Your Voices

On practicing virtual medicine—and getting paid for it

"E-care, or virtual medicine, will become commonplace and at times indistinguishable from actual care, as broadband and home monitoring become less expensive and of higher quality. The ability to accurately monitor and, in some cases, diagnose illness (via secure video, audio, and biometric devices) will allow much of what we do in the office to occur more conveniently, and perhaps more economically, for both doctor and patient. Regular monitoring of patients with high blood pressure, congestive heart failure, and diabetes will probably be better done in this fashion than with sporadic office visits.

While simpler communication between patient and physician clearly can improve efficiency and productivity, the proper mechanism is not unsecure e-mail. While true e-care is probably a few years off, secure messaging is available now and makes possible HIPAA-compliant communications between doctors and patients. It takes under a minute for your front desk to process an elective appointment request in this manner, compared with a five-minute phone call to accomplish the same task.

I would never encourage physicians to provide care over the Internet, however, without its being considered compensable time. Otherwise, when we reach the point where a good part of our day is spent on e-care, we will find that our income from practicing medicine approaches zero. I would urge instead that we start now to develop a more thoughtful definition of physician work, which will lead to a future where the provision of care in any setting is valued and reimbursed appropriately."

—Peter Basch, internist, Washington, DC

On being just like Dad

" As a boy in the 1930s, I was very proud of my dad, a country doctor in upstate New York. He was the smartest guy around, and people respected him (and indirectly our entire family) enormously. Such phrases as 'You're the doctor' and 'Just what the doctor ordered' were very familiar around our house. I wanted to be just like him.

To become a doctor was my notion of the American dream. Among my true loves back then, it was right up there with baseball. So after medical school, an internship, a military tour in Korea, and a residency in general surgery, I was ready to start living my dream.

Faced with the responsibility of a wife and two children, I took a job with Kaiser. I never liked the idea of having a job (it's hardly the same as having a dream), but Kaiser was a good experience. I got to do plenty of surgery, far more work than I'd have garnered on my own. After just two years, though, my yen for the dream—private practice, being my own guy, being like my father—drew me away. Burning with idealism and enthusiasm, I went out on my own. Looking back, I've never made a better decision.

Today it saddens me that a young doctor can't jump into medicine with the same fire I did. No longer the joy it once was, the profession has been consumed by those who would control it. No longer is a therapeutic decision 'just what the doctor ordered,' but rather what the HMO will allow. We no longer decide what we're going to charge; we're told what we may charge. We no longer pay $175 for liability coverage (as I once did); we pay five figures. In essence, the practice of medicine has become a virtual reality; my dad wouldn't recognize it.

So, should the situation dissuade today's young man or woman from entering medicine? If the student finds his enthusiasm and idealism outweighed by these and other realities of the modern physician's life, if he's no longer chasing his dream, then I think he should look in another direction. All he's giving up is a job."

—Robert T. Schorr, general surgeon, San Diego

On promoting your practice with a health fair

"Last fall, more than 350 people came to a health fair to celebrate the grand reopening of our practice, the Family Health Care Center in Royal Oak, MI. We had two objectives: to thank the many patients who had supported us for nearly 20 years, and to increase our visibility in hopes of attracting more patients from the surrounding community.

We started with a ribbon-cutting that included our two oldest patients, both in their 90s, and our youngest, a 9-month-old, to symbolize the spectrum of our patient care. We also unveiled a cornerstone. The facility has been nominated for a small business and professional Building of the Year award.

People who came to the fair could receive $5 flu vaccines and any number of free tests: vision and hearing screening, cholesterol testing, spirometry, bone density testing, fat analysis, and Doppler scanning of the extremities. We also showed patients how to navigate our practice Web site—and our automated phone system.

In turn, they learned about our practice expansion. What started in 1981 with two doctors, four staff, six exam rooms, and 1,250 square feet of space has grown to five doctors, 20 staff, 18 exam rooms, and 8,650 square feet.

More than 20 sponsors—a combination of pharmaceutical companies and local merchants—took part, providing literature and giveaways. We also included face painting, a magic show, and a coloring contest for the kids along with raffle prizes for the adults, ranging from $10 gift certificates to a $500 annual fitness club membership.

Want to run your own health fair? Consider these tips:

• You need a central coordinator and a media relations person. And you need to start at least four to six months in advance.

• You also need to agree on a focused objective, like our aim to enhance visibility.

• Pick a charitable organization to promote in tandem with the event. We chose the Make A Wish Foundation and made a generous donation to the cause. It became a win-win situation.

• Hold meetings with individual sponsors well in advance of the fair.

• Promote the event with articles in the local paper, flyers in grocery stores and pharmacies, and broadcast faxes to local businesses. I was able to get on a popular TV call-in show the morning of the event and left my beeper number, which was pre-set with information about the fair.

• Write thank-you notes afterward to all organizations and businesses that supported the event.

We feel the fair helped create a higher public profile for the practice, in both the residential and business communities, and gave our two newest physicians a boost. We plan now to do a minifair yearly, focusing on niches of our practice that need growth and development.

We spent about $12,000 on last fall's event, and every penny of it was covered by sponsorships and donations. It worked for us—it could work for you."

—Paul Ehrmann, family physician, Royal Oak, MI

For more details on setting up a health fair, e-mail the author at PAULEDO@aol.com or visit his Web site at www.docpaul.com. .

 

Jeff Forster. Your Voices. Medical Economics 2001;7:26.