Do You Remember Marcus Welby?
This question serves two purposes. First, those of us who remember the show are getting to the age where health - both maintaining good and preventing bad - is becoming a greater focus of our time; and second, it recalls the concept of personalized, friendly, knowledgeable care delivered by ‘your doctor’ which is a concept rapidly disappearing from today’s healthcare system.
A true Family Medicine doctor, allowed to practice medicine in a manner they were trained to do, can be the friendly, personal doctor who is a careful diagnostician, your greatest health advocate, and your most trusted confidant in important medical decisions. We should all have a doctor who is a partner in our healthcare, who is focused on screening, prevention and health maintenance, and who is conscientious and detail-oriented about new health concerns and chronic disease management.
As our country’s population changes over the next 10 years - approximately 35% of the people will be over age 50 (1 in 5 will be >65) - the need for and benefits of preventive care, screening and chronic care will increase appreciably. As the demand for well-trained, comprehensive doctors increases, the supply of and access to them is decreasing. Furthermore, the current payment model for these doctors demands high volume and brief visits often delivered impersonally and without attention to other patient concerns and without focusing adequately on disease prevention measures. Unfortunately, our current health care model only adds to our alienation from the system and the fragmentation of care delivery.
In this setting, there are a small but increasing number of doctors who, along with their patients, have created an alternate care delivery model which is founded on reestablishing personalized, comprehensive care. They offer reduced patient volume and an office focus on friendly, coordinated care, based on accessibility and proactive health maintenance. With this, patients and doctors alike are reviving the traditional care we knew and infusing cutting-edge screening and preventive medicine. This will not be the answer to our overall healthcare system’s woes, but it is the solution for many forward-thinking people right now.
Certainly not all doctors or medical offices that practice in this ‘concierge’ or ‘retainer’ style are equal. Access alone will not help you if it lacks thoughtful evaluations, coordinated care and follow-up. Body scans and blood tests can never tell the whole picture of a person’s health status and risks; in fact, it is the attentive discussion of a person’s complaints which identifies the diagnosis 80-90% of the time, and lifestyle factors account for 60% of US deaths. True value lies in establishing a rapport with a knowledgeable physician in an open, comfortable environment with the confidence that your doctor is genuinely interested in your health. In this practice, no avenue is ignored, no prevention tool is omitted, no resource goes untapped and no concern is ignored.
As a family physician practicing in this setting since 2004, I daily see the value this personalized attention offers and the impact comprehensive medical care can have on the health and well-being of a patient. Being able to truly know my patient allows me an opportunity to participate in their health decisions fully, explain the reasoning behind testing I recommend or the advice and treatment I offer, and practice medicine utilizing all my skills for the betterment of my patient.
In other realms of our life, we make choices based on costs, value and comfort; we choose whether quality and longevity of a product or service is worth the value. A growing number of people are deciding these important considerations should be applied to their most important asset - their health. It is up to us to take charge and prioritize our health; we have the most to gain
Kevin J. Kelleher, M.D.