Saturday, September 22, 2007

Our Family Physician

When I began this blog I thought I would be posting often on political topics. I haven't at all, as it turns out. Each time I go to write something I feel like I'm just not quite informed enough to say something intelligent. But the one topic that is really making my blood boil this election cycle is health care. We are big health-care consumers in this household, so it's something we've been able to think about quite a lot. Red Cardigan gives an excellent overview of some of the problems plaguing our modern system. To encourage Red, I thought I'd highlight one sign of hope: our family physician.

Our family doctor is, first of all, a family doctor. I certainly believe in specialized medicine and we see many specialists but for run-of-the-mill medical problems, it's much more important to the quality of care that the physician know the patient. I have never personally needed to see our family doctor, but I have taken both of my kids in on several occasions. When I do go to him for some malady, he will already have an established relationship with me

Our doctor is in solo practice and has no staff. He doesn't have any partners, any nurses, any receptionists or any billers. When we need to see this doctor we call or e-mail him, and schedule the appointment with him personally. He always knows who is waiting to see him because he makes all his appointments. I once had to wait five minutes in his waiting room but otherwise we've always gone in on time. Our entire 30- or 60-minute appointment is spent with our actual doctor. We don't answer a dozen questions from a nurse only to spend half of our precious five minutes with the doctor answering all the same questions again. Our doctor weighs babies, gives them their shots and even replaces their cloth diapers after an exam.

Our doctor does not work with any insurance companies. He provides standard "diagnosis" forms for the convenience of his patients who wish to file for reimbursement. He also encourages Health Savings Accounts. Because he does not work with insurance companies he can charge a fair hourly rate instead of an exorbitant rate that is then "negotiated" with a third-party. Our doctor does the negotiating with his patients directly. He does not refuse patients because they can't pay but will work with them to find an acceptable financial arrangement. Because he does all his own billing, he knows exactly what the visit is costing his patient. He knows, for example, that each vaccine costs $30 and that administering five in one day might be a financial burden (as well as a physical burden on the health of the baby).

There are a lot of other things we love about our doctor that have less to do with the current state of health care, but that still buck the current trends of the medical establishment. He trusts the judgment of parents: he asks parents to make informed decisions about vaccinations and he doesn't insist on endless well baby visits. He responds to e-mail and often offers simple solutions and advice this way. And, because his second-floor office does not have an elevator, he has often met me at my car and walked me back out again so he could carry one of my kids.

This is an unusual doctor. There should be more like him. If healthcare in this country become increasingly privatized, I think others will follow his model of practice. If healthcare becomes nationalized, I'm afraid this doctor might be forced to find another line of work--or radically change the way he deals with his patients.


Robyn said...

Hey Susan,

I am glad you wrote this and I am even more glad that I read it. This is so interesting.

How much is his hourly fee? Does he work with a hospital?

I sort of miss the days that I didn't need to worry about health care because my fam was covered so thoroughly. But, I guess it is nice to know that not having good healthcare does not have to do with things like laziness. So the education provided by walking down this path might be worth the worry.

Cool yo.

Hélène said...

Your doctor sounds similar to our doctor. I have never seen any other employees, but once I called and a woman answered the phone. Maybe she was his wife? When we took our second child in for a newborn checkup he told us that we should read the book How to Have a Healthy Child in Spite of Your Doctor. He even encourages not vaccinating. His fees are very reasonable as well. The only thing I don't care for is that he is a strict homeopath. I am kind of skeptical of the efficacy of homeopathy for every single ailment.

Susan said...

Our doctor is also a homeopath, but he isn't exclusive or strict about it. He is very open to alternative treatments, though. We've never had an antibiotic or other "medication" prescribed by him. He always seems to know a less-expensive and less intrusive cure. So far they've all worked!

He is affiliated with a hospital. This isn't like the unfortunate situations of midwives who have to be renegades to practice. He's fully licensed and all that--just in solo practice. His fees start at $170/hr--though after the first visit you only go for 30 minutes. You do see the doctor for every one of those thirty minutes, though. And he is always willing to adjust his fees if you can't pay the full amount (he reminds me of this every time I see him). He's also given us so much phone and e-mail help where I think other doctors would have insisted on an office visit, so he does really make sure you only pay him when it's necessary.

Susan said...

Wait--that's $140 an hour. That's better. And again, when I say "start at" that's the most you would ever pay.

Mrs Pea said...

That sounds amazing, but as poor as the health care we get locally from the NHS system in England ("free" at point of use, paid through taxation, and you need to pay something for prescriptions (about £6-7) and for dental care (about £15 for a simple exam, £65 for a filling) - I can't imagine us ever finding the money for seeing a doctor. And we'd be so humiliated to need to say we couldn't pay. Before we had the NHS, dh's grandma was a midwife and she was always paid somehow by her clients, but they'd often be in debt to someone else in order to pay her. Even so I wish we had your doctor!

Susan said...

I wonder, if there were more doctors like this, if it wouldn't seem humiliating to not be able to pay. It would be normal all around for some people to pay more than others and it would all be worked out. Maybe bartering would be more common. I don't know.