meeting from my colleagues?  Would I remain silent, guard the secrets and dysfunction infused through our specialty and the health care church? Would I pretend to ignore the illusion that health care is free? If I would not fight now, when, if not me, who?

I didn’t abandon the goodness of our profession, or the advances of science, or the importance of humanism and trust that is needed in a doctor patient relationship. Instead I said no to nonsense, no to secrets, no to lack of transparency and no to anyone interfering or trying to unduly influence my duty to each of my patients. It’s their health and their life and their decisions; it’s no one else’s business.

Now we answer phone calls and emails 24/7 for all our patients, eliminating 60 percent of unnecessary office visits. We see anyone that needs to be seen that day, even night and weekends. Patients control the time they need to see us. No billing surprises: you, the patient, owe for time. Talking, procedures, diagnosing, treating, researching, educating — time is time. Pay me for my time so I can stay in business and grow the idea to others and I’ll provide transparent high quality, immediate and inexpensive care. It’s much less expensive than the insurance model and provides better care. No games, no control issues. About 75 percent of our patients get continuous 24/7 access and convenient almost no wait primary care and can be anywhere, even on travel for roughly $300 a year.

Making a decision to dismiss the insurance companies and Medicare can be seen in many lights. Judging from the general silence of my medical colleagues and organizations I’d guess some see our medical practice as foolhardy even suicidal, others might misconstrue that I’m trying to get rich or am very egotistical. Even others might say I was trying to steel their agenda.  Various doctors have told me that I am a “slave” to my patients, another said, “Sounds like being a dairy farmer.”  nd in front of a national audience one doctor called me a “cherry picker” of rich patients.  But I will stand my ground. I see it like Anne Rice — that all dysfunction needs to prevail is for the good people (in this case doctors) to do nothing. Our future, our profession, our integrity is in your hands, too. Our patients remain watching and waiting.

Until next week, I remain yours in primary care,

Alan Dappen, M.D.

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