Happy Sunday to all!

Hopefully you have completed the worship of your deity of choice and now plan on relaxing out in your marsh like backyard, playing the "Who will get West Nile First" game with your family.

Today's post will be a welcome distraction from the itching mosquito bites while you are decorated with calamine lotion.

This past week there were two medical articles that fall into that annoying category (for me, anyway), which I call, "Almost Correct"

The reason being, that both articles are actually quite good, but, don't quite represent the entire picture.

Let's begin with the beloved Chicago Tribune's article, "More doctors embrace membership fees, shunning health insurance". (Which can be found here.)

This article discusses a new variant of concierge medicine, where you join up with an internist for a flat monthly fee, allowing you virtually 24/7 access to them.

Fees range anywhere from less than $100 to several hundred per month.

The gist of the story is that you could almost avoid having health insurance, because any labs or x-rays are available at discounted rates, such that, if you're healthy, you get off paying less than you would if you were insured.

Alright, let's start with the basic premise about needing to have a doctor available to you 24/7.

What the hell is wrong with you people?

Why do you need a doctor all the time?

Unless you have a chronic illness, like diabetes, asthma, etc., what are you seeing them for?

I'm guessing so that you can get that script for a Z-Pac every time your nose runs.

Here's the problem I have with these practices, especially as a specialist.

Most healthy individuals really only need to see their doctor once a year for a physical.

Sure, they'll be the occasional cases of strep throat, diarrhea (from too many tacos) or some other minor issue.

If that's the case, then why be a member at all, just go to a doc-in-the-box, and be done.

On the other hand, if you do have a chronic illness which requires frequent visits, then you probably should have health insurance, in the event of a serious complication requiring hospitalization.

Of course, you can play the game of getting insurance once you're sick, but it will be both expensive and crappy.

Now, I realize that getting insurance is problematic for some, but, in that case you're almost better off just going completely bare, because it's unclear what this is really buying you, other than some peace of mind.

However, I do want to point out one issue that's not well covered here. This MD may not take insurance, and be at your beck and call, but guess what happens when you need a specialist, like, God forbid, me?

I do take insurance, and, I don't drop everything, because Dr. Concierge's patient is on the line and needs an appointment, pronto!!

You wait like everyone else, and if you have no insurance, and it is not an emergency, I might even opt not to see you at all.

I fully realize that practicing primary care has become virtually impossible today, at least as a solo practitioner, which is why so many are now employed. However, this option really only serves the needs of a few with disposable income for membership, and is not a solution to the problem.

For the MD's that can pull it off, more power to you, except I don't know how you can be infinitely available without it ultimately taking some toll on your life.

And, for the consumer, caveat emptor.

Now the second article is also very interesting. (Otherwise, why would I write about it?)

It can be found here.

Basically, it talks about doctors telling little white lies in order to get a test or treatment covered by the patient's insurance, and whether this is ethical.

Let me begin by clearly stating that this is actually health care fraud, which carries with it pretty significant penalties.

But put that aside for now.

The thought goes somewhat like this:

My patient has disease "X", and in my judgement, test "Y" is necessary, even though the insurance company disagrees. So I'll make up symptom "z", in order to get it approved.

What a good doctor!! Bless him/her for standing up for his/her patient!! Bravo!!

Unfortunately, there can be a problem.

However, before I begin, in the interest of full disclosure, I do now work in the insurance industry, but was in private practice for 3 decades, so I think I can be unbiased.

First, the doctor may think a test is necessary, but actually, the scientific studies show it isn't and unnecessary testing can often lead to "false positives", which then can trigger a chain reaction of further tests and procedures, which occasionally can produce real harm.

Second, while not too common, but not rare, a doctor may have a financial investment in said test, which leads them to ordering for everyone, because "it's a good test". And it might be, assuming it's being used correctly.

It's amazing how quickly one can rationalize the reason something is needed, while at the same time, ignoring the bias the financial benefit may produce.

Finally, we do not have infinite resources. Sure it'd be just dandy to use every test and treatment on everyone, but when it's unnecessary, we are wasting resources that might have better served someone else.

So that's it for today.

Remember, if someone tells you how great Dr. X's medical club is, because he tests the hell out of you and will treat everything-STAY SKEPTICAL!!!

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Filed under: Health Care

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