Pratice Model
We have become educated consumers in almost all fields – except healthcare. We spend exorbitant amounts for "healthcare insurance", but when we try to use the system we are frequently frustrated. We have all heard the common complaints about the current dysfunctional system: Practitioners unavailable, unreasonable waits, appointments rushed, concerns unheard, and questions unanswered. And patient outcomes are substandard – all studies show our outcomes are inferior to most other industrialized countries. If service were this bad in any other sector of the economy, consumers would have demanded a fix long ago.
But what have we purchased? Insurance: Your money goes to a profit-making corporation to pay for your care – whose self-interests are separate and different from yours. That corporation controls the care you receive through miserly fee schedules and disingenuous payment denials. Effectively doctors work for those corporations rather than patients. This perversion of loyalties frequently thwarts an effective doctor-patient relationship. Doctors are forced to spend overwhelming time and energy addressing insurance company mandates, rather than health and care.
 Payors disproportionately reward for tests, procedures and specialist services. "You get what you pay for.” Payors do not compensate physicians for adequate time to hear patients' symptoms and needs, and there is no reimbursement whatsoever for availability, prompt care, good outcomes or patient satisfaction. In the absence of time to elicit a thoughtful history, the doctor instead orders lab tests and procedures, many of which would be unnecessary if that time was initially invested. Patients and practitioners both lose. The winners are pharmaceutical companies, test facilities and specialists who treat only one body part.
Primary Care Physicians want to provide the care and service you need. But they can't give you time and still pay the bills. Our country's critical shortage of Primary Care Physicians is rapidly worsening. It seems no one is fixing the flawed foundation of our crumbling system.
One solution is radically simple: Return medicine to its roots – have the doctor work for the patient. The consumer needs to be heard, respected and given proper service. The physician needs time to pursue symptoms and concerns, perform an examination and discuss possible diagnoses and treatment plans. We need to collaborate with each other, and determine the best course for you personally. Experienced practitioners understand that a meticulous history leads to an accurate diagnoses at least 80% of the time, even before testing or treatment trials. With this time-honored approach your diagnosis and treatment are usually right the first time, producing quicker recovery, and minimizing ineffective treatment and repeat visits for the same illness. Fewer tests and procedures are necessary, reducing high-tech expenses and preventing tragic injuries sometimes caused by unnecessary procedures. When doctors themselves become a patient, this is the standard of care they expect: access, thoughtful evaluation and treatment, mutual respect and collaboration. You deserve the same quality care that the doctor expects personally. We urgently need to promote this standard of care, for the health of individuals and our society.
Only collaboration between consumers and providers can drive this urgent and fundamental change. The Patient-Centered or retainer model exemplifies this approach. Consumer and provider needs are both met more effectively at less overall cost. Patient experience with this model has been overwhelmingly positive, with evidence that overall costs are much lower. Doctors are happy to provide high-quality care at a sustainable pace. And a single-payor system could fund this for all citizens.
Bloated vested interests claim a direct relationship between patients and doctors is unethical. In fact, the current common experience is grossly unethical, when conventional practitioners see too many patients each day, keep them waiting for hours, spend only a few minutes leaving concerns unanswered, and order them to tests, procedures and consultations that are frequently unnecessary. In my opinion ethics demand that patients and physicians together collaborate in a direct relationship of mutual respect. Once voters understand our health requires this service and care, society will work out a payment system for all citizens. We must foster this opportunity to restore an effective doctor-patient relationship and salvage our health and care. |
