Dr. McDream On
by Harley

I got this letter from my doctor recently. Not a “please call re your Pap smear” letter. Less sinister. More puzzling.

Dr. Welby, as I shall call him, told me what a valued patient I am, how crazy he is about me, and how he’s eager to fill me in on the exciting changes in his life. (He’s going bald? Leaving his wife?) He then invited me to a meeting on a Tuesday night to find out all about it.

Call me crazy, but an 8 pm rendezvous with my doctor does not sound like a raucously good time. Not that I don’t love Dr. Welby (he cured my pneumonia) but I have a book deadline. I chucked the letter.

Then came the phone messages. Eager voices assuring me that I’d DEFINITELY want to be in on the Big Changes going on in Dr. Welby’s life (short-listed for Surgeon General? Nominated for an Oscar?) and to PLEASE call the toll-free number.

So I called. More ad-copy spiel about Dr. Welby’s fabulous future. Then: “Did you know Dr. Welby has 2000 patients? And wants to cut back to 600?”

“How much?” I asked.

“Excuse me?”

“How much will it cost me to be one of the six hundred?”

“There’s an $1800 annual fee, but you’ll be guaranteed next-day appointments—”

“Thanks, can’t afford it, bye.”

See, I’ve been down this road before. That’s how I found Dr. Welby—my previous physician, Dr. Kildare, had “gone boutique.” Or “concierge.” His annual fee was higher, but that’s because he’s younger, cuter, practices in Malibu, and offers mood music, aromatherapy, and designer chairs in his office. If money were no object, I’d still be with Dr. Kildare. But when I go to a boutique, I want to come home with new shoes. And to me, a concierge is someone who gets you tickets to “Blond Bond: The Musical,” not someone who hands you a plastic cup and asks you to pee in it.

Don’t get me wrong: Dr. Kildare and Dr. Welby are smart, dedicated, and empathetic. Great guys, the kind you’d want at your deathbed, or delivering The Worst News You Ever Got. They’re People Persons, working in a system that says they can spend 12.5 minutes with each patient, regardless of her/his problems. They have to run ragged, talk fast, placate sick folks who’ve been waiting an hour+, and, in Dr. Kildare’s case, still pay off medical school bills. They’re not demanding their inalienable right to a third vacation home or 18 holes of golf every Friday, they just want to earn a nice living and give their patients humane care.

And that being the case, despite the sales pitch that sounds like he’s selling time-shares, I might’ve paid up if Dr. Welby’s next big announcement weren’t going to be, “I’m retiring.” Instead, I’m doctor shopping now, while I’m healthy and (relatively) young and can live with “Tell me your symptoms, make it quick, no adjectives or adverbs. Go.”

But my bigger question: is physician-on-retainer the Next Big Status Symbol? Worse, will the day come when it’s Drs. Frankenstein & Mengele (We Take Insurance!) versus Drs. Boutique & Concierge?

If so, here’s my wish list for my annual full-fee physical:

Fluffy bathrobes instead of paper gowns.
Candlelight in the exam rooms. Plus blankets & pillows so I can nap.
No scales.
Male nurses who look like extras in a Zeffirelli film.
Valet parking. Free.
No Fox News on the TV in the waiting room, ever.
Complimentary pedicures, psychic readings, and Godiva chocolates.

Happy Presidents Day!
Harley

Comments

[toni]

I think this is one of the scariest posts I have ever read.

(and funny, but geeeeeez)

If I had to pay that sort of fee on the off chance I'd get sick and need a doctor? There had better be private TVs with courtesy DVDs, gourmet snacks, and a massage therapist standing by because I'm going to need to be very very preoccupied before I write out that check.

[Hannah]

if i had to pay that kind of fee,i demand a doctor who doesn't write any of the following remarks to my medical file:

- 4 toenails gone bad.remove all the toes.
- patient has recovered inspite of the
treatment.
- Patient has moved from NY to
Chicago.healty in every other way.
- The lab test indicated abnormal lover
function.
- Both breasts are equal and reactive to
light and accommodation
- Healthy-appearing, decrepit 69 year old
female, mentally alert but forgetful
- The patient is a 79-year-old widow who no
longer lives with her husband.
- Between you and me, we ought to be able
to get this lady pregnant
- The patient has been depressed ever since
she began seeing me in 1983
- The patient refused an autopsy
- The patient has no past history of
suicides.
- The patient is tearful and crying
constantly. She also appears to be
depressed.
- Discharge status: Alive but without
permission

and you trust your life to hands of these guys...
these are all actually written to someones medical files!scary,uh?
is it just me or do these doctors sound male...?

great blog,Harley!and thanks for the chat yesterday!

[Luce]

My HMO doctor of 10 years also went private. His annual fees are lower at $600 but charges $50-200 per visit. I liked him a lot - but it's true he was always booked if I needed to make an appointment sooner than 2 months in advance. But I didn't love him enough to much to pay his fees or more importantly travel to his less convenient new office. I like the new doctor and he makes it a point to schedule time with each patient. We will see how long that lasts as he picks up more patients. But it's been almost 2 yrs - and so far so good.

[Kathy Reschini Sweeney]

Ahh - the two-tiered system nobody wants to talk about. Thanks, Harley, for a first-hand view.

There are many reasons to support universal health care - our current system is just not working.

But be aware - there will always be another tier of service available only to those who can afford it.

First on my wish list? Chocolate and instruments at a temperature close to mine.

[J.D. Rhoades]

An orthopedist of my acquaintance had to cut his practice in half....at the insistence of his malpractice carrier.

Two thousand patients is INSANE.

[Laura (in PA)]

It's amazing what I learn on this blog.

Good luck finding a "non-boutique" doctor, Harley. What does it say about me that, if I could afford it, I'd be more likely to pay a "membership" fee like this for a hairdresser I liked than a doctor?

[ramona]

Harley, please tell me you are writing this into a book. Because, as Kathy pointed out, the inherent unfairness of this makes me think someone needs to die. Fictionally, of course.

[hollygee]

BTW Harley is interviewed in the April issue of Writer's Digest. Nice one.

[Nancy Martin]

600 patients times $1800??

Is it too late for me to go to med school, do you think?

[Maryann Mercer]

My town has two dueling clinics (mine seems to be winning-and creating its own mini-state ala Disney). My doctor is also the team physician for the Illinois sports teams (Does this get me free tickets? No.)which is a good or bad thing depending on when you need to see him (or whether the team has won or lost the last few games. Right now we don't talk basketball!). But,that said,if I need to see him, he can usually work me in within 24 hours, his nurses are the best at the clinic, and he's not once suggested I get my aging body over to geriatrics just across the hall. He doesn't mince words or skirt issues.And he knows I know my own body, which makes diagnosis easier.He's younger than I am by a few years, which hopefully means I won't have to doctor-shop for a while, or until I move. The down side of the clinic? Busy. So I need to know what to answer when he asks what's up. And if I have other concerns, I can't beat around the bush. I lucked out, but then it was Catherine who found him once she got too old for the pediatric department and told me to get myself transferred from Dr. Golf and Tennis. My kid is so smart :o)
PS. I'll keep an eye out for WG and Harley's interview

[Sue]

You are freaking kidding me?! That practice hasn't hit Kansas yet....at least to the Dr. Doogie's on my medical plan, but dayum. What's a real family supposed to do? Maybe I should have bought my kid a doctor kit when he was young, instead of springing for the full set of Power Ranger action figures. Nah...he'd probably charge me double.

[Maryann Mercer]

Nancy-just remember he probably has to pay malpractice insurance :o)

[Maryann Mercer]

That should be WD (although there is a G in the middle of Digest). I need caffeine!

[janetlynn13]

I will second Sue's "You are freaking kidding me?!" and Kathy's "There are many reasons to support universal health care - our current system is just not working."

I've never heard of that, but I'm not surprised some doctors found a way around the workload. I could see that in LA, but I hope it takes a LONG time to hit PA.

[Harley]

Good morning -- sorry, I slept in until 5:45, since it's a holiday.

Okay, this is such a bummer! Here I thought for sure everyone would be saying, "Oh, Harley, where've you been? We've had boutique doctors forEVER here in Kansas."

On the plus side, you can walk out of your colonoscopy appointment and go surfing without moving your car.

[Harley]

Yes, Nancy, I did that math too, but I expect Dr. Welby had to pay a chunk of change to those telemarketer kids who make the incessant phone calls, the "Boutique Conversion Kit."

[Sheila Connolly]

Finding a doctor who is willing to take on new patients isn't easy either (forget about finding one with glowing references). And if you do, s/he will know nothing about you and will forget all details between visits (don't you love it when they ask you to remind them of your history?); when you're gasping for air with the flu, they will tell you the next available appointment is in three weeks; when you want your essential prescriptions renewed, and they insist that the pharmacy fax (yes, fax) a request to the office, they will ignore the fax for weeks.

There has to be a better way!

One other note: my sister lives in a midwestern city, population 50,000 or so. As of a year ago, there was only one OB/GYN accepting new patients there. Population control?

[Karen Olson]

This is quite frightening. I thought having to wait more than a year for a physical was bad enough. But to pay an annual fee to a doctor? So far I don't think this trend has hit Connecticut, but I'm sure we're not too far behind.

[Karen in Ohio]

Medical care right now is insane; I just had no idea it had gotten THAT bad. If things don't change soon, we are all going to have to make some major decisions, I guess.

Harley, congrats on the WD interview! I haven't read it in years, maybe this is a sign I should resubscribe, if they have the good sense to choose you as a subject! And by the way, Books-a-Million does not carry your books. I was at two of them yesterday looking, and asked at the desks. Maybe it will raise a teeny flag for you.

[Harley]

Okay, pardon my ignorance -- I come from a family of teachers and lawyers (and knitters), not doctors - is there a shortage? It would seem so. Are fewer kids going into medicine and is it because they DON'T any longer make the big bucks, as a rule?

Sorry to ask such serious questions on a holiday.

[Harley]

Uh-oh. Pardon my ignorance again, but what is Books-A-Million?

[Maryann Mercer]

Books-A-Million is a big bookstore chain. Competes with B&N and Borders in some cities.

[ArkansasCyndi]

Being a "health care worker survivor" (meaning I WAS a nurse and got out), I have been hearing about these boutique clinics for a couple of years. From what I'm reading, the doctors that do these do it because they want more time with patients, and want to keep their living standard.

It was hard to find a good doctor and when I did, I continued to go to her even though I moved about 80 miles away. It was just too hard to break in a new doctor.

Our health care system is broken..unless you have $$$, then it's doing just fine. The "problem" with universal health care, regardless of whose plan you support, is that there will a tiers of care. Those who can afford it will have better access to health care. I think these boutique clinic are simply getting themselves positioned for universal health care.

I've also been reading about practices that no longer take insurance. You see the doctor, pay the bill and get reimbursed from your health care insurance. What most of the public doesn't understand is that a doctor's office taking insurance is doing a service for the patient. TECHNICALLY, the contract is between the PATIENT and THE INSURANCE COMPANY, not the doctor and the insurance company. With insurance companies not wanting to pay, and playing so many games with the doctors' offices to avoid paying, it's no wonder some office want to get out of the business. In fact, I wonder if that might be the way of the future (and a career for some - the career being companies that file for the consumer instead of filing for the doctor.

I amazes me how many individuals do not understand insurance and explanations of benefits (EOB's). That's an business in itself.

Good luck to us all with our future health care.

[ArkansasCyndi]

wow, just looked at my post. Sorry for the rant!

[Harley]

ArkansasCyndi, between my doctor, dentist, eye doctor, ob-gyn, and my kids' doctors, dentists, allergists, etc., I probably pay the full fee at the time of the visit half the time, and pray to get reimbursed later.

And I'm one of the dummies who doesn't really understand the EOB.

AND we're all healthy! Good grief. For the real horror stories, ask Elaine.