By Editor-in-Chief, Concierge Medicine Today | January/February 2021
Today we’re going to talk about ‘uncommon kindness’ in healthcare.
In the podcast you’ll hear below we talk about this. We expand on the idea that ‘Life isn’t fair, but it is beautiful.’
We’re also going to talk about ‘fairness’ and how that works in other countries healthcare systems. I also want to address the idea of ‘radical hospitality’ in healthcare.
These might seem like odd topics.
Well, they’re only odd until you’re the one bumping into the obstacles we all face in healthcare, hospitals, clinics small and large, specialists offices, and exam rooms.
The fact is we want fairness for everyone when we talk about healthcare … until it happens to you.
It is human nature to resist and critisize something we do not understand.
We pay attention and address the tension that surrounds Concierge Medicine every single day.
We’ve taken our share of arrows. Maybe you have as well.
Those that understand the mission, personal and professional reasons that Doctors and Patients who participate in Concierge Medicine and subscription-based healthcare programs do so because they’ve developed a healthy discontent for the status-quo.
“More than twenty years later, the bustling and innovative Concierge Medicine space is inviting Doctors everywhere in to lead by example,” said Michael Tetreault, Host of the 2020-2021 #conciergemedicineforum six week long Virtual Conference from Atlanta, GA USA and Editor of Concierge Medicine Today (CMT). “You must be a good leader to be a great Doctor and this unique niche in healthcare will test you and bring out the DocPreneur inside every Physician, if that’s what they want. Concierge Medicine has become the conscience [an inner feeling or voice viewed as acting as a guide to the rightness or wrongness of one’s behavior …] by which many Physicians in healthcare today routinely measure their own personal career satisfaction in medicine. It might not be right for you now but ultimately later in life we find Physician’s decide how satisfied they are in their own career and consider the option of moving into a Concierge Medicine or some form of subscription-based healthcare delivery business model that is rewarding to themselves and their patients.”
When critics of Concierge Medicine and other free market healthcare delivery ideas bump into these topics they usually prefer to judge quickly and move on. They may cite that they have moral authority. But do they? Or, are they defending the status-quo of healthcare or protecting their own revenue stream because maybe they realize that this concept, this delivery model [and others ] are threatening?
“We expect a level of quality and service from a great hotel. And why not? We’re paying for it. There’s a reason my family and I many have selected this hotel. Yet, when it comes to our Doctor … we acknowledge and concede the status quo if acceptable. We all know great Doctor’s who are constantly innovating. Where are they learning from? What is their secret? Furthermore, why is it that these learned social graces (e.g. kindness and creating a better way or a closer relationship with a Doctor) in the Healthcare environment of today are constantly being insulted but also emulated? Concierge Medicine plays an important role and that is … to set the example and send back maps for others to follow (if they can).” ~Editor, Concierge Medicine Today
Healthcare delivery, not the actual provision of or medical advice and/or treatment, but the actual business and economy built around the expertise of the Physician him/herself seems to be in a business setting, in a world and economy that doesn’t play by the standards of service which other businesses thrive and survive in. Meaning, successful brands, businesses outside of healthcare realize that in order to create a repeat customer, a sale, etc., they must create a sustainable and thriving business that will last for years. In order to do that, the leadership, CEO, Board, etc., must systematize top down service. Applied practically, this means, the CEO is intentional about planning and blending opportunities to serve customers.
In the Andy Stanley Leadership Podcast, a monthly podcast [not a healthcare podcast] intended to help business leaders and managers, the topic of ‘Do For One What You Wish You Could Do For Everyone’ and striving to provide exceptional customer service was brought up.
We found them circling around this idea of ‘Do For One What You Wish You Could Do For Everyone’ and there is application and lessons that can be learned when we apply to healthcare.
If we approach the topic of Concierge Medicine with some, not all people, we find that when they bump up against the idea that [In healthcare …] You Simply Cannot and Should Not Do For One What You Wish You Could Do For Everyone … they attempt to make the argument that That is not fair.
As parents, you may have taught your children that the world isn’t fair. I know with my three kids, we have this conversation quite often in our household.
You probably remember as a kid bumping into this when a teacher wasn’t handing out candy or prizes in his/her classroom as liberally as you thought they should. You may recall hearing something like If I do it for you, I have to do it for everybody.
We all think the same thing when we come face to face with this argument, Well, no you don’t.
So we really cannot talk about Concierge Medicine without addressing the concept of fairness. Somehow this statement Do For One What You Wish You Could Do For Everyone became imprinted in our minds and has become a leadership axiom. You probably know people who may hide behind this argument. We all see executives in healthcare, insurance agents/companies, academic medical professors and possibly some of your colleagues say [In healthcare …] You Simply Cannot and Should Not Do For One What You Wish You Could Do For Everyone.
Afterall, Primum non nocere, the Latin phrase that means “first, do no harm.” This is a commonly taught principle in healthcare. In fact, the Hippocratic Oath, taken by doctors, promises you will abstain from doing harm to their patients.
“In order to prevent doing harm in medical practices, we need to decrease the number of patients that each doctor cares for daily to give him/her the time to adequately address the patients needs, be able to critically think about each clinical situation, and coordinate care with other practitioners if needed,” says one Concierge Medicine Physician from Connecticut. “It’s not “fair” to patients to rush them in-and-out of the office, merely treating symptoms without getting to the root cause of their complaints. Building a trusting relationship with patients is at the core of what concierge doctors do on a daily basis. I’m hopeful that every young physician sees a future in which they can practice high-level medical care, achieve a work-life balance, and form a bond with their patients that will last a lifetime.”
So you have to be honest with yourself. Do you not want to do for anyone what you could
do for one?
But that’s not fair.
And you’re right, that’s not fair.
In healthcare today, we already know that paying thousands of dollars for a prescription, an Epi-Pen or an emergency room is not fair. We know as Patients that waiting hours to see a Physician isn’t fair.
The arguments against Concierge Medicine do not hold water upon further scrutiny.
You know that when you walk into your practice tomorrow morning, you cannot possibly be fair to everyone. So, do not try to be fair because you cannot be fair.
One of the first things they do is look at you and fear how much all of this ‘today’ is going to cost. The fact is … People don’t know you [their Doctor]. They don’t like you. And, they don’t trust you. That’s not fair some may say. Well, do we not do our kids a disservice in life when we do not instruct them that ‘life isn’t fair?’
Patient Fatigue is here. In the same podcast, they made the argument The fact is if you try to be fair at the end of the day, you won’t be able to. Give up on fairness and get engaged.
We tend to agree. We need more Doctors willing to be engaged vs. distracted. We want them to treat us as if we are the most important person in the room.
Don’t take our word for it on this however. Look at Appendix IV. Listen to the people around you who complain and bellyache about their last visit to a Doctor’s office. Take a look at the figures and responses we received as a result of our hypothesis on the publics trust of their current, plan-reimbursed Physician and see for yourself.
Why do we think Physician burnout is so high? Why do we see entry rates and numbers of young Physicians moving into primary care or family medicine year after year continue to flatline? Because they’re trying to be fair in an economy and culture that doesn’t work that way. Model something for the world of healthcare that can be replicated and respected.
Patients want you to Do For Them … What You Wish You Could Do For Everyone.
According to Dr. Steven Knope, ‘They sign contracts with HMOs and insurance companies in exchange for Patient referrals from these companies. In many of these contracts, doctors agree to limit or ration care to Patients to maximize profits for these companies, their Wall Street shareholders and their CEOs. Some contracts even prevent the doctor from sharing this information with their Patients. By any reasonable assessment, this third-party payer system is intrinsically unethical. Concierge Medicine, by contrast, has no third-party conflicts. Patients pay their doctor directly for his services in the concierge model, just as they did in the days of Marcus Welby. In the concierge model, the doctor is the advocate for one party and one party only: the Patient. He/she has no allegiance to or conflicts with third parties.’
If you pursue a career path in Concierge Medicine, you may hear some of your critics argue that by charging a fee, you limit access to Patients, thus, your way of doing business is not ethical.
For Dr. David Bisbee, the son of a seventh-generation Vermont dairy farmer, the motivation for switching to a concierge practice in late 2013 was only partly financial. The 59-year-old family practitioner says he was driven more by a desire to regain his “autonomy” as a physician and get back to the basics of why he got into medicine 27 years ago.
“I do house calls, I deliver babies, I go to the hospital and the nursing home,” explains Bisbee, who is also the Medical Director of a long-term nursing facility in Morrisville. (He waives his annual fee for most of his elderly Patients and allows others to pay in installments.) “This is what I call a modern medical practice with a lot of old-fashioned notions.”
Dr. Robert Nelson of Atlanta, GA notes “One cannot legislate or mandate professional ethics; a physician either possesses it or not. Physicians (providers) will NOT be more likely to put Patient welfare first in a third – party payer, heavily regulated system as compared to a system where the Patient also acts as the consumer, not just a passive recipient of care. In fact, the opposite is true. Our present system encourages providers to only do the minimum to satisfy audit requirements of payers. A consumer-driven system where the provider works FOR the Patient, not as a bill collector for the insurance company, would be MORE responsive to Patient needs and wishes; working with the Patient to establish an agreed upon level of care based on an informed Patient who is exercising choices allowed because they are both the consumer AND the Patient.”
Stanley, in his book, Next Generation Leader: 5 Essentials for Those Who Will Shape the Future he says “Only those leaders who act boldly in times of crisis and change are willingly followed. Accepting the status quo is the equivalent of accepting a death sentence. Where there’s no progress, there’s no growth. If there’s no growth, there’s no life. Environments void of change are eventually void of life. So leaders find themselves in the precarious and often career-jeopardizing position of being the one to draw attention to the need for change. Consequently, courage is a nonnegotiable quality for the next generation leader. The leader is the one who has the courage to act on what he sees.”
We think there’s a lot in these statements FOR Doctors. Would you agree?
Donald O. Clifton said in the book Now, Discover Your Strengths’ “There is one sure way to identify your greatest potential for strength: Step back and watch yourself for a while. Try an activity and see how quickly you pick it up, how quickly you skip steps in the learning and add twists and kinks you haven’t been taught yet. See whether you become absorbed in the activity to such an extent that you lose track of time. If none of these has happened after a couple of months, try another activity and watch and then another. Over time your dominant talents will reveal themselves, and you can start to refine them into a powerful strength.”
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