Direct Care is Not the End of Empathy

If you’re currently running an insurance-based fee-for-service primary care facility, and planning to switch to direct care, you should read this op/ed from the Wall Street Journal. Jerald Winakur practiced internal and geriatric medicine for 36 years and is a clinical professor of medicine at the University of Texas Health Science Center at San Antonio. His cousin Irene, a 90-year-old woman living in Queens, was recently notified that her internist was joining the concierge medicine ranks.

Winakur’s thoughts are less than enthusiastic about profit-focused decision making. But, they actually don’t contradict our own belief in Atlas MD-style of direct care. Why is that? Because concierge medicine is not the same as direct care. According to Winakur:

“What Irene learned was that her internist was converting her fee-for-service office into a ‘concierge practice.’ For a yearly retainer of $2,200 (in addition to the usual charges that would still be billed through Medicare and supplemental insurance), Irene would receive “value-added” services. These include same-day appointments, electronic access to her medical records and lab reports, shortened waiting times, and other ‘frills’ that Irene said her doctor always provided anyway.”

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Preserving Doctors Means Preserving the Patient-Doctor Relationship

David Bornstein is making a career of empowering, thought-provoking articles on the emotional state of healthcare. In his New York Times op/ed “Medicine’s Search for Meaning” he advocates that as the patient-doctor relationship vanishes, so too will the doctors. He says, “Medicine is facing a crisis, but it’s not just about money; it’s about meaning.” Adding that, “As administrative and documentation burdens have exploded in the past three decades, doctors find themselves under pressure to work as quickly as possible. Many have found that what is sacrificed is the very thing that gives meaning to the whole undertaking: the patient-doctor relationship.”

Bornstein’s piece is powerful, weighing in on the manner with which we doctors handle grief. In his opinion, med school is where the doctor burnout is first felt. Students are pushed to absurd extremes–losing sleep, and being trained to approach medicine in a distant, compassion-less manner, even reprimanded if they break down and cry in the presence of a patient. So is it okay to cry in the presence of a patient? You have to decide for yourself. However, reprimanding a student for doing so is pure Vulcan, cold. But, according to Bernstein, almost half of medical students get burned out during their education. He claims that, “medical education has been characterized as an abusive and neglectful family system.” It places unrealistic expectations on students.

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