Fixing Patients In A Broken Healthcare System

"Status Quo, you know that is Latin for "the mess we're in."" -Ronald Reagan

As I glanced at the chart of my next patient I felt my heart sink. It was littered with warning phrases; words like progressing, recurrence, and worst of all, suspicious. Most of the time these charts are filled with unintelligible scribble recorded in a half-hearted SOAP format. A few lab results, a differential diagnosis or two, followed by the solution to the patient's ailment. However, as a medical student, you learn to develop an eye for the warning phrases. Once they begin to pop up you know that a doctor is trying to communicate that this patient’s findings are giving them a bad feeling. It seems that once you have been in the game for some time you develop a visceral reaction when you see certain patients. It transcends the lab tests, the imaging studies, even the all hallowed physical exam. There is some thy of "gut factor" experienced physicians develop, and evidently my patient had triggered a few on her way to see me.

“Do you people even care if I live or die!?” My patient blurted out as I entered the room, she looked tired, exasperated, and scared. Her question left me reeling, but only for a split second. I knew that this was one of those questions that required a swift and definite answer. You have a similar time frame when your wife or girlfriend inquires about her outfit and if it makes her look fat. Of course in that case the only response is an immediate and decisive “are you kidding, no....” Thought the implications of this encounter where much more serious. I did my best to deliver an answer dripping with as much empathy and reassurance as I could heap on, but I knew in my heart that I could not deliver the full truth to my patient.

Of course it’s ludicrous to think that any doctor would ever have total indifference toward the lives of their patients, however, we are the face of a system that, by some measure, truly does not care. This patient had recently lost her job and the “perks” of health insurance that came with it. I knew that eventually she would be able to get the care she needed but I could not have confidence in the timeliness of this remedy. This is understandably disconcerting for someone with a mass relentlessly growing (and possibley spreading) inside your body, with no regard for the timing of an overloaded clinic schedule.

The simple reality is that we work in a world of limited resources and at some point there must be people who will bear the brunt of this limitation. As it stands now the nature of selection favors those who have the means to pay for options. In some ways, this may always be the case but I do feel that we can do alot to make the system better. The political rhetoric surrounding health care at the moment is in many ways missing the boat because no matter how many people you give access to health care we still come back to this issue of limited resources. Sure you can give everyone health insurance but it won’t mean anything if it takes 5 years for an appointment to get your colonoscopy done so the doctors can rule out colon cancer. All you have done is substituted one form of selection for another.

I do not know what will become of my patient. I want to truly believe she will get all the appointments in all the free clinics that she needs in a timely manner so that she can go on and live a meaningful life. Though by the end of our visit, after calling various clinics, and coordinating lab tests that must be complete before surgery,  I have begun to develop an imperceptible feeling in the pit of my stomach. I cannot seem to shake it off as I go back into the exam room. I try my best to hide it and leave my patient with a bit of hope as we part ways.

As I go forward in my medical training I not only see the challenges of developing my own clinical skills as a doctor but I also see that future physicians will be taking over a health care system that is, at best, overburdened and, at worst, dysfunctional to the point of breaking. It is for this reason that our health care system is in need of a different type of doctor or at least a greater variety of them. Attributes like creativity, vision, outside-the-box thinking, and risk taking are likely not the ones that got you a spot in medical school or residency. However those character traits are the ones that must be cultivated in the next generation of physicians as we move forward in finding better ways to care for our patients.

Man Robs A Bank For $1 To Get Medical Care

A felony is all you need if you want affordable health insurance.

As reported by SFGate.com

James Verone calmly walked into an RBC bank in North Carolina and committed his first crime in his 59 years on this planet. Verone handed the teller a note that read "This is a bank robbery. Please only give me one dollar," took the dollar from the terrified clerk, and sat down on a couch in the bank's lobby.

"'I'll be sitting right over there in the chair waiting for the police," Verone told the bank teller. And wait he did. Police arrived moments later and apprehended him, hauling him off to the jail cell he so desperately wanted to enter.

No, James Verone isn't crazy. He isn't a career criminal. He didn't rob the bank to get drugs or booze. He didn't do it to get attention or on a lark. James Verone walked into that bank and committed a felony because going to jail was the only way he could receive the health care he needed to survive.

Why Your Stitches Cost $1500

The Unites States is one of the richest countries in the world. I guess that means we have to pay more for healthcare.

Created by Medical Billing And Coding

Interview With Dr. Steven Knope: Concierge Medicine, Medical School & Doctors Taking Control Of Their Careers

Steven Knope MD weighs in on concierge medicine, medical school, the future of healthcare, and doctors taking control of their careers.

The television show Royal Pains explores the thrills, challenges, and adventures of Dr. Hank Lawson an Emergency Room Physician who, through a simple twist of fate, became a concierge medicine doctor. Though I’m not an avid fan, I have seen a few episodes and remember thinking, “Sure it makes for great television, but nobody really does that...right?” Well I was wrong. Enter Dr. Steven Knope MD; he has become a leader and innovator in the field of concierge medicine. A quick look at Dr. Knope’s biography and you realize he is part physican, musician, athlete, and ninja. His bio includes a stint as a professional french horn player, triathlete who has completed four ironman triathlons, and a martial artist with a 3rd degree black belt in Kenpo Karate. He is a physician who has always been willing to chart his own course and follow his passion to deliver the best health care possible to his patients. I was able to catch Dr. Knope in between seeing patients and practicing Chuck Norris round-house-kicks to pick his brain a bit; here is what I learned.

How did you get started doing Concierge Medicine?

I was actually asked to start a concierge practice by 4 of my patients 11 years ago.  They wanted more of my time and more access to their physician. They liked my care, but they didn’t like having office visits limited to 10 minutes. They wanted a more personal relationship with their doctor. After they approached me with this request, my initial thought was that this type of practice model was “elitist” and “unethical." How could I limit patients access to my services to only the few who have the means to pay up front? These thoughts forced me to do a lot of reading and soul searching. I ultimately came to the conclusion that our current third-party system was in many ways unethical in it’s own right, and I decided I wanted to begin treating patients on my own terms. So, I started a pilot concierge program with just 4 patients, and it slowly grew into my present full-time practice.

What do you like best about being a concierge doctor?  

I enjoy having the time to practice good medicine and the freedom from corrupt insurance companies, HMOs and the U.S. Government in the form of Medicare.  In short, I am intensely individualistic, and I like practicing medicine on my own terms. For example, in addition to helping my patient when they are sick, all of my patients have a customized nutrition and exercise program. This type of freedom comes with a price, but I feel it is worth the price.

What does a day in the life of a Concierge Medicine Doc look like?  

Every day is different, which is why I like it. In my old practice, I used to see 30 to 40 patients every day!  It was mind-numbing. Every day was the same, and I was always running, always buried in trivial paperwork, always trying to meet my overhead – as Medicare, insurance companies and HMOs determined how much money I was allowed to make.  If you like servitude, you’ll love third-party medicine.  If you are an independent soul, you’ll need to get outside of this system.

What where some of the key lessons you learned while making the switch from a more traditional medical practice to becoming a concierge doctor?  

You have to develop entrepreneurial skills that you never were taught in medical school.  You have to learn to follow your own path and not pay attention to the crowd.  You have to question some of the group-think mentality that was taught in medical school.  As an example, I’ve publicly debated medical professors from academic centers on ObamaCare.  These people pretend to be geniuses in the field, yet they can’t, or simply refuse, to do the simple arithmetic and see that Medicare and Medicaid are going bankrupt. It really does not take a genius to realize that ObamaCare is insane.  They are ideologues, not thinkers.  Learn medicine from your professors, because this is what they know best; but don’t internalize their liberal, socialized medicine dogma without thinking long and hard about it. It is just a simple fact that many academics could not run a private medical practice if they wanted to because they simply do not understand the first thing about making a payroll, paying an overhead, or the basics of “eating what you kill."

What is the best piece of advice you would like to give to today's aspiring doctors?

Think for yourself!  Internal medicine and family practice has sadly become a bad job under the third-party system; there is just no other way to put it. It is almost no longer a profession. The word about primary care has gotten out to students, and very few young doctors are going into these areas of medicine. However, this means that there will be a shortage of primary care doctors, as the demand is continually increasing. There will be great opportunities for young doctors in these areas, provided that they are willing to go into direct practices, without the interference of third-party payers.

You have had some critics. What advice would you give to students on dealing with criticism?

Listen to the criticisms objectively, think about them, and then make your own decisions.  If you think the criticisms are baseless, ignore them.  It doesn’t matter what other people think of you.  Period! Personally, I could give a rat’s ass about what other people think of me.  I’ve written an entire chapter in my book, Concierge Medicine, on the ethical arguments on this topic.  I happily challenge any doctor to debate me on the ethics of our current third-party payer system.  The current system just doesn’t work.  It is corrupt and unethical to its core.  And if you think socialized, government-run medicine is the answer, reflect back on your experiences at any VA hospital.  Does the government provide great care to our veterans?  Not in my experience.  Big government, big business, and crony capitalism are not the answers for our broken system. These things are what broke the system in the first place.  We need to return to the days when doctors ran their own, small private practices if our goal is to provide compassionate, quality, personalized medical care to patients.

You seem to have a lot going in and out of medicine.  How do you stay at the top of your game as a doctor while still maintaining an active balanced lifestyle?

I love medicine, but there is more to life than medicine.  I’m a martial artist and an athlete.  I believe that being physically and mentally strong makes me a better doctor.  You only live once.  You want to be more than a doctor in your short time on this planet.  Be the person you want to be first; this will determine the kind of doctor that you become.

If you could recommend that every medical student read one book what would it be? (In addition to your book, of course)  

Atlas Shrugged by Ayn Rand!  Trust me on this one.  It is a long book, but it will change your life.  If you don’t have time to read it now, put it on your list and read it later.

More: Listen to an hour long interview with Dr. Knope from Medical Spa MD