Thursday, May 16, 2013

In Which I Respond To A Faithful Reader

Below find excerpts of an email sent by a faithful reader.  I have included the whole text, but broken it down to respond to each point accordingly.

I have really enjoyed your blog postings and the sensitivity you showed toward patients. But, your new venture is a real turn off, and makes it hard for me to want to read your posts anymore.

I have been waiting for this.  Expecting it.  I knew that when I changed my practice model there would be anger and disappointment.  For this reason, I have gone to the trouble of telling each patient face to face in the office when they come in for an appointment. 

This has been my decision.  I will own up to it.  I won't hide behind a formal letter or slink out of the room.  If patients are upset, I will soak in the anger and accept it.  I owe that much.

So far I have received mostly understanding with a smattering of joy and disappointment.  My patients know me very well, they don't believe I mean them harm.

My dear reader, sometimes you have to look eye to eye to see into some one's soul.  A blog, unfortunately, does not allow for that.

As a patient (not yours), it seems like you are abandoning patients who do not have the money to pay your new fees for which you will take no insurance. Instead of staying in the trenches and finding the insurance battle with them, you seem to be washing your hands of it and leaving them on their own. Onward to people with disposable incomes to pay for handholding.

On the contrary, I'm still taking insurance.  For fifty percent of my practice: nursing home, hospice, and palliative care there will be no extra charge.   These are some of the most difficult and high risk patients.  I will continue to stay in the trenches and battle for them.

I am changing, however, my outpatient primary care practice.  I will charge a yearly fee along with billing insurance.  The yearly fee pays for uncovered services like home care, cell phone access, and prolonged visits.  I believe this is a fair trade off.

My perception may well be wrong. Perhaps I did not listen carefully enough to your explanations. I want to believe that you are who you appeared to be, a great, caring physician. But, I thought that you might like to know that at least one of your loyal blog followers doubts that now. Take care.

I would like to think that I am still perceived as a great, caring physician.  I would also hope to be viewed as a strong patient advocate.  But the problem is, I can't protect my patients from the ridiculous, pervasive stupidity of medicare and our modern day insurance Goliath.

I can keep bending, and giving, and finding ways to work around the vicious beast.  Or, I can choose to step out of the lion's den.  I will not be an enabler of this broken system. 

Change will only come when doctors and patients alike are willing to stand up and say enough is enough. 

I am in the unique position to do just that.


Diane said...

Years ago, I sat on a board for Gifted services for my daughters school district. They had few to no services. The Director explained it would take 5-8 years to implement services. I opted to pull my daughter. I was accused of not being supportive.

Should I have sacrificed my child's education for the others? How would that have helped? Would it not be as beneficial for me to first properly educate my child and then also volunteer my time to make changes for the whole? To show that when a system is not working you do not have to participate, you always have a choice- you can follow or you can lead.

I don't always agree with your point of view- however, I have never doubted your determination to practice, real, quality medicine.

To continue to participate in a system setup to provide less then adequate care to patients that you know are not getting the care they deserve, is not fixing the issue. Patients pay more, Drs. get paid less and the quality of care is dropping by the day.

What you have chosen to do is stick your neck out, risk your reputation to PROVE that medicine can be provided for fair prices. That good medicine is easier to provide without multiple layers of middle men . You are saying your patients deserve better and have found a way to provide that..

I respect you immensely because you are opting to "walk the talk" at great personal risk.

Very few Drs. are that brave and I hope the example you set is followed by many. As long as Drs. only talk but not walk nothing will change.

Anonymous said...

I think, what people forget most is that we (providers) have professional wants and needs as well as personal ones, such as supporting our own family and thinking of that future as priority.

We can decide to stay in medicine or open up a deli if we choose - just like anybody else.


Unknown said...

Staying in a system that is broken and destroying your soul is not right. I choose not to do so because my husband is uninsurable, otherwise I'd be standing shoulder-to-shoulder with you. I went into medicine to give the best care I can, and in today's system that is truly impossible. Bully for you! The Direct Primary Care model can work for poorer populations as well, but not until it becomes an accepted model for care. We need more doctors standing up and saying "I'm mad as hell and I'm not taking this anymore".

Anonymous said...

Patients have absolutely NO idea how the phone calls and longer visits just suck you dry emotionally and financially. They want return phone call consults on labs and scans so they don't have to leave work and come in..but they have no idea that's 10-20 minutes (the scanning the labs, reviewing the original complaint, tracking down the patient, explaining the results in their terms and coming up with a follow up plan) that is *completely* unreimbursed for your office staff and your time. Have no shame in what you are doing.