As part of my ambulatory medicine clerkship, I rotate through the practices of different physicians. One of my clerkship settings takes place in a concierge medicine practice, that is, a practice where patients pay a yearly fee, and in return they have longer appointments and round the clock access to their doctor. It’s, at times, a controversial medical model, but underneath one corner of that debate, there is a deeper question which relates to what medicine has become and what it has lost.
The physician I worked with is an older gentleman, in his 70’s, and the reason he started his concierge practice is that he longed to practice medicine the way he used to and the way he loved it. In Lewis Thomas’ The Youngest Science, Thomas describes a vignette where a doctor was being awarded a prize at a dinner reception in his town, an honor that meant a great deal to the physician. However, that night, one of his patients passed away, an elderly woman. And so the physician missed the dinner reception that was held in his honor. He had looked forward to it all year, but “some things just can’t be helped,” he said.
That type of healthcare, where a doctor is woven into a fabric of a patient’s life, in and out of the hospital, is endangered if not extinct in modern medicine today. And so while I don’t think the concierge medicine model has much to offer in terms of addressing the large problems with our healthcare system, its emergence highlights some of the humanistic elements we’ve lost along the way and somehow need to recapture.