I got a letter from my doctor a while back letting me know that he was changing his practice type (he’s becoming a concierge doctor, in effect) and beginning in May, I would have the opportunity to become part of his “smaller, more personal” practice… for a small monthly fee. He promises to see fewer patients, be on time, spend more time with each of his patients, and provide on-demand service, 24/7 as they say. And because he’ll have a smaller case-load, he’ll be able to stay up-to-date with the latest medical information and techniques.
This news was disappointing because I’ve really come to like my doctor. He’s about my age, so he’s got some experience and I’ve never felt that he was rushing my appointments. I always trusted that he was staying current with his medical know-how and lord knows I’ve gotten lots of tests over the years. The only difference I can see in the change in his practice is that it will cost me more out-of-pocket (“For about the cost of your monthly cable bill. Isn’t your health worth it?” That’s the way it’s advertised. Well, to tell you the truth, I’m not that happy with my cable service.)
I’ve decided not to continue with my current doctor, but here’s what I’ll be proposing to the new one, when I find him or her: I’m going to become your “concierge patient.” For a small monthly fee (I haven’t decided how much yet, but it will probably be about the cost of your monthly car payment, if your car is a Mercedes S550), I will be available for medical issues 24/7. If I’m ill at 3:00 a.m., I’ll be happy to let you come to my house to diagnose my problem. If I need tests or referral to a specialist, I’ll split the cost with you, over and above what Medicare pays. I promise to be on time to my appointments (or no more than an hour late) and spend as much time with you as you think appropriate, even if it takes all afternoon to figure out why I have a pain in my elbow/knee/big toe. I’ll gladly let you take your free time in the evening to keep up with your reading (except when I need you to come to my house at 3:00 a.m., of course) and even bid you “bon voyage” when you go on vacation, except that I expect you to come right back from Spain, Greece or the Caymans if I’m sick.
If you agree to these terms (and why wouldn’t you; I’ll be a great patient), please sign and date below and expect a call at say… 3:00 a.m.
Let the waters come... 
Dear me…sad really but love your reaction !
Such is the state of the health care system in the U.S. Everyone – doctors, hospitals, patients, insurance companies – are scrambling to fit themselves into what they perceive to be new slots in the game. For most patients, the game hasn’t changed, but Fox News and the Tea Party have whipped everybody into a frenzy about the Affordable Care Act. There are lots of companies now that are trying to skim off the best doctors into these “managed care” systems. Interestingly, yesterday, I got a recorded call from my doctor saying that he has decided not to change his practice and that everything will continue just as it is. His practice is mainly those of us over 65, so I’m guessing he got an earful about his plans and decided that he’d keep his current caseload until he retires in four or five years. I’m sure most people are relieved because he’s really a very good doctor, though some have already found new doctors, so his practice has become smaller in fact.
We count our blessings here..but the Uk is perilously close to jeopardizing its universal care system….