The Doctor Is In, If You're Under 40

As many of you know, I work in health policy. I know a lot about the practice of medicine in this country. So this story that hit the blogosphere today struck my fancy: A young doctor in NYC has set up a virtual practice, limiting his patients to the under 40 crowd. He doesn't see people over 40 because they could be *big gulp* actually sick. He charges people with insurance less money than he does people with cash (and they say medical schools don't teach doctors how to make money). Hospitals and clinics aren't "his thing." To get a better idea of this plastic, fantastic doctor, see interview below.

I sincerely hope he is flooded with hypochondriacal phone calls from 20-somethings with major mental illness. Is that mean of me?

How did you get the idea to do this?

Well, I’m not a typical doctor. I get along fine with other physicians, but I didn’t enjoy the hospital or clinic environment. I’m a photographer as well. I shoot for Men’s Journal and stuff like that.

Are there any special hurdles to running your practice this way?

No, not really. You have to have your New York State license. The e-visits are more for things like acne, allergies and follow-up labs. Things that aren’t life-threatening. There’s no way in hell I would prescribed narcotics online. It’s a kind of telemedicine. People have traditionally used it for access [for care in rural areas]. I’m looking at it as a way to practice convenient medicine.
Is your service cash only?

If somebody has insurance, I’ll charge them less and provide them with receipts. You can get cheaper care. But you can’t get it immediately, nor will you get care where people will help you spend your money wisely. I’ve spent the the last two or three months calling physicians associated with the best hospitals in New York City and getting their prices. I called one radiologist and found he’d do a chest X-ray for $75 and another would charge, say, $300. For cash-paying patients the prices are all over the place. I’ll make referrals based on quality and price.
What’s your online process for taking a patient?

I have a few questions that I ask whenever patients contact me. Name, age, that sort of thing. If they’re over 40, I’m not going to see them. The disease profile changes after that. If you’re under 40 you have the same disease profile as an older child, adolescent or young person that I saw during my preventive medicine and pediatrics training. I’m not going to deal with people who have old-people diseases.

How many patients do you think you’ll take on?

I want to keep this small. About a 1,000 patients. It fails in its mission if it’s a large corporate thing.

Without an office, how will you pull this off?

I run this entire thing off my iPhone and a laptop. I can access any patient records from my iPhone. Patients can make an appointment on my website and it’ll text me and I’ll go see them. This is, to me, what’s missing from medicine: personalized attentiveness. Going to someone’s home allows you to get to know them ridiculously well.

Sicko, the movie

David and I went to see Sicko this evening.


Two thumbs up. Way up.



Since Ms. Duncan asked me to give my thoughts on this movie, I thought I would post a couple of my thoughts as I watched:

• The government spends a lot of time dissing lawyers - especially trial lawyers. Why? 'They' drive up malpractice costs. Or 'they' bring frivolous lawsuits. But quite frankly, in this movie (and in real life) the only noble people bitching about health care are lawyers. In the movie it is either plaintiff attorneys suing for the benefits of patients against health insurance companies or in the despicable case of the patients being dumped at the mission on skid row in LA - the City Attorney's office sent a lawyer down there to be nice to the poor woman who had been severely beaten. No doctor was in the room with the woman attending to her pain, but the city attorney asked the woman "are you in pain? Is there anything I can do for you?" Why are people so afraid of lawyers? One possible answer: lawyers can demand justice for those suffering in a very unjust situation, which is threatening to those who are profiting from a very unjust system.


• If anything, Michael Moore did not go far enough - the greed doesn't stop at insurance companies or hospitals. Heck, everybody knows about the doctors. It's the hidden and unexpected greed mongers that will really make you sick - he touched a bit on the pharmaceutical industry, but it doesn't stop there. Think about all the sycophants who produce the merchandise that gets sold in healthcare settings, anything from stethoscopes to swabs to bandages, etc. The mark-ups and bad business dealings are rampant in every setting. If you want to understand the scope of the problem, I suggest you read a few other blogs who document it on a daily basis. Start with Health Care Renewal, which is a bunch of doctors who publish stories about excess, waste, fraud, etc in the US health care system. They post, on average, about 3-5 stories a day.

I'm sure I'll have more thoughts about this movie as I get further away from it, but for now suffice it to say: if you live in this country and are at the mercy of this healthcare system, it should be required watching. And in the meantime, stay healthy.