The paradox of what we do

[FrustratedFamDoc]

You concierge/DPC guys don't really apply to this one (I'm jealous).

I want nothing more than for all my patients to feel great, not smoke, take great care of themselves, and need all of 0 prescriptions on a daily basis. Saw a really interesting new patient yesterday that dovetails nicely with what I'm getting at. 20 years in the navy, then fire/rescue, then 8 more years contract work in the middle east. He's been shot down in a helicopter, blown up by a suicide bomber requiring a 3 disc cervical fusion and has some lower back troubles to go along with his numerous other althralgias. his med list: lisinopril/HCTZ. Doesn't even take an NSAID and he has 40 years of hard living. Mood and more importantly, ATTITUDE are great. I'll see him twice a year, if I'm lucky.

If all my patients were like this, I would LOVE IT but I couldn't keep the lights on in the office. If you think about it, it's the 20-30% of frequent fliers that keep most of us fee for service guys going.

Discussion.

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[deleted87716]

Yep. I've had a handful of patients over the years who actually take my advice with regard to diet, exercise, weight loss, smoking cessation, etc. and either dodge the bullet (e.g., don't become diabetic) or end up being able to stop most or all of their meds. It's usually the younger ones (>50), and mostly men (oddly enough, but maybe that's a sampling bias).

 

[VA Hopeful Dr]

You concierge/DPC guys don't really apply to this one (I'm jealous).

I want nothing more than for all my patients to feel great, not smoke, take great care of themselves, and need all of 0 prescriptions on a daily basis. Saw a really interesting new patient yesterday that dovetails nicely with what I'm getting at. 20 years in the navy, then fire/rescue, then 8 more years contract work in the middle east. He's been shot down in a helicopter, blown up by a suicide bomber requiring a 3 disc cervical fusion and has some lower back troubles to go along with his numerous other althralgias. his med list: lisinopril/HCTZ. Doesn't even take an NSAID and he has 40 years of hard living. Mood and more importantly, ATTITUDE are great. I'll see him twice a year, if I'm lucky.

If all my patients were like this, I would LOVE IT but I couldn't keep the lights on in the office. If you think about it, it's the 20-30% of frequent fliers that keep most of us fee for service guys going.

Discussion.

I'm actually looking to sell my DPC practice if you're THAT jealous (its going great financially, but we're relocating for family issues and I can't take it with me).

I would say I have better success now than in FFS, but its not a huge difference what with human nature being what it is. If we say that maybe 5% of regular patients actually take advice and get better without drugs in FFS, in DPC I might get up to 8-10%. Sure its more, but still an irritatingly small number.