Trusting the Guest to Take Care of Things

A guest at the Crowne Plaza was feeling under the weather.

The guest spoke poor English but, through the bellman, asked if I took his insurance: April Assistance. I did, adding that, unless he wanted to pay me directly, he must call April and ask for a doctor. Then April calls me.

After giving April’s 800 number to the bellman who passed it on to the guest, I hung up and immediately regretted it. I should have asked for the guest’s insurance I.D. and then sent him to his room. Then I should have phoned April to tell them a client wanted a housecall. They would have phoned him and then approved. I’ve done this in the past; when I’m lazy and trust the guest to take care of things, I often never hear back.

I called an hour later, but the bellman didn’t remember the guest’s name.

Concierge Doctors

I belong to the American Academy of Family Physicians (AAFP), the leading organization for family doctors with about 100,000 members. My physician brother, more activist than I, belongs to more  liberal physician organizations which are much smaller.

I bought a lifetime membership years ago, so I’m stuck with it, but its heart is in the right place. The AAFP wants members to practice high quality, compassionate medicine and requires that they stay educated and pass a test every seven years. It expresses deep concern with Americans who can’t afford medical care but refrains from urging doctors to greatly inconvenience themselves to remedy this. Most doctors are conservative; the AAFP’s leadership is more politically sophisticated than its members, but, in the end, it reflects their interests.

That brings me to today’s subject. I was perusing the AAFP’s weekly news bulletin. One article cheerfully announced that direct primary care was piquing everyone’s curiosity and that two physician-entrepreneurs would provide the “inside scoop” in a web workshop free to AAFP members.

I was preparing to move on when, with a shock, I realized that direct primary care is a euphemism for concierge medicine. The AAFP was plugging concierge medicine!!! That’s like promoting Mexican cancer clinics!

If you’ve followed this blog you know my low opinion of concierge doctors. They don’t accept insurance. Patients usually pay a monthly or yearly retainer in addition to the usual fees; in exchange, they receive quick access, longer appointments, and, if necessary, housecalls. This money pays for the doctor but nothing else. Tests, X-says, therapy, specialists, and hospitalization cost extra. It’s a luxury service.

When concierge doctors address the public they extol the superior care they deliver to a grateful clientele. Around the lunch table with only doctors present, they extol the pleasures of a cash-only practice. I've never met a concierge doctor I could respect. 

Finishing the article, I hit the “comment” button and forgot my rule about not responding in the heat of emotion. The satisfaction of delivering my opinion which included the adjective “sleazy” evaporated when I read the avalanche of abuse that followed.

Later that day an E-mail from an AAFP official explained that readers were complaining at the lack of respect shown in my response, so it was being deleted. It vanished, but the angry responses remained. You can read them at http://www.aafp.org/news-now/practice-professional-issues/20130508directwebinar.html. If that’s too much of a mouthful, google “inside scoop on running a direct primary care practice” and it will turn up.