Philosophy

We have become educated consumers in almost all fields -- except healthcare. We spend exorbitant amounts for "healthcare insurance", believing this will buy the care we need to keep us healthy, and heal us when we're sick. But when we try to use the healthcare system, we frequently are frustrated because our needs are not met. Our healthcare dollars are not purchasing what we need!

In the current dysfunctional system, you frequently cannot get an appointment in a timely fashion, and when you finally get to the office, you will likely spend over an hour waiting. You might see a nurse practitioner, but if you see a doctor, he rushes through the exam, then scribbles a prescription, and orders a battery of tests, and refers you to a specialist -- rather than taking a careful history of your symptoms. He rushes out of the room to see the next patient, before you have a chance to process your diagnosis and ask necessary questions. Most patients are frustrated, because it seems that no one respects you, your time, or your concerns. And all published statistics indicate the performance of our entire healthcare system is mediocre, and inferior to many other industrialized countries. If service were this bad in any other part of the economy, consumers would have demanded a fix long ago!

But what have we paid for? "Insurance", which means you've given your money to a profit-making corporation to pay for your care -- that corporation then decides what you need, and controls the healthcare available to you through fee schedules and denials of payment. Effectively, the doctor works for the insurance company, because it is the insurance company that pays him/her. These payors overshadow the doctor-patient relationship, distracting doctors from patients’ needs. They obligate doctors to spend inordinate amounts of time and energy addressing the demands of those insurance companies, ultimately reducing the time that is available for patient care.

Payor fee schedules disproportionately reward for tests, procedures and care by specialists, and pay amazingly little for the doctor supposedly coordinating your care. Physicians who spend more time and provide better service are penalized for their efforts, because it decreases the number of patients they can see each day, and the number of insurance codes they can bill. "You get what you pay for.” Payors do NOT compensate for adequate time to hear patients' symptoms and needs, and there is NO reimbursement whatsoever for availability, prompt care, good outcomes, or patient satisfaction. Since there is no time to take a thoughtful history, the doctor instead orders lab tests and procedures, many of which would be unnecessary if that careful history was taken. The only winners are the insurance companies, test facilities, and specialists.

Primary Care Physicians want to provide the health care you deserve. But they are very frustrated that they cannot give you personal attention, while still paying their bills. We love to take care of patients, but cannot tolerate the working conditions. Very few young doctors are going into primary care, and many older doctors are retiring early or taking administrative jobs. There is a drastic shortage of Primary Care Physicians, which is worsening quickly. We need to make Primary Care attractive to doctors.

One solution for this healthcare crisis is radically simple: Return medicine to its roots, and have the doctor work for the patient, rather than the insurance company. The consumer needs unrushed time with the doctor. The physician needs time to actively listen to symptoms and concerns, perform an examination, and discuss possible diagnoses and treatment plans. When you are given enough time and energy from an experienced physician, a meticulous history leads to an accurate diagnosis at least 80% of the time, even before any examination or testing. Given that time, your diagnosis and treatment are usually right the first time, producing quicker recovery, and minimizing the need for repeat visits for the same illness. Fewer tests and procedures are necessary, reducing high-tech expenses, and preventing costly injuries sometimes caused by unnecessary procedures. When doctors themselves become a patient, this is the standard of care they expect: Time, focused listening, and mutual respect. You deserve the same quality of care that the doctor expects for himself, when he is the patient. We urgently need to promote this standard of care, both for our individual healthcare, and our whole society.

Only the consumer can drive this fundamental, urgent and critically-important change in our healthcare system, by demanding this new standard. When the consumer hires the primary care physician, then the first responsibility of the doctor is to provide excellent care, at an acceptable price. Finally the needs of the patient are aligned with the needs of the physician -- time together to develop a relationship of mutual respect, in which the concerns of the patient can be heard and understood. And their needs are met more effectively and efficiently, at less cost to the healthcare system.

At the moment, there is only one experimental and controversial model of medical practice that empowers the consumer, and supports face time between patient and physician. This is the “Patient Centered” or "retainer" model. The physicians limits their practices to 300-600 patients, promise same-day appointments with little or no wait, constant access to their personal physician by cell phone and e-mail, electronic medical records, and other amenities in exchange for a retainer fee. Thus far, patient experience with this model has been overwhelmingly positive, with evidence that overall costs can be less, despite the retainer fee. And the doctors are happy that they can provide high quality care, working at a pace they can sustain.

The only naysayers are those who profit from the traditional system, or fear that the disadvantaged will be excluded. They ignore the basic need for adequate face time with the physician, and object that a retainer fee is unethical. In fact, it is grossly unethical for the traditional practitioner to see 35 patients a day, keep them waiting for 1 1/2 hours, spend 5 minutes with them and then cut them short, and order them to tests, procedures and consultations that are frequently unnecessary. Ethics demands that the physician and patient listen to each other, with mutual respect. Once people realize that they can have this quality of care, society will work out the eventual payment system. We must foster this wonderful opportunity to restore the doctor-patient relationship, and salvage our quality of care. It should not be discarded because of an experimental payment method, necessary to get the Patient Centered Care model established.

I believe it will become very clear that Patient Centered Care provides superior medical care, much more effectively and efficiently than our current system. In other words, it will better meet the needs of both patients and physicians, at less cost. And when the population comes to expect and demand a more relaxed, personal relationship with their physician, then will the voting public make this the mainstream model. This fundamental change in the delivery of healthcare will have to be driven by the consumers, patients, in concert with physicians. The current system driven by business and government has failed us.

The Future:

I plan to support lawmakers who work toward Patient Centered healthcare, with the goal of making this quality of care available to everyone, and to attract more doctors into primary care. The future reimbursement structure must reward physicians for giving each patient the time they deserve, and therefore usually "get it right the first time”. And when people see this quality care is available, and overall costs are less in the long run, they will vote with their feet, and this new system will thrive.

We need a public forum, to harvest patient experience with health-care providers, and publish information we need to empower consumer choice. Which doctors actually listen to patients, and which don't? A list of physicians who provide the quality of service that we want and deserve could take the form of a website, with questionnaires designed to measure whether the doctor actively listened to them and focused on their concerns. Other questions could address whether they receive health maintenance advice, and assess the quality of their outcomes, and the nature of the overall experience. The data would have to be evaluated and summarized by physician editors, and allow for a background incidence of unreasonable patient expectations, incurable disease and other factors. Such a website would also allow for evaluation of various treatment modalities, within both traditional medicine and alternative therapies. Consumers with specific medical problems could then find a practitioner most suited to their particular needs, as judged by outcomes of others with the same condition. Such a consumer evaluation of medical services would steer patients toward those doctors providing the best service, and toward therapies with the best outcomes. This would revolutionize the experiential evidence in evidence-based medicine, and finally focus healthcare back on the essentials: Health and Care.