Someone Who Actually Knows How to Put Patients First

Posted on July 18, 2009
Filed Under Primary Care in America, Uncategorized |

Well, as planned, DrRich was in Washington, DC, yesterday at the National Press Club, participating in the conference, “Healthcare Reform - Putting Patients First.” DrRich believes the conference was a great success, and as promised, will offer the following initial impressions. (More impressions might come later, especially if new information should come to light, such as, say, that the promised “video highlights” of the conference reveal that DrRich actually made an ass of himself.)

Before describing the experience, DrRich will quickly relate a brief summary of his five-minute opening remarks. It will be brief because readers will have heard it before. DrRich said (more or less): “Covert rationing systematically destroys the doctor-patient relationship, thus leaving patients fully marginalized and fully exposed during each of their adventures within a hostile healthcare system. And since our current battle over healthcare reform will merely determine which entity - the private insurers or the government - will get to control the covert rationing, patients will remain screwed no matter who wins. So, let’s have a nice talk about “putting patients first,” but until something fundamental changes it will just be talk.”

That was pretty much it, but DrRich added enough hems and haws and wisecracks to stretch it out to five minutes.

So, with that unpleasantness aside -

Dr. Val Jones arranged and organized this entire event with expertise and grace, including: obtaining and setting up the venue at the National Press Club; arranging for an all-star cast that included an actual congressperson; travel, accomodations, meals, and transportation; publicizing, reporting on and recording the event itself; and a myriad of other difficult mind-boggling tasks and details. DrRich has no idea what kind of living Dr. Val makes running Better Health, but after observing her pull this off he’s certain she could do very well (should she ever want a career change) as a wedding planner for the most elite and demanding among us. Thanks, Dr. Val.

That Congressman Paul Ryan showed up at all for the conference is impressive. He had been working virtually all the previous night, “marking up” the health care reform bill in committee, and leading Republicans in 50-some unsuccessful attempts to attach various amendments to the bill. (Among these was an amendment that would require Congresspersons to enroll in the public “option” health insurance that the rest of us will soon be enjoying. It was soundly defeated along party lines, Mr. Ryan reported. But DrRich suspects that if it had any real chance of passage, even the Republicans would have voted against it.) Mr. Ryan’s speech showed a deep understanding of the healthcare system, and was delivered with sufficient passion to rouse the enthusiasm of the conservatives, and the ire of the liberals in the room. DrRich was impressed with how articulate Mr. Ryan is, especially (one must say) since he is a Republican. And, DrRich could not help noticing that many of the ladies present were quite “taken” with the congressman’s charms. So all in all, Mr. Ryan might be someone worth keeping in mind, if you are a Republican who is not of the Romney, Huckabee, or Palin schools of thought.

For DrRich, the best part of the conference was the opportunity to meet all those amazing medical bloggers whose stuff DrRich has been reading for years. Being in the same room with the likes of Kevin Pho (Kevin, MD), Rob Lamberts (Musings of a Distractable Mind), Kim McAllister (Emergiblog), Evan Falchuk (Better Health) Edwin Leap, (Edwin Leap),Jim Herndon (Better Health), Kerri Morrone-Sparling (Six Until Me), Duncan Cross (Duncan Cross), Lisa Emrich (Brass and Ivory), and Mother Jones RN (Nurse Ratched’s Place) made DrRich feel like the token Pittsburgh Pirate at the all-star game (i.e., someone possibly in the stadium only because of some rule).

For DrRich, meeting Westby Fisher (Dr. Wes) was a special highlight; almost like meeting an old friend. As much as DrRich (as his regular readers surely know) likes to remain humble, he must say he was proud that he and Dr. Wes - both electrophysiologists - made up half of the “specialists panel” at the conference. Electrophysiologists are noted for being smart (if only by electrophysiologists), and the fact that the only two electrophysiologist-bloggers in the known universe were both tapped to be on this panel supports that general contention. (DrRich has a neurosurgeon friend who, wishing to express that a certain task he may be doing is really not all that difficult, and, constrained by the fact that what he’s doing is, in fact, neurosurgery, will say, “It’s not exactly electrophysiology!” I’m just saying.)

But the best part of the event for DrRich was getting to meet Alan Dappen, MD, and one of his colleagues, Valerie Tinley, NP. Both write for Better Health. Alan and colleagues have set up a primary care practice in the DC area that really does put patients first.

Dr. Dappen and his colleagues are actually doing what DrRich has been begging disgruntled primary care physicians to do for over two years now - drop out of the grid, and offer medical services to patients who pay them directly. Dr. Dappen does not have a concierge practice, nor does he have a retainer practice. His practice charges patients a fee, in 5-minute blocks, only when patients use his services. Those services can be provided in the office, over the phone, or even in their homes. If they don’t need a doctor patients pay nothing. If they need a doctor they pay only for the services they use. The fees are very reasonable. Patients who can affort to pay a plumber, an electrician, a neighbor kid to mow the lawn, a cell phone bill or a cable bill can afford to have Dr. Dappen as their primary care doctor.

And the patients who do are getting not only excellent medical care (practiced by a doctor who is happy rather than terminally frustrated), but they also get a genuine advocate, a doctor who believes in what he is doing (and is doing what he originally went to medical school to do), and who cares nothing for and owes nothing to a third-party payer. His only duty is to his patients. Here is a team of medical professionals who have done far more than just talk about putting patients first.

Please take five minutes to watch this video of Dr. Dappen’s practice:

Dr. Dappen, by the way, is every bit as genuine as he appears in this video.

There are thousands of PCPs who would jump at the chance to practice medicine like this. But most believe that Americans have been completely captured by the idea that paying doctors out of their own pockets is somehow a travesty of justice.  DrRich believes, on the other hand, that there must be a huge, pent-up demand for the kind of service Dr. Dappen provides, if only people understood that such a thing were possible.

So please tell everyone you know that such a thing is possible. And let your doctor know you would use a practice like this if he/she would set one up.

Comments

9 Responses to “Someone Who Actually Knows How to Put Patients First”

  1. Dr. Val on July 18th, 2009 9:13 pm

    What a lovely summary, Dr. Rich. It’s always good to have a fall back strategy - and since medicine might not work out for many physicians in the near future, wedding planning seems as good as any plan B. :) Of course, I’ve also been toying with the idea of joining Dr. Dappen’s practice!

  2. Robert Rodriguez on July 19th, 2009 12:20 am

    I just came across this article and find it very interesting for three reasons.

    1) It is pretty clear to anyone who has practiced medicine, or been in the business, that people who pay out-of-pocket are clearly more involved in their health care management than those who don’t. BANNING ASSIGNMENT is a great idea for the entire country and I never hear anyone talk about it.

    2) No matter how “feel good” the Dr Dappen story is if every MD drove around to see patients — we would worsen the PCP shortage. Fact is, if you have a bottleneck in an industry you need to keep that bottleneck busy. Not driving around in a car.

    3) Putting patients first is great. Avoiding lawsuits is better. Without tort reform, no matter what pricing/billing model one has, Defensive Medicine will prevail and with it the blizzard of diagnostics and procedures which suck up resources, drive up costs and yield little. Problem is — only the MD knows what is needed and it is impossible for an insurer or patient to determine this.

    4) Rationing would not be needed if reimbursement rates were raised marginally such that a PCP could improve his/her income and also use Mid-Levels to generate additional income. Fact is better money means more students becoming PCPs and PCP working more hours. The money simply sucks right now.

    5) To point 5, get rid of Stark. It is a work around anyway which further drives costs up. Let MDs earn a few bucks with other routine in-office services.

    I could go on but alas it is late …..

  3. Robert Rodriguez on July 19th, 2009 12:21 am

    Oops five. I alwasy start with three. Sorry

  4. Trusted.MD Network on July 19th, 2009 1:44 am

    Washington Wrap-Up…

    Once again, I have to thank Dr. Val Jones for setting up the Putting Patients First event at the National Press Club in Washington DC on Friday. For a full summary of the pagentry, Dr. Rich does a much better job summarizing the whole event than I eve…

  5. Lisa Emrich on July 19th, 2009 6:57 pm

    It was great to meet you Dr.Rich. Admit it, you were one of the all-stars at this meeting. Just look at how many participants promised to read your book now. ;) And so good to see you on Twitter. Welcome. Thanks for everything you do - I learn a great deal.

  6. Bob Danielson on July 29th, 2009 10:01 am

    Great video, great concept…

    Dr. Dappen is based in Vienna Virginia where the average household income is $85,000 per year.

    Would it work in my home town which clocks in at less than half that amount???

  7. DrRich on July 29th, 2009 11:17 am

    Bob,

    His services would be quite affordable to anyone who can afford to pay a cell phone bill, a cable TV bill, take a dog to a vet, or maintain a car in good working order.

    The hurdle, I’m afraid, is the general idea we’ve developed in this country that it is somehow a sin to ask any patient to pay anything out of pocket for their own healthcare. If we could get over that hurdle, practices like Dr. Dappen’s could work almost anywhere.

    Rich

  8. Bob Danielson on July 30th, 2009 8:55 am

    Rich:

    “pay a cell phone bill, a cable TV bill”

    Okay, let’s benchmark that. I pay $45 a month for cell phone, about $60 a month for cable.

    Can Dr. Dappen provide full spectrum primary care services, for elderly patients as shown in the video (some of whom no doubt have several serious degenerative diseases) for that kind of money?

    If so I would love for him to share his business model with a couple of the primary care groups I do financial and auditing work for.

    Bob

  9. DrRich on July 30th, 2009 2:59 pm

    Bob,

    I believe that for most patients the answer is yes. He charges for time, in increments of either 5 or 10 minutes, like an attorney. Patients only pay for the time they use.

    You can contact Dr. Dappen via his website: http://www.doctalker.com/page.php?id=49&name=Contact%20Us

    Rich

Leave a Reply