forgoing the apple a day

I wish I could say that I've been keeping up with the health-care grouchfest that's been happening in the country over the past couple of years. You'd think that I'd be the world's expert, after Jeff's accident, but that's not the case. It's not that I don't care -- I do -- but I've hit my limit of what I can hear about the medical care crisis in this country before I start having what most sane people would call flashbacks.

If you could see my reaction to seeing an insurance company's name on a letter in the mailbox, you'd understand. You'd probably even call it mild PTSD. I can joke about it, a little, but the truth is that most of us can tell the difference between a mass-produced advertising letter and a bill just by looking at how the envelope's printed. I've seen so many letters from this insurance company that I can tell, just from the outside, if it's a bill, but every time I wonder if this is going to be the magic letter that takes away my home, my financial security, and my future.

So no, I haven't followed the debate about health care. It sucks -- I totally should be following -- but for now, and the foreseeable future, I can't.

So when the letter came from our doctor, it was unsettling and frightening. I knew he'd been trying to find some way to make his family practice fiscally viable, and I knew from small hints over time -- letters from the practice, things seen while visiting, statements made to me while I was there -- that things were frustrating.

He's decided to take the plunge into concierge medicine through the MDVIP system. I looked at the price, $1500/year, and blanched. Doctors don't give me a warm, fuzzy feeling; I dread the process, the impersonal intrusion, everything about it.

I went back and forth about the idea. On the one hand, it was a great deal of money, but on the other hand it gave me something that I desperately could've used in the first twelve months of Jeff's recovery: an ally. If I could've had a primary-care physician whom I could've called at any time, day or night, how much less overwhelmed or alone might I have felt in ICU after ICU, surgery after surgery?

Maybe a little less PTSD, a little more trust.

I'm under no illusions here. We're paying for spectacular care: need to see your GP? Call the office, reach a real person, make arrangements, and get an unhurried same-day appointment. Get a GP that follows up with our specialists, instead of us traipsing records from office to office, hoping we can get someone to read them and be aware of our history. 24/7 access, and not just to an after-hours call center -- my actual doctor, and his actual cell phone.

I'm part of a generation who grew up with nothing but hurried, stressed doctors. My parents and grandparents had GPs who stayed with them through their entire lives, knew their histories, knew their trajectories. I've always been painfully aware that in comparison, my life, from the point of view of my doctor, is boiled down to a quickly-reviewed chart. I am a name they can't quite pronounce, a set of numbers ... and little else.

It's why I hate going to the doctor. I can barely talk about the things that matter with my closest friends; it's harder still to talk about personal medical details with an effective stranger who I have a vague generally-good impression of, but who sees me only for a few minutes every year.

Though I have misgivings, I decided to join the program, and Jeff was part of the reason; it would really help to have a GP that actually knew and remembered his medical history since the accident. I need to not carry this burden alone, because I am neither academically trained nor emotionally capable of shepherding his care. Jeff needs a wife, but he also needs a doctor.

It's harder to justify it for myself. I'm reasonably well, but I think what made me decide to do it for myself was the realization that I'm the caregiving spouse now. I'm depended on, and needed, and as such I have to find a way to make me see myself as a precious resource. I don't tend to see myself in those terms, except when I allow myself to think about what Jeff's needs would be if I were injured, incapacitated, or ... gone.

I don't know if it's the right choice, but I don't know that there is a right choice. I don't think we can find this level of care outside of a for-pay system in the US, and I think both of us, for differing reasons, need a health-care champion.

I think about how my doctor's drastically reducing the size of his practice as part of this switchover. His current practice has about 4200 patients, and he's capping his new practice at 500 adults plus their dependents.

I wonder where the rest of them will go. I know that he's part of a 4-doctor practice, and 3 of the 4 of them are switching over to this style of practice. I have to assume that the other doctors in the practice were carrying similar patient loads. I wonder how inundated the fourth doctor is going to be after the changeover, and I wonder where those thousands of patients will go.

I don't know if this is a workable model for Jeff and me, for forever and always, but for now, it has benefits to us. We'll try it out, and see how we feel in a year. Maybe it'll be the best thing that's ever happened to our health, and maybe we'll feel we over-paid. 

We'll see.


Right there with you with the hospital/health insurance envelope reaction. I hope the move works out for you two, in your situation, you really do need continuity above all.


This definitely sounds like a good move for you - for peace of mind, if nothing else.  I'll admit I take blatant advantage of the fact that my father is a physician - even though it's been ages since he's done anything except ophthalmology, he did go through medical school first.  I really do appreciate that I can call him up in the middle of the night with questions about "XYZ happened; is this serious enough I need to [go to the ER | wake up Sonja's real doctor | call my doc first thing in the morning and demand to be seen]?"  I don't have to trust the internet to find answers about "What do I take for ABC symptom?" or "Could X be causing Y reaction?"

Not everyone has this (and I know I won't have it forever, either) - but it's a primary reason we picked the peditrician we did.  We can call after hours and get a call back in less than 20 minutes from the girls' actual doctor, not just a nurse or whoever happened to be on rotation that day.  They're always running late, but I can deal with it because I know it's due to the doctors being so good about fitting in kids to be seen ASAP when necessary!

My endocrinologist went to this model a few years ago, and though I initially almost passed out at the cost, what it's gotten me is far better care, immediate access when I've needed it (even when I had a crisis in CHINA!!!), and (*gasp of real incredulity*) an actual relationship with my doctor. I'm so tired of dealing with the stressed out, take-a-number care from my GP that I'm considering finding one that does the same thing. I applaud your decision wholeheartedly and I know you'll be glad for the peace of mind for you and Jeff. :)

You're the first person I've talked to who has actually done this. It's comforting to hear that it actually works as described. If it really does, then I think it's likely to be worth it, but it's a hell of a leap.