AAPP President, Dr. Marcy Zwelling responds to Dr. Michael Stillman’s article in The Annals of Internal Medicine:

Thank you to Dr. Michael Stillman, for a reasoned article about “concierge” medicine.  His questions about validating that those of us who enjoy the opportunity to work more directly for our patients actually results in “better quality care” at a lower overall cost are just and appropriate.

There is in fact literature to suggest this is the case. In 2006, Wasson, Johnson, et al. published in the Journal of Ambulatory Care Management,  that collaborative care, a centerpiece of direct care, was associated with better blood pressure management, blood glucose level, serum cholesterol level as well as better pain control and  better control of emotional issues. The American Academy of Private Physicians is in the process of initiating a study that will prove conclusively that spending more time with our patients and being available 24/7 does make a difference in the quality of care we offer.

That said, I do want to make a single criticism of the valid challenge that Dr. Stillman has voiced.  He assumes (as do many) that “quality” care is about meeting a set of established “best practices.”  I believe that quality of care is about providing our patients with that better, more productive day.  Sometimes, that means understanding your patients “real” question, his or her level of anxiety and worry, or the fact that they value their time very highly.

Dr. Stillman has established that he takes good care of his patients and he cares about them deeply.  But, patients, as humans, have other ill-defined needs that must be addressed in order for  them to be productive and in control of their lives.  Direct practice physicians are better able to meet that need because they have created the time to make that happen. It has already been proven that P4P and other paper-based controls and initiatives are time consuming and do not offer the value-based opportunity government and other administrative authorities had hoped for. Quality of care analyses belong to our patients not to administrators.

Direct practice physicians hope to take back the profession by re-establishing that the patient-doctor relationship is the cornerstone of quality and affordable care.

Finally, please do NOT assume that our patients are wealthy. They are not all wealthy. Those choosing to pay for their care directly make a value-based decision about their healthcare.  Some of my patients have chosen to purchase my time and dedication in lieu of vacations or new cars.

10% of my patients do not pay me one dime. They receive care in exchange for offering their time at a charitable organization in the community.  America’s patients have the right of self determination regardless of the size of their bank account.  This is not an insurance issue, or a government obligation.  America’s doctors should seize the moment to work directly for their patients.  The self-respect that it offers both patients and doctors could be the substance the country is looking for to climb out of the doldrums and distrust we have found ourselves in over the last decade.