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Patient-Driven Primary Care Shouldn’t Be Labeled “Concierge”

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 »

Primary Care & The Advantage Of Continuous Communication

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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Trapped in Family Medicine Can This Marriage be Saved ACT II: The Counseling Session

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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Trapped in Family Medicine. Can This Marriage Be Saved Act I: The PCP Encounter

Last week, I introduced the key characters in the parody of family medicine which I entitled, Trapped in Family Medicine. Can This Marriage Be Saved.

As the scene opens, we see a typical day in the waiting room of a family practice: the primary care physician (PCP) is 45 minutes behind schedule. The room is packed with frustrated patients who glare accusingly at the receptionist, transferring their feelings of resentment to her for this routine and expected predicament.

Every few minutes someone storms to the front desk, demanding: “How much longer will it be before I’m seen?” … “My time is valuable.” …“I’ll send the bill for my time to PCP and see how he likes it!”…“What makes the PCP so special?”… “This wait happens every time I come and I’m not waiting anymore!”
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Trapped In Family Medicine, Can This Marriage Be Saved?

Prologue
This is not news: your primary care provider (PCP) has been listed on the endangered species list. Harvard Medical School has decided to no longer train primary care physicians – they are too quaint and old fashioned. Estimates show that for every seasoned PCP leaving primary care (which they are doing in larger numbers), it will take 1.7 PCPs to replace them due to expectations of shortened work hours and believing that life style and balance are deservedly theirs over a grinding 60+ hour work week.

Nothing PCPs do to reinvent ourselves frees us from the singular patient question on which the entire primary care patient-doctor relationship hinges: “Doc, are you still a ‘preferred provider’?”  Perhaps it’s time to reconsider the plight of the PCP and even our day-to- day health care under a “family system” lens and re-examine the relationships from the perspective of the family therapist.
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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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