Friday, August 22, 2008

Primary care - A "Personal" Physician Speaks, everything's in the name

A “Personal Physician” Speaks, Everything's in the Name

There is no other profession as personal as the medical profession. It physicians continue to allow non-physicians and businesses such as hospitals and insurers to control them, they will lose their patients and will nothing more than over-educated technicians.

Donald Copeland, MD, Innovation-Driven Health Care: 34 Concepts for Transformation, (Jones and Bartlett, 2007)
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Yesterday I was speaking to Don Copeland, a friend and a family physician, in North Carolina. My wife says of Don, “When I get sick, Dick, I want Don as my personal doctor.” Don is a fine physician, beloved by patients. He takes their best interests to heart and acts accordingly.

A “personal physician” is exactly what Don considers himself to be – nothing more, nothing less. He thinks of a personal physician as a personal guide, confidante, and trusted advisor. He thinks of the personal physician-patient relationship as a spiritual bond, best left untouched and untouchable by remote third parties.

Don insists the very terms, “primary care physician” and “provider” are misnomers. The proper designation ought to be “personal physician.” Don is equally disdainful of the adjecti ve “cognitive” and “proceduralist” as applied to personal physicians. A personal physician, after all, may perform procedures in the office, sparing his patients the inconvenience, expensive, delays, and paperwork involved in needless referrals.

Besides, any physician, not matter what he is named or how he is characterized, ought to have the liberty to charge directly for his services, which is the reason, Don champions health savings accounts. Don even has visions of starting a national HSA organization in collaboration with community banks.

Don maintains, and rightly so, that doctors and patients lie at the very core of the health system. Government bureaucrats , health plan executives, and hospital leaders are secondary players, who depend on doctors. Somehow, in the process of labeling doctors as “primary” and “provider,” these players have over-played their hands, and reduced a noble profession to a dec idedly impersonal business.

It may take a while for these big players to see the error of their ways. Unitl then, I'm reminded of a Casey Stengel tale. After managing the world champion Yankees, Casey managed the lowly Mets. Marv Thornberry was one of his hapless crew. Casey was disgusted with Marv's playing and decided to show him how things were done. Casey took to the field, had a fungo fly hit to him -- and dropped the ball. He turned to Thornberry and shouted, "Marv, you've got this position so fowled up, nobody can play it!" The same may hold true for payers who have placed physicians on the field of play as quasi-employees.


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