Concierge Medicine And The Time To Listen

By

Leonard Zwelling

It has always been my belief that at some point the United States must swing toward a medical system that covers everyone. How we get there is beyond me. My guess is that someday the Democrats will have the power to push through a public option and that it will be cheaper than commercial insurance and akin to Medicare, which everyone over 65 loves. Eventually the public option will crowd out commercial insurance and we will have a single payer system. Except…

There will always be a market for those who wish to pay for their health care. Today, I put myself in that market for the first time for a host of reasons.

First and foremost, I am 71 years old. That’s more than just a little old. It’s old. What is unfortunate is that most of my doctors are my age. That means I could outlive their careers in practice. I needed a plan B. Friends recommended a concierge practice in the Rice University area. I thought for a fiscal quarter’s worth of cash payment, I’d give it a try.

Second, I was basically juggling my own care among a series of specialists. I was acting as the captain of my own health team. This is a bad idea. Someone who cares for himself has a fool for a patient, indeed. I was no longer willing to play the fool.

Finally, I felt that no one person was looking at me as a whole. That required a good internist. I used to be one of those. I’m not any more and haven’t been for a long time. At least 30 years or so. I needed someone to guide me through the latter years of my life, however many there may be, and to do so in a manner that I used to employ when I was a truly good internist. I have made some great diagnoses in my life, but none greater than the ones I have made on myself. I fear my luck caring for myself is running out.

Good decision.

My first appointment was last week and consisted of a series of blood tests and non-invasive clinical tests that are used for screening like pulmonary function tests, eye tests and an EKG. Today I met with my doctor. I had also been given a long questionnaire to fill out before I returned today. It asked for information about sleep, sex, food and exercise. All important topics. None of which any one physician had asked me about in years.

The doctor reviewed my entire history, which, unfortunately, is quite colorful from by-pass surgery, atrial ablations, hernia repairs, pulmonary emboli, and sleep apnea. Over a lifetime you accrue diagnoses. I have certainly done that. We looked at each one of them and how I was managing them now and some changes I could make. Most were simple things like drinking more liquid, sticking to the keto diet, making sure I take in enough iron, and getting the latest version of the zoster shot because the effectiveness of the previous one wears off. I also got a C on the test for color vision. That’s a function of cataracts, which I knew I had. It looks like they will have to come out sooner rather than later.

He then made sure he covered everything in a detailed review of systems. He used a checklist—just like I did as an intern. I was one of the first house officers at Duke to use such a checklist and I had to fight to allow the chief residents to let me use it. Even when I was 25, I didn’t trust my memory.

He finally did a real physical exam.

I did fine. There are things, as I said, I can improve, but on the whole, I passed. We will check in with one another in 4 months although I have ready access to him whenever I want it. That’s part of the service.

What I received today used to be called medical care. Now medical care is a 15-minute visit and “see you next time.” Many are the patients who resort to the web for lack of access to a doctor to whom they can speak. That’s what Medicare for All will be as well. There are simply too many patients and too few doctors for everyone to receive concierge care. It’s also a bit pricey, but not when compared to what you get for the premiums paid for private insurance.

I am going to guess that there will be an explosion of concierge type services with various price points. A doctor will be high, a physicians’ assistant, lower and a nurse practitioner even less. But in the end, this will all sort out and the insurance companies will eventually go away because they cost too much, keep too much, and deliver too little. There’s a market to be made, even in medicine. But, what most patients want, is someone to listen and to hear them. I am afraid that is going to come with a price.

I just began paying it and it was worth every penny!

Leonard Zwelling