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« Can you please shut up? | Main | Well-Chosen Words in the Doctor's Office »

June 07, 2009


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Is there anywhere in the world where boutique care exists short of fee for service? I don't believe so but if there is, we should pay careful attention.

Difficult problem indeed.

Kairol Rosenthal

That is what I call burying the lead.

I once had an endocrinologist who I saw for my cancer care. He operated in much the same way, though instead of no insurance, he took only patients with Blue Cross Blue Shield PPO. He had one secretary and she still used a manual typewriter for all of her work. There was never a wait - not much chance for me to leaf through his waiting room binder with clippings of wry New Yorker cartoons mocking the cost of health care and the absurdity of the system.

My BCBS PPO coverage was through a state high risk insurance pool for people who had been rejected from other plans because of pre-existing conditions. It was great to avoid red tape and gets tons of uninterrupted attention from him. Yet, I chose to leave his practice because it missed the university teaching environment. I don't care how much attention I get, I want access to the docs who are chatting with other docs daily about research and new breakthroughs. Give me the red tape headache, 5 minute appointment and all. In the long run, better care is a more educated doctor in a bustling medical setting with rapid exchange of ideas. If I yearn for a boutique experience, I'll get it by window shopping downtown.


Wendy S. Harpham, M.D.

Dear Kate,
No, I don't know of a modern boutique practice that does not charge boutique-practice fees.

Dear Kairol,
You make an excellent point, one I agree with completely and make clear in HAPPINESS IN A STORM: Healthy Survivors separate issues of quality of life and quality of physician-patient relationships from quality of care.

If you feel cared about and comforted, but you are not receiving optimal medical treatments for a serious disease, you are not a Healthy Survivor.

An post in the upcoming week will address this specifically.

With hope to all, Wendy

sue chizeck

As I recall, the British system is capitated, that is the doctor is paid a monthly fee by the government for all the patients on his/her "list." So they have a set income. However, I have heard about people having long waits in a clinic, so presumably they have more patients on their list than they can comfortably see, unlike boutique practices.

Wendy S. Harpham, M.D.

Dear Sue,
It's important that people weigh apples against apples. To do that, issues like "long waits in a clinic" or which treatments are covered (allowed) must be clarified. I'm sure we'll be discussing this topic through the blog over the next few years. Thanks. With hope, Wendy

julie weed

Hi - i think you might have misread. Dr. Batlle in NY does take insurance. It's the other example, Dr. Sacks in Seattle that does not. Dr. B lowers his overhead through a variety of tech solutions, not just EMRs. thanks

Wendy S. Harpham, M.D.

Dear Julie Weed,

Thank you for pointing out my unintentional error. I see now that I assumed Dr. Batlle and Dr. Sacks were in same practice situations. I will make a correction.

Thanks again! With hope, Wendy

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