I have been asked a lot of questions since starting my concierge internal medicine practice in San Antonio. The most common question is “Why did you choose this model?” It’s a valid question.
Physicians are used to being asked questions. We are asked lots – and I mean LOTS – of them. The questions start during the interview process to get into medical school. The most frequently asked questions are “Why do you want to be a doctor?” and “What kind of doctor do you want to be?” We know what questions are coming, and we have answers to them that we have recited over and over again. It’s predictable.
Then classes begin. We are asked questions about medical facts such as “Can this medication be used for this condition?” and “What is the next step in this chemical reaction?” We take test after test after test to prove what we know. We study and prepare for these questions, and our performance is directly related to our preparedness. These questions are intellectually harder, but they have textbook right and wrong answers. We are graded and ranked, and everything is easily measured. It is neat and tidy and safe.
Then we graduate and enter residency, and the questions become more difficult to answer. Suddenly the grey zone appears. We are asked “Should we do this?” “What do we do when the textbook ‘right’ answer has failed?” “How do you help a patient cope with the impact of your textbook ‘right’ answer?” The medical facts suddenly have color and meaning and impact, and medicine comes to life. It’s magical.
Then residency is done, we enter our careers, and the questions take a darker turn. Suddenly external entities start to answer the questions for us. Our textbook “right” answers are even questioned, and that magical time comes to a sudden halt. No longer are we judged by our knowledge, our preparedness, or our care, but by whether an outside entity makes more or less money off our choices. It’s ugly.
Worse still, we are told that our time spent working through the grey zone with our patients is no longer valuable. Our “quality” as physicians is suddenly defined by the quantity of patients we see in a given time, whether we fill in arbitrary data points on a spreadsheet, and whether someone thinks we answered the phone fast enough. It’s demoralizing.
“What kind of doctor do I want to be?”
In my first month of practice, I was invited into the home of a terminally ill patient to have discussions about how to die with dignity and without pain. I watched my son play hide-and-go-seek in my office with a patient while her spouse took care of office matters and I put together some office furniture. I brought patients in for visits just to talk them through their diagnoses face to face – something I could not have done before because visits like that are not easily billed to insurance. I have called my patients personally about their test results. I have had the time to speak directly with consultants about their plans of care rather than just reading their notes and trying to guess at their thought processes. Quite simply, I have been able to take care of my patients.
So, the answer to the question “Why did I choose this model?” is very simple. A concierge practice allows me to be the kind of doctor who has the time to talk with her patients, get to know them, educate them about their medical issues, and work collaboratively with them to achieve better health.
Erin Reese, M.D.