Tuesday, March 31, 2009

Time for a Change

Patients come to Qliance from many different places. Some come to us from excellent, long-term patient-doctor relationships, others come from having no doctor at all. Some are unaware of the challenges the current insurance-based system presents, others, like Tess, join Qliance because they are simply fed up. In the letter below, Tess shares her frustrations with her former doctor and expounds on some of the many downfalls of our current medical system.


February 16, 2009

Dear Doctor,

I wanted to let you and your colleagues know the reason for my leaving your care. I have been a patient at [your clinic] for several years, but have now become a member of Qliance, a relatively new practice in downtown Seattle.

Since I am self-insured and carry a high-deductible “catastrophic” plan (for which I pay $163 monthly), I rarely come to see you unless it’s really necessary. The last time I came in was for my shoulder, which I had injured when I fell on the snow. I talked with you for maybe 4 minutes, x-rays were taken, and the visit cost me $180.

I understand that the insurance companies are really at fault here. They require you to handle a certain volume of patients, and you don’t have much time with each one. I’m sure you and your staff spend countless hours documenting every diagnosis and recommendation to the insurance companies. I’m not alone in believing that the insurance companies have become an evil pox on our medical system.

To give an even more extreme example, last year I cut my hand with a utility knife and went to the emergency room. For 4 stitches (and the appropriate cleaning and tetanus shot) I paid $1200. It’s criminal.

I recently heard about Qliance, which is a group of doctors who have formed a practice based on patients paying a monthly membership fee. They don’t accept insurance and are able to offer all kinds of preventative and simple urgent care on site, with discounted prescriptions and lab tests at just over cost. I pay $69 monthly and can see my doctor as often as I want-for no additional payment.

I went to my first visit last week and was astonished that the doctor spent over and hour with me, getting to know my medical history and me. Today I had my pap (no charge), breast exam (no charge), blood tests ($21) and some skin tags removed (no charge), which all took about an hour and a half of my doctor’s time. Finally, she has suggested I try changing from Lexapro to the generic (Citalopram Hydrobromide), which will cost $4/month instead of $93/month.

And just so you don’t assume that they are a government-supported, low-income clinic, they’re not. Their monthly membership rate is based solely on age, not income or any other factor. For more information, they are at
www.Qliance.com.

I appreciate that you’ve always been kind and encouraging when I’ve come to see you. I think you’re a very nice person. However, the consistently short amount of time I spend with you when I come in for my infrequent visits often leaves me feeling like I’m a piece of meat on an assembly line. And while the medical assistants have always been polite, the office staff has always given the impression of being way overloaded, stressed and hurried. They never ask how I am, what the weather is doing or other small talk and on the phone they are clearly just trying to get to the next phone call-probably because they have too much to do among too few staff.

I’m sorry to write so negatively about your clinic, but I thought it was time to let you know. I don’t blame you personally, but rather, I blame the system where insurance companies can dictate how many patients you should see in a day or a week, and how much paperwork the support staff is require to manage. Maybe clinic like yours have a high profit margin and everyone is getting paid way too much. I kind of doubt it.

However, in writing this I realize that there is a very basic thing that your clinic and others could do if you really cared: ask your patients about how they feel about the service provided. For so long I have just assumed that the way I’ve been treated by the health care system is just something to put up with, but now I’m thinking, do you really not care to ask your patients how you’re doing and try to improve, just like most other businesses take the time to do?

Please feel free to share this letter with anyone you like, especially your partners and/or the insurance companies. I know it won’t make a big impact, but it’s time for something to change in our country’s medical system and I wanted to voice my opinion for whatever it’s worth.

I wish you well.

Sincerely,
Tess



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