Concierge Medicine?

[MomWithOCDSon]

There was an article in the magazine section of today's paper about "Concierge Medicine." I guess the concept began out in Seattle in the 1990's, and it is starting to gain some fresh momentum in other parts of the country just now.

 

Basically, you pay a doctor a retainer (the article said it's typically about $1,000 to $2,000 per year), and they work one-on-one with you for every piece and phase of your healthcare. They maintain a significantly smaller patient load so that they can provide this more personalized care, rather than having a patient load that's so hefty it precludes their availability to that level. And they are supposed to act as advocates for you with respect to procedures and medications that are integral to your health.

 

The article told the story of a woman who had a concierge contract with her doctor; in her case, that gave her 24-7 access to this doctor, including cell phone number, direct email address, etc. She also had access to an appointment within one week of requesting one. So when she developed some stomach pain, she made an appointment for 3 days in the future. At the appointment, it was discovered that she had appendicitis, so this doctor accompanied her to the hospital, scrubbed up and attended the appendectomy, and visited her in recovery after the surgery.

 

Considering the kind of medical costs many of us spend on our kids, would something like this make sense, presuming you could find a doctor who would embrace PANS treatment, perhaps in consort with a PANs doctor? I've always wished for a doctor for DS who would be committed to seeing the whole picture, rather than wanting to stick on their side of the street only.

 

Just wondering if anyone here . . . perhaps particularly you folks out west . . . have had any experience with a concierge practice?

[dcmom]

My mom's gp now offers this. It is a group. I don't remember the specifics, but it was about 1k per year, and offered things like: access to appt with your doc quicker, a cell phone number, and I think the possibility for email communication.

 

When we read this (and this was prior to an article I did read on concierge medicine) we were not thrilled. I felt like more than half of the concierge "benefits" were something I would expect from my doc. I wondered what type of message this sent to the patients that didn't sign up- we could be dying- but were WAY down on the list. I also felt that GP's in general were fairly useless for more serious health issues, that I usually bypass them and go directly to a specialist, so I wondered why I would pay $1k per year for someone I only see for the flu or a cold.

 

Unfortunately, this does seem like a trend. I don't blame the docs- I do blame the insurance companies. I could see a program like this being useful for someone on their own, especially an elderly person- but how many seniors on a fixed income want to put out another thousand a year.

[Kiera]

I work in an ICU in an area of the country with a large senior population and this is becoming popular. Again, it is a large group of Docs, so you've always access to a Dr. I can see some benefits to it, particularly in an older person with multiple health issues. In fact, I would argue, it is the dedicated drs who actually want to practice medicine the way it should, that go for this idea but the way the system is set up now, it's like a production line, Drs don't have the time to go indepth with patients at a typical Dr visit. The extra money is the money you would pay if you went to an alternative Dr as they do hour long visits, really get to know the patient etc. The patient that came into my unit with this service was indeed on his cellphone with his Dr, and I work nightshift! So if you have a really good internist, have many health issues, have the money, I do think this is a good idea. Yes you should expect this from a Dr anyway, alas that was the way things worked in the old days but these days everything comes down to cost - therefore wait an hour, see Dr for 5mins, fill your script and off you go! As regards Pandas, we can only dream! You do kinda get this service with a DAN Dr, they look at the whole body, promote more natural remedies, but you pay for it and no cellphone or immediate access!

[MomWithOCDSon]

You do kinda get this service with a DAN Dr, they look at the whole body, promote more natural remedies, but you pay for it and no cellphone or immediate access!

 

Well, our most local DAN! 1) is no less than 4 months out on appointments and 2) states specifically that she is not your child's "primary care" doctor . . . will not do regular physicals, general sick visits (colds, flus, etc.). That's what has, up til now anyway, put me off going that particular route. If I could pay such a doc an extra $1,000 and then know that I could count on them to coordinate and oversee my DS's full range of healthcare needs, I would do it in a skinny minute!

 

DCMom, I completely agree that this is the way it "should" be, but our experience has been that it simply isn't. So the idea of entering into a contractual relationship for which I pay for a service at a certain level, and I am contractually guaranteed said service at that level . . . well, there's something very appealing about that to me. Especially if it means appointments when we need them, ready email access for exchange of concerns, questions and research, an advocate with insurance and specialists for treatments and services we need? Where do I sign up?!?!

[Kiera]

I did say DANs "Kinda" give this service! I did the DAN thing several years ago, yes everything you said is true, they're not the primary Dr etc but my point is they do look at the whole body like it's connected, try to get to the root of the problem, treat the cause not the symptoms etc, so there are some benefits to them also. But as in everything, there are good ones and bad ones, a personal referral is best. They can be an important contributer to your team of Drs, but unfortunately, very costly!

[tpotter]

I did say DANs "Kinda" give this service! I did the DAN thing several years ago, yes everything you said is true, they're not the primary Dr etc but my point is they do look at the whole body like it's connected, try to get to the root of the problem, treat the cause not the symptoms etc, so there are some benefits to them also. But as in everything, there are good ones and bad ones, a personal referral is best. They can be an important contributer to your team of Drs, but unfortunately, very costly!

 

 

Depends on the DAN dr. Ours is Family Practice, and he does do primary care (DS19 currently uses him as primary care, but dS16 has a more local doc, that takes all of his insurance.) Also, our DAN doc takes DS19's primary insurance (leaving on the co-pay for us.) I guess it really depends on the doc.

 

There is someone I've spoken to who has a concierge doc. But, I can't remember who...someone with PANS kids. So, I guess it does pay sometimes.

[JAG10]

I don't know about the whole buffet, but I would love if docs gave you an option for tele-consult credits. Maybe something like $400 buys you 90 minutes of email consultation a year. If people knew they were paying by the minute for the read and reply, it might help them develop the skill of concise communication. It is so irksome when you only need a few minutes of their time and can't get it.

[airial95]

I can see the usefulness of this for the elderly, or someone who has complex medical issues (like many of our children). I have a good friend who is a pharmacist and she always complains that her least favorite part of the job is having to tell patients that the script that specialst X prescribed shouldn't be used with the script that she's currently taking from speicalist Y. This happens mostly with her elderly patients who see multiple doctors and don't communicate well with each other. Seeing as we live in Florida, she see's that alot.

 

I could see how even a GP - though not the expert, could at least be the gatekeeper of all the records to make sure that care is being managed well and there are no conflicts with rx, etc...

 

That being said, we are very fortunate that our kids' pediatrician sort of acts in this manner already. He's responsive to email (within 24 hours if it's something requiring follow up, 48 hours otherwise), has an on-call service in the evenings (never waited more than 15 minutes for a call back). Even though he's a single doctor practice, with no other physicians supporting him, I've never had to wait for an appointment - he's even kept the office open late for my daughter when she was having an allergy attack at day care that looked bad so he could see her immediately.

 

Not to mention he's extremely PANDAS friendly, and fairly knowledgeable. He sees treating with long term abx somewhat of a no-brainer, but is hesitant on other treatments (IVIG, steroids, PEX) becuase he's not as familiar with them - but will absolutely defer to the experts and work with them willingly. He insists on having copies of ALL records from any other doctors or specialists our kids see so he always has a complete picture of what's happening.

 

So these guys do exist - they're a needle in a haystack, but they're out there without the additional costs!!

[HT's Mom]

"In fact, I would argue, it is the dedicated drs who actually want to practice medicine the way it should, that go for this idea but the way the system is set up now, it's like a production line, Drs don't have the time to go indepth with patients at a typical Dr visit. The extra money is the money you would pay if you went to an alternative Dr as they do hour long visits, really get to know the patient etc. "

 

My brother-in-law is a family doctor who is just about to go into one of these programs. He is exactly as Kiera describes, a very dedicated doctor who craves thorough and deep relationships with his patients but is forced by the current insurance situation into ten minute appointments and 80 hours a week to keep up with all the paperwork, etc. In his case, he will be the doctor in his group offering the service, and the patients who do not chose to go with him can stay in the group with other doctors. He debated for a long time, as he is guilt ridden about charging more for what he would want to (and used to) do as a matter of course, and telling patients that he has had for twenty years they can't see him anymore if they don't join. But the current situation is killing him, and he really wants to be an on-call doctor who can help a patient at any time with anything. When specialists are needed, he will have the time to communicate and coordinate with the specialist on behalf of the patient.

 

I actually wish I could use him as our local doctor (we do live in the same town), but ds refuses to see a family member for what he sees as embarrassing pandas stuff.

[bulldog24]

Where do i sign???

 

Are you sure its 1k and not 10k???

 

 

 

[BoyIowa]

I am with bulldog24 on this one. With the amount of useless doc visits we had last year that were a huge waste of time, mileage and money, $1k would have been a bargin.