Recently I read an article by senior endocrinologist,Dr Mathew John about the fragmentation of care in medicine and endocrinology ,its causative factors and possible solutions. You can read the article here.
After reading the article, I had a few thoughts — the foremost of which centered on the idea of “family doctor”. A family doctor of the not so distant past, knew the patient and medicine.
As medicine became more and more complex , the family doctor basically disappeared — replaced by ever growing specialization and fragmentation of care.
It takes two to tango
A simplistic thought is to long wistfully for the days of family doctor -but those days won’t return, since patients themselves don’t want it. If they really did, the ‘family doctor’ wouldn’t have disappeared as easily as it did. While it is true that patients don’t have all the power to change the trajectory, it is naive to think that they are completely powerless. It’s common for doctors to blame themselves for the fragmentation of care, and then suggest some technological solution — to the problem. However, patients have a role to play too — as do other stakeholders. It takes two to tango.
The million dollar question(pun intended) is if patients value holistic care, as opposed to fragmented care, are they willing to pay for it?
Voting with the wallet — Concierge medicine
Assuming patients are willing to pay for better holistic care, how can they vote with their wallet if there’s no option in the medical ballot? One option that can approximate the family doctor of the past, by combining its best features with the advanced medical specialization available today.
Let’s take a fictional medical practice by Dr Rahul called Orion and a patient named Raghav. Orion clinic sees about 40 patients per day, rushing them through the day, referring patients to other specialists whenever the need arises. The patient goes to the specialist, gets things done, but Raghav does it on his own. When Dr Rahul sees him again, Raghav has a bunch of reports and case notes — some typed, others written with the notorious handwriting of doctors. Now Dr Rahul, has time constraints, and does his part of the care well , but has no way to know if the others are doing the same. Even if all doctors did their part well, the end result can be less than the sum of the parts.
One fine day, Dr Rahul gets tired of seeing so many patients and delivering suboptimal care. He changes from Orion clinic to Orion Concierge Services. Now, he is the fulcrum of care. He becomes his patient’s nodal point, care co-ordinator. He liaises with other specialists, takes their opinion, but implements the one he and his patient Raghav agree on. Because he sees fewer patients, he is able to spend more time, doing high quality holistic care. For this service, Orion concierge services charges a retainer or annual subscription. Dr Rahul is able to negotiate with nearby labs,imaging services etc and lower the cost of testing. Similarly he has struck a deal with the other doctors / specialists to give his patients preferential appointment and even multidisciplinary zoom meetings.
Gourmet meal or fast food ?
Dr Rahul faces a problem — since he has to spend much more time with the patients and sees fewer patients, he has to make up for the loss by charging patients more for the enhanced services. Unfortunately such business model innovations are pretty risky, because there is no way to know if patients will be interested. Most doctors don’t know how to do WTP (willingness to pay) studies, since they have done MD,DM or MS, MCh not MBA.
Is it possible to sell gourmet meal in a market that only wants cheap fast food ?
It is possible — however it is not possible to get gourmet meal at the cost of fast food.
People don’t like to be reminded of the reality , but you get what you pay for. Even in healthcare. A holistic care model which includes state of the art advanced medicine is expensive.
Dr Rahul won’t be able to become a family doctor. Nor can he be omniscient. He can’t be a master, but a damn good jack of all trades. A medical James Bond, if you will — provided the Raghavs of the world really value holistic care and are willing to pay for it.