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Jewish World Review
Dec. 12, 2008
/ 15 Kislev 5769
Medical Humor Or is it? Massachusetts resorts to patient group visits with the doctor
By
Michael Arnold Glueck
http://www.JewishWorldReview.com |
At times this writer has attempted to scribe humorous or satirical
medical-legal columns. However, the following is really true, as
substantiated by a release from The Association of American Physicians and
Surgeons, which noted that Massachusetts is now resorting to patient group
visits with physicians.
Massachusetts, the once proud Universal Coverage model for likely
Obama-Kennedy reform, is trying a new answer for the problem of a severe
doctor shortage: group appointments.
Deluged with demand from newly insured patients, doctors have no room on
their appointment schedules for all the new patients. At Holyoke Medical
Center it takes 4 months to get an appointment.
A patient with chronic Lyme disease couldn't find a single primary physician
in three towns who would accept a new patient, so she went to the emergency
room, recounting her history to a different intake nurse for all medical
needs, including her regular prescriptions.
The Massachusetts universal coverage law required 440,000 more people to buy
insurance or sign up with expanded Medicaid, and every one of them has to
have a primary doctor in order to get into the system. Yet in the past year,
18 primary physicians have left the Amherst area (All Things Considered
). , NPR
11/20/08
Harvard Vanguard Medical Associates now features "shared medical
appointments." Dr. Gene Lindsey, reputedly HVMA's best cardiologist, sees
all his patients in groups. HGMA plans to offer group appointments with 50
physicians and nurse practitioners (Kowalcyzk, "The Doctor Will See All of
You Now," Boston Globe 11/30/08).
One group appointment, featured in a Boston Globe video showed nine
patients seated in folding chairs around a table with snacks. Dr. Erickson
shook hands with each of them and examined them one by one, discussing their
medical details aloud. The video showed him listening to and percussing
chests through clothing.The appointment lasted 90 minutes. This is said to
reduce doctor and patient dissatisfaction about feeling rushed during a 15
to 20 minute visit.
Patients are pleased that they are spending much more time in the room with
the doctor. Some patients are said to benefit from hearing others describe
their symptoms and ask questions.
"People came to me with similar complaints and I had these canned speeches,"
Erickson explained.
Patients have to sign a form promising not to reveal information they learn
about other patients.
The doctor can bill for nine individual visits for the time period in which
he previously could have seen only four to six individual patients. He can
thus increase his productivity without having to work more.
In response to the Globe column there were many comments and not all
patients were pleased.
One wrote: "Nice business model if you can achieve it. Convince state
lawmakers to require everyone to 'get' medical insurance which is really
privatized medical taxation. Now convince the check-writing insurance
companies that it's justified to pay you the same for less service. Sorry,
sharing the appointment with others is less service."
Another said: "There aren't enough doctors because doctors are required to
practice high-speed cookbook medicine. So their answer is to speed it up
more so patients can listen to canned speeches together?"
One reader said: "A Third-World standard of care with many people being seen
by a doctor at the same time, sharinggerms. A 'commoditization' of human
beings. Having to listen to all the other patients is a 'tax' on people's
time."
One idealist thinks it's just what we need: "I think that as a nation we
need to move AWAY from rampant individualism toward a system that embraces
shared responsibility in a community. You are more likely to follow those
pesky lifestyle recommendations if you feel like you'll not only be letting
down yourself and your doctor, but also your community."
The appointments are "voluntary"although possibly the only kind available
for months. They are focused on health care, not sickness care: "1)
education, 2) individual goals, expectations, and treatment plans, 3)
self-management strategies, 4) developing a personal action plan.
Many physicians responded to the AAPS news release.
One wrote, "It's getting closer to quitting time."
Another wrote, "What happened to medical privacy? What has happened to the
HIPPAA regulations in these group appointments? What will the future of
these grouped meetings among patients and a single physician bring? Lawsuits
with regard to consequences of revealing medical secrets, weaknesses
mortality and threats to others who might use information against another
member?"
Noted another doctor, "This sort of de facto rationing is an inevitable
consequence of the "Massachusetts plan". Unfortunately, there are powerful
Democrats who wish to impose this system on the rest of America."
Responds one physician, "Of course this is not the type of medical care
anyone with a modicum of intelligence would want. But don't forget the
facts50% of the population has a below average IQ."
Obama needs to look no farther than Massachusetts for a [bad] model, notes
one writer. One small problem: Massachusetts knew it was not addressing the
cost issue. Annual state spending could top $1 billion by 2009 (Workforce
Management ).
11/11/08
This writer wishes Obama well - however, should the nation adopt the
Massachusetts group model -- my personal fear is that partially clad
patients will be seen running from examining rooms at an alarming rate.
Stay well, my friends.
Every weekday JewishWorldReview.com publishes what many in the media and Washington consider "must-reading". Sign up for the daily JWR update. It's free. Just click here.
Michael Arnold Glueck, M.D., writes on medical, legal and allied social issues in numerous newspapers, magazines and journals locally, nationally and internationally. He is widely quoted in the media.
Comment by clicking here.
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