A Better Kind of Health Care
Certainly the quality and cost of direct care medicine is far superior to that of the insurance model, especially for anyone who finances their own medical care. But what about the efficiency?
Let’s consider the standard insurance medical model. When practicing in this model, I typically saw 20-30 patients/day. I recently spoke to a close friend practicing in California who sees 30-40 patients/day, sometimes more than 50. For initial visits I would be fortunate to receive 30 minutes with the patient, 10-15 minutes for follow-ups. These time restrictions were necessary to cover the excess overhead, allow time from laborious documentation mandates and still earn a fair income. So, for new patients I had 30 minutes to meet the patient, review medical history, review labs/tests/imaging, perform physical exam, create a list of differential diagnosis and finally create a treatment plan for the patient. This left very little time to actually get to know the patient and even less time to have a discussion about the diagnosis and treatment options. Routinely I just told the patient what they needed to do before their next appointment, oftentimes without an explanation as to why, as time was prohibitive.
For follow-up patients we spend the first 5-10 minutes reviewing implemented treatments and how the condition has progressed, leaving 5-10 minutes to perform physical exam, determine current state of condition and then create a treatment plan moving forward. Again, this left very little if any time to actually have a discussion about all of the treatment options or explain why we were doing what we were doing. Unfortunately this often results in the patient being a passive bystander in the creation of their own care plan, just simply being told what is going to happen as opposed to being part of the informed decision making process. Unavoidably this frequently resulted in extremely fragmented and frustrating care for both the patient and physician alike.
The insurance medical system is extremely inefficient like this, not to mention exhausting. Ultimately the patient gets stuck in a vicious cycle of follow-up appointments every 2-4 weeks, sometimes making little to no improvement and growing increasingly more frustrated because there is no time for education, discussion or continuity of care.
Now let’s look at the direct care model.
I routinely spend 45-60 minutes with initial patients who require no labs/imaging, 60-90 minutes with more complex initial patient visits or anyone needing imaging, sometimes up to 120 minutes. This allows for an extremely thorough consultation during which I can truly get to know the patient and include them in the decision making process. I’m able to determine all possible variables contributing to the symptoms, THOUGHTFULLY review images/labs in great detail WITH MY PATIENT, perform a THOROUGH PHYSICAL EXAM, have an IN DEPTH CONVERSATION about the diagnosis and then subsequently spend ample time DISCUSSING ALL TREATMENT OPTIONS. By the end of the consultation not only does the patient know exactly what their diagnosis is and why they are experiencing their symptoms, but they also understand ALL the treatment options and have assisted in creating the best treatment plan which is most appropriate for themselves. Ultimately this facilitates a more accurate diagnosis, more thorough understanding on the patients behalf, a more custom/appropriate treatment plan, a more efficient recovery and subsequently less follow-up visits.
When making follow-up calls a few days later most of my patients are well improved and never require a follow-up appointment, as they have all the information they need to achieve full recovery. It’s a win-win for the patient and myself alike. Not only is the care more efficient and enjoyable, but it comes at a fraction of the cost. It’s the future of medicine.