Comments on: Paying for primary care – side effects

By: BladeDoc

BladeDoc — Wed, 03 Oct 2007 14:31:42 +0000

I know I’m late to this but anyway here goes. Patients SAY that that they want “high touch” care but aren’t willing to pay for it. Well I want to be a triathelete — just not enough to go jogging. Put up or shut up.

By: Rachel

Rachel — Mon, 24 Sep 2007 19:59:55 +0000

Nice post. What about the potential for mid level practitioners to provide some of the ‘high touch’ care that patients prefer more cost effectively?

By: Dr Ben

Dr Ben — Fri, 21 Sep 2007 16:19:16 +0000

DB, great post-I think we’re on the same page ( see my post at http://drbensblog.kruskal.com/2007/07/25/not-enough-primary-care-doctors/).

@Darrell, I respectfully disagree re previous medical records. It is a HUGE PITA to read through old records, esp if they’re handwritten and illegible. However, you very often strike gold there. It’s another good example of exactly what DB is talking about–if you were paid for your time, you might take the time to read through those old records–but since you’re not, you don’t unless you have an explicit question to answer. As a part-time primary care pediatrician, I very much understand this trade-off. As a part-time ID specialist, I know that there is unexpected treasure in old records, and that a chart biopsy is the least invasive procedure you can do; you just don’t get paid well for it.

By: Darrell

Darrell — Thu, 20 Sep 2007 16:40:11 +0000

Actually, we DON’T know that a longer visit is better than a shorter visit; we just think that it ought to be because it “sounds” as though it should. I know a doctor who is famous for his 2-minute visits who is trusted and beloved by his patients. As for the other comment about the physician who was uninterested in “previous medical records”, that’s because he’s not going to look at them–so why bother receiving and filing them in your patient chart. He’s going to look at HIS chart. No physician wants a new patient to show up with a wheelbarrow full of moldy records. Your medical past maybe fascinating to you–but it’s not to her/him.

By: Maggie

Maggie — Wed, 19 Sep 2007 23:40:40 +0000

I moved to another state, found, on the recommendation of my doctor, a family practitioner and saw him initially for a small problem. He really was very nice, took care of the problem very well and efficiently without seeming to rush me. But he didn’t seem at all interested when I offered to get to him (by paying for them myself) my previous medical records. That worried me.

By: Rob

Rob — Wed, 19 Sep 2007 16:30:16 +0000

OK, I agree with you on this one 100% (it does occasionally happen). As of now we are torn between the business case (seeing 40 pts/day) and the compassion and good care of our patients (seeing 15). I am hopeful that the political pundits actually do seem to realize that primary care is a good thing and that it also is an endangered profession. Will that translate to good change for us? Well, trusting a politician is bad enough, but trusting a bunch of them is even worse.

By: Steve Lucas

Steve Lucas — Wed, 19 Sep 2007 14:40:51 +0000

Good point. I was a more than a little surprised to find the American Cancer Society will be spending its budget on promoting politically correct universal coverage, not antismoking or other lifestyle changes to promote a healthy lifestyle. The Mayo Clinic has also jumped on the band wagon.

I wonder who will take up the cause of promoting an increase in generalist?

Steve Lucas