What's Best For You As A Patient

Amidst all of the talk about health care at a national level, doctors are quietly changing the local face of medicine a little at a time.

A doctor in downstate Illinois was reported to be giving his patients a document to sign before he will treat them. Part of the document provides that the patient "understand(s) that meritless and frivolous claims for medical malpractice have an adverse effect upon the cost and availability of medical care, and may result in irreparable harm to a medical provider. As additional consideration for professional care provided to me by Physician, I, the patient/ guardian and/or my representative agree not to advance, directly or indirectly, any false, meritless and/or frivolous claim(s) of medical malpractice against Physician."

First, that doctor incorrectly asserts that patients are filing frivolous actions. Lawyers cannot accept frivolous medical malpractice cases that could cause them to lose up to $100,000 in costs and experts' fees to prepare a loser for trial.

Second, this contract of adhesion has no other purpose than to serve as false propaganda to poison the patients' thinking and the jury pool with the false notion that frivolous medical malpractice cases are causing harm to health-care access and cost.

The unenforceable contract goes on to say that "should a meritorious medical malpractice case or cause of action be initiated or pursued, I (the patient) and/or my representative agree to use American Board of Medical Specialties (ABMS) board-certified expert medical witness(es) in the same speciality as Physician" who are in good standing. This is also meaningless, as Illinois law already requires qualified experts in a medical malpractice lawsuit.

Other doctors in the Chicago area are taking a different tack that may be the wave of the future.

Some doctors are taking a limited number of patients, say 300 to 500, and then promising what is called "concierge service." The patient plays a flat annual fee of about $1,700 a person. What that patient gets is a guaranteed return call within an hour, even on weekends or if the doctor is on vacation. The doctor promises to be responsive by sending return e-mails within the hour. Annual physicals include sitting down to discuss your overall health for an hour or so. Routine blood tests are conducted at cost.

This may sound like a dream come true, except when you remember that insurance should be covering all of this already. And what if, thankfully, you don't even need the doctor that year? Even if you do, what happens when the inevitable occurs - one needs medical attention requiring a specialist, something out of that doctor's realm of knowledge?

For those who aren't yet receiving "concierge" medicine, it was recently reported that some medical groups are charging for e-mail responses. It is accepted that patients are expected to pay sometimes to reprint records, but now some Northwestern Medical Faculty Foundation doctors have decided to charge for nonemergency responses to patients.

The foundation is open 8 a.m. to 5 p.m. weekdays. Starting in late September, patients of the foundation's general internal medicine division - doctors who teach at Northwestern University's Feinberg School of Medicine and practice at Northwestern Memorial Hospital - were told they will be charged $25 a call to their doctors outside of office hours.

I have always quipped to my friends and family members that it isn't wise to get sick on weekends or holidays. Most private doctors work on a rotating basis during those times and often the more inexperienced personnel are the ones stuck with these less desirable shifts. The foundation, recognizing that people do indeed get sick at times other than during business hours, said in its letter to patients that it wanted to provide more "efficient service" without compromising quality.

The letter also said that an e-mail consultation will cost $25 and missing a doctor's appointment without a day's notice will cost the patient $50. The story in Crain's Chicago Business reported that the doctor would not charge the online fee if it leads to an office visit within seven days of the initial contact.

"This is about a thoughtful medical practice trying to enable its physicians to provide care to as many patients as possible without becoming overwhelmed," Dr. Jeffrey Glassroth, president and CEO of the foundation, told Crain's."This initiative is primarily being done to enhance service and spread work evenly."

With all due respect, it appears that it is simply to collect more money. It's not clear that such service could be reimbursed by one's health insurance company, so if patients need to speak to a doctor that urgently, it is likely they will get stuck with the fee.

Certainly, the face of medicine has changed in the past several years and it will certainly change even more. It really comes down to whether doctors are really good communicators.

Is there really time for true informed consent in a patient visit that is scheduled for 15 minutes or in a phone call or e-mail?

Patients are entitled to ask necessary questions to find out their choices and to decide the proper course of treatment. It appears that medicine may be headed in a different direction.