Well, you folks have kept the drumbeat going, improving your health, spreading the word about Fat Head and healthy eating, driving the numbers on Hulu and Netflix, and DVd sales. All of which gets Tom invited to places like the Ancestral Health Symposium at UCLA to present his “Science for Smart People” speech.
So he’s already gone again and I’m already back again. You have no one to blame but yourselves.
First, a quick housekeeping note. It sounds like Tom’s going to be severely out of pocket for the next few days and the comments on the site are already piling up. In the interest of keeping the dialog here moving, I’m going to approve the ones that I don’t think require his attention. If you’ve submitted one and don’t see it, please be patient.
I was going to put up a post about some amazing BLT’s The Wife and I make — including low-carb options — along with some hints on bacon and avocados ( I know, add a couple of eggs to the bacon and avocados and you’ve got the whole paleo food pyramid, right?).
But I had an interesting experience this week and I thought I’d share it. It’s not nutrition or food, but it is about your health, so here goes…
This past Wednesday, being a guy over 50 who generally manages his health by avoiding doctors, I finally went to a new doctor. It took an hour and a half, which was amazing.
Normally, there’s nothing amazing about spending an hour and a half at the doctor’s office. In fact, that would generally fall under “completely normal.”
You know the drill. Get there 15 minutes early so you don’t lose your place, spend 15 minutes refilling out the same paperwork you filled out the last ten times you were there and letting them copy your insurance card again (OMG, you didn’t change insurance companies, did you? Start over!)
Half an hour after your appointment time, the nurse escorts you back to the exam room and spends five minutes asking you some questions, writing your answers, and taking some measurements (height, weight, blood pressure, etc.). The nurse disappears and hopefully after only another fifteen minutes or so your doctor comes in and asks you most of the same questions again. She’ll determine a few tests for the lab to do. If you’ve got a particular ailment, she’ll probably want a few extra tests. Then off she goes.
You get escorted to the lab, wait there for fifteen minutes, a tech spends another ten or fifteen minutes drawing blood or whatever needs doing, then back you go. After another wait — again, fifteen minutes qualifying as a lucky day — your doctor returns, spends up to several minutes reviewing your test results with you, and then tells you that you need to be on statins. Har!
So what’s so different about spending an hour and a half at my new doctor’s? Well for starts, I spent the entire hour and a half — brace yourself — with my doctor! This is him — Dr. Craig Backs
Craig has over 30 years experience as an Internal Medicine Physician, is a past president of the Illinois State Medical Society, and recently returned to private practice after a stint as Chief Medical Officer at Saint John’s Hospital in Springfield. Good person to know.
Almost the entire time was spent with Dr. Backs, except for maybe the first three minutes, which I spent in his reception area, which looks like this…
The seating is comfortable, but this is probably about as crowded as it’s going to get. More on that in a minute.
And when the nurse came to take me back to the exam room? Well, that didn’t happen. He doesn’t have a nurse. Anything that has anything to do with my medical experience, he does.
Also, we spent the first hour of that hour and a half sitting here:
Since this was my first visit, we spent an hour not only going over my medical history, but also any current complaints (coincidentally, I happened to be having a flare-up of sciatica from old injuries) and my goals regarding maintaining and improving my general health. We also spent some time on my conviction of the benefits of, and my personal results from moving to the low-carb lifestyle. With a couple of short detours into politics and economics, of course.
Craig has been a personal friend for years (his son and The Oldest Son went to school with each other from preschool through high school, and remain close friends). As a result, I’d recommended Gary Taube’s Good Calories, Bad Calories in a social conversation before he started his new practice and he read the whole thing. Craig is not a low-carb or paleo (or anything else) physician, but he was comfortable with my decisions about nutrition and health. He’d also support a patient intent on the low-fat approach. Imagine that — a doctor who wants to help his patients work their way towards their health goals on their patients’ own terms.
After building the foundation of our doctor/patient relationship, we moved into a standard exam room for the actual physical, including all of the usual equipment, although most of them were hooked up so they would load results directly into his laptop and my medical records, which are now all electronic. This all took most of the other half hour, including some helpful suggestions on addressing the sciatic flare-up.
[It also unfortunately included the usual test for a guy over fifty, which I was not able to get Dr. Backs to waive for an additional fee. I suppose it’s nice to know your doctor has professional integrity, but it’s even more important that their hands aren’t too big, if you get my drift. Sorry — just had to throw that in as a final shout-out to Kenny M — Tom’s vegetrollian stalker!]
In case I come up with another question or problem, in addition to his office number, I’ve got Dr. Back’s email address. And his cell phone number. Not because he’s a personal friend, but because he’s my doctor. When I called to schedule my first appointment, I asked when I could get in. His office manager asked when would it be most convenient for me?
As I said, none of this occurred because Dr. Backs is a personal friend — it’s all part of his practice that any patient receives. By now you should be wondering how this could all happen. The answer is very simple:
Because I pay him.
I know that may sound strange in a society that’s reached a point where most people think that either their employer or the government is responsible for providing health care for them.
Instead, this is how Craig’s practice operates:
I pay an annual fee for his services. It’s a little more than my cable/internet service bill is for the year, but not enough to be called “concierge health care.” Craig’s term for it is “personal medicine.”
For that fee, I get my annual checkup and his email and phone numbers. There’s a nominal fee for additional office visits (probably a polite way to discourage hypochondria overuse) and I pay for any lab work. I also get a commitment from Craig that he’ll limit the number of clients his practice will accept, probably no more than 500 to start. I won’t be dealing with nurses, physician assistants, or — under normal circumstances — answering and message services. When I have a problem or question, I’ll be talking directly to him. The fee covers kids in the household (up to a certain age), and also any friends or family who are visiting from out of town.
I don’t have to worry that some insurance company is going to tell me I’ve got to pick a new physician because Craig is no longer on the “preferred provider” (low bidder) list. Or that any tests or treatments Craig suggests are dictated by an insurance company policy manual instead of my doctor’s judgement.
Since I’m paying a decent fee up front, Craig doesn’t have to payroll an entire accounting and clerical staff to code, process, submit and follow up on insurance and government reimbursement claims. He doesn’t have to wait until the state scratches enough money together to send him some percentage of money he’s due. He doesn’t have to wonder if the feds are really going to cut his reimbursement rates for seniors by 30 percent next year. He can also respond and help with many patient issues via email or phone. This is something many physicians are understandably hesitant to do, because they’re still using their time and putting themselves on the hook for liability concerns, but reimbursement in the insurance systems all center on an office visit.
That reception area will continue to be lightly populated, as it doesn’t have to be sized and used as a revenue queue/holding pen like under the current medical paradigm, where contracts and reimbursement rates mean if the pipeline isn’t full and the doctors aren’t seeing 30 or more patients a day, they’re losing money. Craig won’t have to order batteries of tests to give him information that he can instead glean with the time he can now spend with each patient.
I believe that this is to health care what the real and local foods movement is to eating and nutrition. That is, this is a modern adaptation to get back to the fundamentals that we lost in the march towards bigger, faster, cheaper. It costs more, but the quality difference is obvious and meaningful.
I’ve always said that although we can all use experts, the bottom line is no one can care about your kids, your money, or your health as much as you can. Personal medicine is a trifecta.
See you in the comments.
The Older Brother
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