In part one of this series I gave a little background on where we are in health care in America today, and touched upon one of the ways we can at least start to repair the damaged doctor-patient relationship, and reduce health care spending at the same time: namely “concierge medicine”. I am now going to discuss the concierge model in more detail, explaining how this practice can deliver what many of us believe is better care.
In the concierge model of health care, the physician is able to reduce the total number of patients in his practice to a few hundred whereas in a traditional practice the panel size numbers are usually in the several thousands. Not only does this reduced number of total patients enable the physician to spend more (often necessary) time with the patient, but it also allows the physician to know his patient better, including the patient’s values, emotions (and how these emotions effect the patient’s reaction to illness), goals and stressors. Additionally the physician is able to spend the time to discuss wellness with the patient; issues such as diet, exercise, habits, stress-reduction, coping mechanisms and more. This in turn translates into a more trusting and effective doctor-patient relationship, enabling the physician and patient to work together, hopefully accomplishing a healthier lifestyle with less chronic illness and a reduction in healthcare expenditures. The physician is able to take direct calls, text messages and emails from his patients, and able to see his patients in a much more timely manner. This results in: 1) improved communication between physician and patient, as well as more effective care as the patient is only speaking with his physician (not one of his partners, a covering physician or PA/NP); 2) fewer need for Emergency Department and Urgent Care visits, as the physician is more available to the patient, and in knowing the patient much better, many times an Emergency Department visit can be averted; 3) fewer hospitalizations, probably related to fewer Emergency Department visits, improved attention to wellness and preventive care, as well as care being provided only by a physician who knows the patient well; 4) personalized care in that the physician both knows the patient better and has more time to spend with the patient, enabling him to not order or prescribe testing or treatments that he knows the patient either would not desire or would not be beneficial; and 5) improved end-of-life care due to the trust between patient and physician as well as more effective communication about end-of-life issues.
The result of this type of personalized care and trusting relationship is also a savings of healthcare revenue. By reducing hospitalizations, avoiding unnecessary testing, providing proactive rather than reactive care (hopefully reducing medication usage), reducing Emergency Department visits, and with the goal being a healthier population, we can hopefully reduce utilization of healthcare resources and reduce overall spending. America needs to change its concept of health care from one of a reactive system to that of a system that helps to prevent illness and promotes overall wellness and better health.
