1100 Queensborough Blvd Unit 102, Mt Pleasant, SC 29464
frustrated with healthcare?
so is your doctor!

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.

Why is this happening? It is only in part because Medicare and other insurances are reducing payments in response to massive healthcare expenditures. It is mostly because of all of the middlemen taking home the lion’s share of said expenditures. Insurance companies are a huge part of that. They make a fortune from patients while increasingly denying payments for medications and services, and while simultaneously increasing premiums and deductibles. A doctor’s office has to employ numerous employees just to battle with insurance companies for payment. This significantly increases overhead. Additionally, more and more doctors are employed by large bureaucratic hospital systems with innumerable administrators. Since the administrators do not themselves directly produce any revenue, it is the burden of the doctors and other health care providers to produce enough revenue to cover the overhead of their salaries.

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.

I have heard a lot of healthcare workers complain that patients have become too demanding. I disagree. They just aren’t getting what they want or need out of healthcare. They just waited an hour for a 7-minute discussion. Of course they’re demanding! But unfortunately this is the new normal.
A lot of people say healthcare is broken. For the doctor (and nurses) and patients it surely is. But it is working perfectly for the middlemen who are benefitting (I was going to say exploiting but that sounded too pejorative) from the complexity and non-transparency, and getting wealthier.
My solution? 86 the middlemen. Simplify it. Make it transparent. Make it about the doctor and the patient again. I schedule 6-7 patients a day at The Men’s Center. I don’t take my computer in the room. I have one phone. There will be no phone menus. Patients will never be transferred. I currently have only two staff members. Their names are Jay and Mac. They’re good guys. Stop by and see us. Let’s spend some time together.

This is my last and only rant about our healthcare system. Let’s get back to the good stuff!

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