Sep 13, 2010

I, Medical Concierge Doctor

I, Medical Concierge Doctor

Hello friends, my name is Dr. Alan Terlinsky and I am presently converting my long-established medical practice in Arlington Virginia into a concierge or membership type of private practice. Essentially I am making this decision in order to continue practicing the only type of medicine I have known… excellent medicine!

The Road to Being a Concierge Doctor

I attended Georgetown University School of Medicine where I completed my medical residency and fellowship in diseases of the kidney (Nephrology). I became certified by the American Board of Internal Medicine and certified in my subspecialty of Nephrology.  Along the way, in order to remain broadly engaged in general medicine and to support my young family, I moonlighted in emergency rooms and a US Army primary care clinic. I learned how to bridge the gap between super specialization, treating very complicated and extremely ill renal dialysis and transplant patients, as well as caring for patients with common medical conditions such as colds, coughs and skin rashes.

Guess what? The super specialization was easy compared to the broad knowledge I had to obtain to be a complete physician by practicing and mastering general medicine. Immediately after going into practice I began to alternate my continuing medical education courses between specialty areas and primary care. One meeting it was renal, endocrinology, cardiology, the next it was asthma, skin moles and low back pain. I choose to take courses completely out of my specialty of Nephrology such as in Rheumatology to remain diversely trained.

I can remember being at the annual meeting of the American Rheumatology Association. When my fellow attendees found out I was a Nephrologist, they asked me “why the heck are you at this meeting? Why not just worry about the kidney?“  I responded that I felt specialists were doctors who continue learn more and more about less and less and one day they woke up and knew NOTHING! They are “leaf “ doctors, knowing only about a much narrowed area as opposed to “root’ doctors who look for the basis of medical problems. I preferred to be both a leaf doctor (Nephrologist) and a root doctor (Generalist).

It was my goal to learn as much as I could about the developments in medicine and to teach what I had learned to younger doctors. I have had teaching appointments at two medical schools Georgetown University and George Washington University for my entire career, I have lectured to my peers and I have given many "Grand Rounds“ at my hospital. I did this and continue to do this to keep sharp and always up to date.

The Necessity of Time

While being informed and broadly updated in both Nephrology and General Internal Medicine was the key to having the skill sets for providing excellent medical care, another factor determined whether superior care actually was achieved. The factor was TIME! Yes, spending the time to obtain a detailed history and physical exam on a patient was absolutely required. The most brilliant physician will not provide proper care, particularly with complicated patients, if for any reason they cannot devote the time for proper evaluation, analysis and communication in treating patients.

It is very time consuming to carefully question patients about their symptoms and to assess the significance of their responses. The patient with chest pain could have anything from heartburn, to a pulled muscle or a serious life threatening heart problem. Patients always don’t provide clinical information in perfect, easy to interpret fashion. Some patients don’t understand what they are being asked. Others may have self diagnosed beliefs or wishes about the symptoms they have and will provide misleading information. Often patients will omit important information which will only be obtained by a careful and detailed interview.

Patients also need to be properly examined. They need to be placed in gowns and a systematic approach taken. Blood pressure and vital signs need to be recorded and all this takes time. How can a patient be screen for skin cancer if they don’t take their clothes off?  A single high blood pressure reading does not mean the patient has hypertension. The reading needs to be taken a few times and again it takes time.

Over the course of my career, I have avoided any situation which compelled me to skimp on time with patients. Factory assembly line clinics or capitated HMOs demanding doctors see “x” number of patients per hour was, and never will be, my style. Excellent medical care breaks down under those circumstances. Sadly, the economic and governmental forces of the past 25 years have demanded that physicians take less time with patients. As we will, see, today doctors are to the point that if they don’t drastically increase patient volume during office hours they will not survive economically.

This has resulted in the 5 minute visit, the maximum of one complaint per office visit, the increased “outsourcing” of patients to specialists by referring anything which may be time consuming to treat. This is all because doctors have been so squeezed by insurance company reimbursement and governmental program reimbursement like Medicare that they are actually losing money when they take the time needed for proper patient care. The result is deteriorating, inefficient care which fails to provide what patients need.

My Choice

Instead of going that direction, I have chosen the concierge medicine model which preserves the ability of a doctor to provide the best care to patients. This is because concierge medicine does not penalize the doctor for taking the time necessary to properly.

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