I am going to stray from my usual posts about men’s health and discuss why I joined the movement of direct care. Direct care means eliminating the scores of middlemen involved in medicine, including insurance companies and administrators. Direct care allows us to actually redirect attention towards patient care and to try to salvage the eroding doctor-patient relationship.
Have you noticed that your doctor has less time for you? Or seems rushed? Or is looking at his computer during your visit? Have you noticed that it is hard to get ahold of him? Those are rhetorical questions. Of course you have. It is annoying isn’t it? It should be. And guess what. Chances are your doctor is just as annoyed with the direction medicine has taken as you are. I promise that when you are an hour behind and frustrated, he is not eating bon-bons in his office. He is scrambling, putting out fires, probably hasn’t eaten or peed, and probably feels really badly about making you late. He probably has an undoable schedule, and usually not by choice. He is set up to fail.
The result? A doctor in a conventional practice has to see a patient every 10-15 minutes as a result of overhead. Taking into account all of the other non-clinical tasks doctors must do for each visit, about 7 minutes of face-to-face time are left on average. What’s up with that? Despite years of rhetoric about “value-based” care, medicine has become even more volume-driven. Believe me, this stresses doctors out. You can ask my wife. In fact, the more that doctors care about patients (believe it or not most really do!), the more stressful it is. We worry about actually being able to adequately and safely care for patients under this model. By the end I was always worried I was going to miss something important.
On a fiscal level, incentives have become more misaligned—while the country’s healthcare budget is being busted (the US has the highest per capita healthcare budget in the world), doctors are pushed by their employers to see more patients, do more procedures, and bill more—exacerbating the problem.
This is my last and only rant about our healthcare system. Let’s get back to the good stuff!