Concierge Medicine, Social Justice & Sex at 100

Some of my medical colleagues who champion the cause of “social justice” bristle when they learn that I practice concierge medicine. 

They fervently believe that it is somehow more noble to practice Soviet-style medicine in America than it is to take professional responsibility for delivering excellent, individualized medical care to their patients.  One of the benefits of being sanctimonious about private doctors who practice in a capitalist model is that you can blame some of the crappy medicine you deliver on your benevolent, utopian system, which claims to be “fair” to everyone.  How convenient.  But what are the consequences of focusing on clinical algorithms, electronic medical records, and the forced “fairness” that comes down from the Politburo?

Today I saw a 99-year-old patient in my office who is on my indigent medical care program.  She pays me $5 per visit, just so that she’s got some skin in the game.  (Quiet…I don’t want my social justice critics to know that I actually see people who can’t afford to pay my concierge fees.)  This elderly woman has diabetes and has been in the ICU twice over the past year with urosepsis, on the sepsis protocol.  Last week she was taken to a local ER at a hospital where I do not practice.  She had a recurrent kidney infection, despite receiving rotating prophylactic antibiotics and intravesicular gentamycin given to her by an expert urologist.  I was never called by the ER physician, because I am merely the patient’s attending physician – a point that is irrelevant to most ER physicians, given that virtually every patient in the ER is now admitted to the “hospitalist team.” 

Instead of admitting this frail, 99-year-old diabetic for IV antibiotics and careful monitoring, the ER physician opted to treat her as an outpatient with generic Keflex.  This would not have been my approach, but I have to agree that it certainly was “cost effective.”  Fortunately, my patient survived this “UTI algorithm.”  The doctor also opted to treat her hyperkalemia with equal efficiency, giving her a single dose of oral Kayexalate, which she promptly vomited after arriving at home.  Luckily, she did not have a cardiac arrest from her hyperkalemia, especially in light of the fact that they did not bother to hold her ACE-inhibitor, which was contributing to her elevated potassium.

As my patient left the ER, the medical team dutifully handed her the ubiquitous, and always helpful, discharge instruction sheet.  This document no doubt met all hospital and governmental regulations for educating people about pyelonephritis and hyperkalemia.  Although my patient is legally blind and cannot read standard print, I’m sure she found this 4 page document very comforting.  More importantly, the purveyors of social justice can rest assured that they followed all of the guidelines set forth by the Politburo and did their duty to deliver the same level of care to everyone, regardless of income, ethnicity or social standing.   

Had my 99-year-old patient been able to read this information sheet, I’m sure she would have found it helpful to know that she should “refrain from having sexual intercourse until after all of her kidney infection symptoms had resolved.”  I don’t know about you, but there is nothing that irritates me more than seeing a non-compliant, centenarian who continues to have sex while being treated for an active pyelonephritis.  The only way to prevent these elderly nymphomaniacs from reseeding their genitourinary tracts is to put it in writing!

What we are now seeing is just the beginning of medicine by administrative committee.  If you think I am misusing the term “Politburo”, just wait until you see what happens under the Department of Health and Human Services in the name of ObamaCare.

Comments

[A concerned doc]

You unfairly skewer the emergency physician in your example. If your patient wasn't with it enough to call you about her medical problem, what makes you think she was with it enough to tell the emergency physician your name? Also, I find that very few primary care physicians are interested in being awakened at 3 am to be told Mrs. Smith is here with a UTI and will need follow up in a few days to ensure she's improving. I can count on one hand the number of primary care physicians who admit their own patients in our hospital.

I suggest you provide your patients a sheet of paper on which to list their medical conditions, meds, and allergies. At the bottom, have your name and number printed in big letters with the instructions to please call you upon the patient's arrival to the ED. Then instruct the patient and their family to always take it with them to the ED. You may find the local emergency physicians would love your assistance in working up and dispositioning your patients.

[John Blanchard MD]

The author of the previous article clearly does not understand the point of Dr. Knope's blog. If primary care doctors still worked for their patients instead of the third party bureaucracy they would take calls from the emergency room at 3am and admit their own patients to the hospital. Health care is full of physicians and hospital administrators who like James Taggart in Atlas Shrugged are only now waking up to the horror of realizing that they have to exist in the very dysfunctional health care system they helped create. If your a physician and not speaking out against whats going on then your part of the problem. If your a primary care physician who wants to be part of the solution stop accepting third party payments and work for your patients in a direct primary care model. When you start working for your patient again you will realize what you have known all along.....Quality healthcare is not derived from clinical protocols and cookie cutter medicine its derived from a relationship between the patient and their physician.