The Real Division in Healthcare: Client vs Patient

Last night, I received in my office a fax correspondence from a mail order pharmacy for one of my patients (JJ). The agency is contracted by my patient’s health insurance company to provide pharmaceutical benefits, to manage medication formularies, and, among other services, to make recommendations to patients and physicians regarding options for cost effective pharmaceutical care. The fax was an alert notification that my patient is taking 2 medications that interact with one another and have the potential for adverse side effect. The alert notification is a good thing! Certainly, any and all effort made, by any agency, on behalf of my patients to ensure excellent healthcare and to minimize the risk of complication or adverse outcome should be embraced, and I welcome such communication from outside agencies. But it was not always that way…

In my former, standard, insurance-driven medical practice, in which contracted health insurance companies had essentially leased time from me and from hundreds of other doctors in the community to provide medical care to their clients, I had no time or desire to receive and review such important correspondence. I was much too busy in my office seeing their clients at an exhaustive pace of clinical practice, authorizing requests for prescription refills, analyzing results of labs and tests, and reviewing the reports of consulting physicians for 50-80 health insurance clients per day. I am ashamed to admit that I failed to review and respond to most clinical and administrative telephone calls, faxes and reports. In reality, I had frighteningly little time during each 14-hour day to consider, in a methodical and professional manner, any seemingly extraneous clinical or administrative correspondence from outside agencies about their clients. I simply could not keep up with the demands of the practice, and it became necessary and commonplace to cut corners in providing medical care to the clients of health insurance companies.

However, in my current, innovative, patent-driven Direct Access Medicine practice, in which patients agree to pay a reasonable monthly fee to me directly for 24/7 access to me (again, directly), and in which I maintain no contractual relationship with health insurance companies or other third-party agencies, I now see 6-8 patients per day, manage promptly ALL telephone and fax correspondence regarding my patients, and have ample time to consider potential risk in my plans for the healthcare of each of my patients. In clarity, I now care for my patients… not for health insurance company clients. Do you see the difference here? When my patients pay me directly for the medical care I provide for them directly, there is no “middle man” given opportunity to assume a primary role in the relationship and to depersonalize or objectify the healthcare. And this makes all the difference in the world to both physicians and patients when each owns and bears responsibility directly for half of the professional patient-doctor relationship.

So, patients, which do you prefer… Being a client of a health insurance company contracted to line up a cache of medical providers for your use, or being a patient who is engaged in a strong, direct and professional relationship with a doctor dedicated and available to manage promptly and with high priority all aspects of your healthcare?

And, doctors, which do you prefer… Being a provider-lessee of the health insurance industry saddled with giving medical care of increasing administrative and clinical complexity to their clients, or being a doctor who is engaged in strong, direct and professional relationships with your patients who are ready and willing to participate in all aspects of your plan for their medical care?

At least for me and for my patient, JJ, whose mail order pharmacy has already received a carefully-considered and comprehensive response to last night’s alert notification to me and whom I have already called personally this morning to inform her of my response to their concern, the choice is clear.

Michael J Lucherini MD MS

Dr. Lucherini specializes in Internal Medicine and Pediatrics. He practices at Summit Medicine and Pediatrics in Mesa, AZ, and is a Pioneer in Direct Access Medicine. His opinions expressed herein are personal and do not necessarily reflect the opinions of his staff, his patients, or his colleagues.

© 2015 Summit Medicine and Pediatrics
All Rights Reserved

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