From Steve Dubansky, MD, SVP, Medical Director, Palio
I read with interest Sven Larsen’s Pixels & Pills blog post praising Dr. Parkinson’s no-office-all-house-call medical practice. Dr. Oz agrees, calling Dr. Parkinson’s idea “slick and smart.” But is it really? And do I want my doctor’s practice to be slick and smart?
As much as we rue the disappearance of the good old days when all doctors were Marcus Welby, when all took time with their patients, and all practiced medicine with the same idealism that they felt (or confabulated) when they wrote their med school admission essays, house calls aren’t the answer.
How many patients can Dr. Parkinson see in one day? I imagine that number to be far fewer than he could see in his office even if he took as much time as needed with his office patients. How much does he have to charge for each visit in order to make enough money to make a comfortable living? I’m sure it’s far more than he would need to charge in order to earn a decent living from an office practice. Is this model more like a boutique practice? Who’s going to see all the patients who can’t afford house call charges? Who will see all those whom a very well meaning Dr. Parkinson can’t quite get to each day?
Dr. Parkinson says this about his business model: “It’s paying attention to what’s awesome about Flick’r and then doing it.” I would prefer that my office model be nothing like Flick’r. At the risk of seeming to be a Luddite, I’d much prefer it be more like a newspaper, the old fashioned kind that you hold in your hands, taking all the time you need to understand each article and to draw a well thought out conclusion.
Sadly, not all well-meaning efforts to improve the quality of medical care result in meaningful improvements. Electronic health records (EHR) have a lot to commend them, but they are no guarantee of better care. During my last two office visits to a dermatologist and rheumatologist, I had the great displeasure of realizing that neither of them, while furiously typing away on their EHR tablets, made more than momentary eye contact with me during my brief (aren’t they always?) visits.
The answer to humane, compassionate, medical care isn’t a boutique practice, house calls, or EHRs. It’s simply competence, a keen mind, and a caring attitude that is unfailingly empathic, communicating understanding, patience, and respect for those the doctor is privileged to call “patients.” And an office works just fine.
