4 ms·

I cannot strongly enough recommend you find and build a relationship with a Direct Primary Care doctor. It will totally change your relationship with modern med

I cannot strongly enough recommend you find and build a relationship with a Direct Primary Care doctor. It will totally change your relationship with modern medicine. Not only will that doctor actually care about your health continuously, but he will connect you with specialists in his own referral network, who will treat your issues with similar care once you mention that Dr. SoAndSo referred you as his patient. At the end of the day, for better or worse, doctors are people too.

01HNNWZ0MV43FF 2y ago
My PCP is great but he isn't going to be the one deciding whether I'm dead enough or not dead enough.
smeej 2y ago
Actually by far the worst experience I have had with doctors was the year I hired a DPC. I had such high hopes for that model, but she was just an awful, awful physician. This year is my year of recovering from that experience. It's costing me tens of thousands of dollars.
- OldGuyInTheClub 2y ago
  I am very sorry that it cost you so much in pain and in dollars. I do sympathize with you that DPC/Concierge is a lot of hype along with the high costs.
- mbreese 2y ago
  As another point, my PCP moved to a concierge model a few years back. We stuck with him and couldn’t be happier with the situation. Finding a good doctor you trust and have a good relationship with can be hard, but very worthwhile.
OldGuyInTheClub 2y ago
I live in the greater Los Angeles area and could not agree less. Primary Care is in deep trouble and will only get worse. I nominally have a Primary Care doctor that works for a large health care org - nonprofit that pays its CEO ~$18M/year. When he was new and had few patients, he took time and initiative. Since then and especially after Covid, his attention to detail has dropped and his bosses increasingly dictate what he can and cannot do. He has to refer specialists within the health care org if they have that specialty. On a couple of occasions he has suggested I go to a specialist but he has no names to recommend. He is perfectly happy to be a salaried employee where the nuts and bolts of running a practice are taken care of by his company. He won't say how many patients he has on his roster but given the time to get an appointment it must be in the hundreds. The front office pushes Urgent Care whenever they can which dumps the whole concept of a doctor who knows you into the toilet. Pay a premium (natch) for someone who doesn't know you and doesn't give a damn (see the reviews). He is required to type 90wpm into the Epic system which prompts him on what to do during the 10-15 minutes he is authorized to spend on me. I am fortunately alert and functional when I have seen him but when that is no longer the case, I am well and truly hosed. If by Direct Primary Care you mean "Concierge medicine" where one pays a private practice Doctor a yearly fee for improved access, I tried that as well before the guy above. The doctor was a big talker when selling his practice but he was scatterbrained, unfocused, and inept in actuality spending more time talking about his extreme politics than actually paying attention during the exam and my questions. I bailed after a physical exam and followup. Before that I had Kaiser which is beneath contempt. Every doctor, medical org, and insurance talks up the relationship between patient and primary care but once you're in, it's a f&*king joke. There are no success stories I can find among my coworkers and acquaintances. We're all on the same stinking sinking ship.
alex_lav 2y ago
> It will totally change your relationship with modern medicine I'm glad you really like your primary care doctor, really, but no it won't. They're still slaves to the broken system they work for (insurance) and they're still overworked and underprovisioned. > Not only will that doctor actually care about your health continuously I think "care" is being used too generously here. Their job is to _be aware of_ your health. They don't "care" about it, necessarily. > but he will I can't help but point out this use of "he" > who will treat your issues with similar care once you mention that Dr. SoAndSo referred you as his patient This is again not true, but again, really happy this is your experience.
- OldGuyInTheClub 2y ago
  Don't know why you are getting downvoted. You are spot on.
  - smeej 2y ago
    I think the down votes are because "Direct Primary Care" doctors opt out of the insurance system. That's the point of the model. They collect monthly subscription fees instead dealing with your insurance company. Granted, if they want to refer you to anyone else, your insurance may be involved, but not a few of them also have arrangements with those "health sharing ministries" where the patient cash pays for any procedure with the assistance of other people in the health share, which again saves enormous amounts of money by skipping the insurance system.
    - htek 2y ago
      Those "health sharing ministries" are a complete scam. They take your money and provide you nothing. Sort of like church and the donation plate, only they purport to provide a genuine service in the health care field.
      - smeej 2y ago
        Are there studies bearing this out? I and many of my friends have been part of them at various points and have had tens of thousands of dollars of care provided through them. I've also had both experiences that correspond to and directly oppose your take on the church donation plate, so I'm curious if you're aware of data about this, or if we're just comparing personal experiences.
justinclift 2y ago
> ... build a relationship with a Direct Primary Care doctor. Of course, you also need to be lucky enough to get a good one.

01HNNWZ0MV43FF 2y ago

My PCP is great but he isn't going to be the one deciding whether I'm dead enough or not dead enough.

smeej 2y ago

Actually by far the worst experience I have had with doctors was the year I hired a DPC. I had such high hopes for that model, but she was just an awful, awful physician. This year is my year of recovering from that experience. It's costing me tens of thousands of dollars.

OldGuyInTheClub 2y ago
I am very sorry that it cost you so much in pain and in dollars. I do sympathize with you that DPC/Concierge is a lot of hype along with the high costs.
mbreese 2y ago
As another point, my PCP moved to a concierge model a few years back. We stuck with him and couldn’t be happier with the situation. Finding a good doctor you trust and have a good relationship with can be hard, but very worthwhile.

OldGuyInTheClub 2y ago

I live in the greater Los Angeles area and could not agree less. Primary Care is in deep trouble and will only get worse. I nominally have a Primary Care doctor that works for a large health care org - nonprofit that pays its CEO ~$18M/year. When he was new and had few patients, he took time and initiative. Since then and especially after Covid, his attention to detail has dropped and his bosses increasingly dictate what he can and cannot do. He has to refer specialists within the health care org if they have that specialty. On a couple of occasions he has suggested I go to a specialist but he has no names to recommend. He is perfectly happy to be a salaried employee where the nuts and bolts of running a practice are taken care of by his company. He won't say how many patients he has on his roster but given the time to get an appointment it must be in the hundreds. The front office pushes Urgent Care whenever they can which dumps the whole concept of a doctor who knows you into the toilet. Pay a premium (natch) for someone who doesn't know you and doesn't give a damn (see the reviews). He is required to type 90wpm into the Epic system which prompts him on what to do during the 10-15 minutes he is authorized to spend on me. I am fortunately alert and functional when I have seen him but when that is no longer the case, I am well and truly hosed. If by Direct Primary Care you mean "Concierge medicine" where one pays a private practice Doctor a yearly fee for improved access, I tried that as well before the guy above. The doctor was a big talker when selling his practice but he was scatterbrained, unfocused, and inept in actuality spending more time talking about his extreme politics than actually paying attention during the exam and my questions. I bailed after a physical exam and followup. Before that I had Kaiser which is beneath contempt. Every doctor, medical org, and insurance talks up the relationship between patient and primary care but once you're in, it's a f&*king joke. There are no success stories I can find among my coworkers and acquaintances. We're all on the same stinking sinking ship.

alex_lav 2y ago

> It will totally change your relationship with modern medicine I'm glad you really like your primary care doctor, really, but no it won't. They're still slaves to the broken system they work for (insurance) and they're still overworked and underprovisioned. > Not only will that doctor actually care about your health continuously I think "care" is being used too generously here. Their job is to _be aware of_ your health. They don't "care" about it, necessarily. > but he will I can't help but point out this use of "he" > who will treat your issues with similar care once you mention that Dr. SoAndSo referred you as his patient This is again not true, but again, really happy this is your experience.

OldGuyInTheClub 2y ago
Don't know why you are getting downvoted. You are spot on.
- smeej 2y ago
  I think the down votes are because "Direct Primary Care" doctors opt out of the insurance system. That's the point of the model. They collect monthly subscription fees instead dealing with your insurance company. Granted, if they want to refer you to anyone else, your insurance may be involved, but not a few of them also have arrangements with those "health sharing ministries" where the patient cash pays for any procedure with the assistance of other people in the health share, which again saves enormous amounts of money by skipping the insurance system.
  - htek 2y ago
    Those "health sharing ministries" are a complete scam. They take your money and provide you nothing. Sort of like church and the donation plate, only they purport to provide a genuine service in the health care field.
    - smeej 2y ago
      Are there studies bearing this out? I and many of my friends have been part of them at various points and have had tens of thousands of dollars of care provided through them. I've also had both experiences that correspond to and directly oppose your take on the church donation plate, so I'm curious if you're aware of data about this, or if we're just comparing personal experiences.

justinclift 2y ago

> ... build a relationship with a Direct Primary Care doctor. Of course, you also need to be lucky enough to get a good one.