Patient: Hey doc, thanks for all your great care, but I have insurance now so need to cancel my membership.
Me: Sorry to hear you are leaving. Best of luck! Remember, we care for folks regardless of their insurance status and most of our patients HAVE insurance, so no reason to quit if you prefer to remain a member.
Patient: Ok, thanks. I really hate to leave, but don’t see the point of paying for membership when I have insurance. Will miss you all!
1 month later
Patient: Hey doc, I really need to get in for [insert any medical need], but I can’t find a primary care physician who’s accepting patients within the next 6 months. Do you have any recommendations?
Me: Not anymore.
Recently I got the news that another Family Medicine colleague was leaving primary care due to the misery that is traditional practice. Even her private practice setting couldn’t protect her from the outside forces that threaten the sanctity of the patient-doctor relationship. As is often the case, this physician was finally fed up with the bureaucracy, the endless check-boxes, the pressure to see more patients in less time and the drain on her personal and professional satisfaction in a career she worked so hard to achieve. And I don’t blame her one bit.
Healthcare, especially PRIMARY CARE is based on relationships. This means that doctors are not interchangeable cogs in a machine and that seeing “someone” is not the same as seeing YOUR physician who knows you, your preference, quirks and life circumstances through a relationship that is established over years together. There is nothing that can replace the value of being known – especially as this also helps to prevent misdiagnosis, over-testing and over-treatment and their downstream effects. In fact, studies continue to show that states with more primary care physicians are healthier and live longer, even when socioeconomic and lifestyle factors are taken into account.
Unfortunately, despite the proven effectiveness and overall cost-savings, primary care is undervalued in this country and many physicians have abandoned what used to be a fulfilling career. What has driven us to this point?
Arguably, one of the biggest drivers in our current healthcare crisis is Our Unhealthy Addiction to Health Insurance, which is summarized beautifully by one of our DPC colleagues, Dr. Jeffrey Gold. As Dr. Gold reminds us, “The main mistake that we have succumbed to as a society is that we have deviated from the original intent of health insurance. The true purpose of health insurance was to protect people against financial ruin in the event of an unexpected, major occurrence – just like car insurance, life insurance, and homeowner’s insurance. But things got murky when people were indoctrinated into the belief that good health insurance should “cover everything” because “everything in healthcare is expensive.”
Not only has the reliance on insurance resulted in an immoral spiraling of inflated pricing, more unnecessary testing, referrals and aggressive treatments, but it has also convinced people that TIME spent listening to patients and TIME to do a thorough physical exam is not worth paying for.
All of this had led to people forgetting that health insurance…is NOT…health care.
Think about that for a moment.
Health insurance is a product that helps protect against financial ruin in case of unexpected, expensive, catastrophic events. Health insurance companies are for-profit entities that are in the business of making money.
Health care is what you need when you are sick or injured. Health care is provided by medical professionals (doctors, nurses, etc) who have spend many years in continual training and are in the business of helping people.
While both are necessary (after all, home-owners insurance is certainly important in case of a fire), only one actually provides the care. Hint: it’s not the insurance company.
So, if personalized health CARE provided by a doctor who knows you and will be there for you regardless of your health, age, income, insurance or job-status is important to you, then invest in a Direct Primary Care practice. If supporting doctors who are willing to sacrifice their financial stability in order to provide real care to patients again, then invest in Direct Primary Care. If transparency in pricing and reducing unnecessary testing and treatment is important to you, then invest in Direct Primary Care.
I could go on and on, but instead, I’ll leave you with one of my favorite Margaret Mead quotes.
“Never doubt that a small group of thoughtful, committed, citizens can change the world. Indeed, it is the only thing that ever has.”
To your health!
There has been a lot in the news recently about voluntary recalls of Zantac (ranitidine). In short, the FDA found trace amounts of N-nitrosodimethylamine (NDMA), a probable carcinogen (cancer-causing compound), in some lots of the medication by several manufacturers.
While the headlines are scary, this topic deserves a little unpacking.
First, let’s gain a little perspective. According to the FDA, the levels of NDMA in many tested ranitidine products are similar to those consumed through "common foods like grilled or smoked meats.” For some people, this statement is quite reassuring, while others are thinking, “What?! My favorite grilled meat can cause cancer?”. Well, yes and no.
Cancer is caused when damages to DNA result in uncontrolled over-growth of a cell or tissue. Most of the time, our cells recognize the damage and either fixes the DNA or destroys the cells that have gone rogue. A person’s overall risk of cancer is based on a number of factors including genetics and environment exposures https://www.cancer.gov/about-cancer/causes-prevention/risk/substances. While some exposures can be avoided (tobacco smoke, excessive sun exposure), others are more difficult to avoid since they are present in the environment, including the air we breathe and the food we eat.
Health Suite 110’s stock of ranitidine was not affected by these recalls as we are stocked by a different manufacturer. That said, the FDA recommends “patients taking prescription ranitidine who wish to stop should talk to their health care professional about other treatment options. Consumers taking OTC ranitidine, which is used to prevent and relieve heartburn associated with acid indigestion and sour stomach, may consider using other OTC products approved for their condition. FDA’s testing of samples of alternatives such as Pepcid (famotidine), Tagamet (cimetidine), Nexium (esomeprazole), Prevacid (lansoprazole), and Prilosec (omeprazole) show no NDMA in these medicines”.
You can read more about the recall and specific lots affected on the FDA website: https://www.fda.gov/drugs/drug-safety-and-availability/fda-updates-and-press-announcements-ndma-zantac-ranitidine.
For patients who prefer to switch from taking Zantac, these medications are not all interchangeable. While Zantac, Pepcid and Tagament are all histamine-blockers (H2-blockers), things like Prevacid and Prilosec are proton-pump inhibitors (PPIs) and have different implications. H2-blockers are generally felt to be safe for long-term use, while long-term use of PPIs can increase the risk for C.diff, pneumonia and osteoporosis. If you require antacid medication on a daily basis, be sure to discuss with your physician. Sometimes there is an underlying cause that can be treated (H. pylori infection, obesity, food triggers) and other times the risk of taking a medication long term far outweighs the risks of not taking it, particularly for folks who have pre-cancerous changes in their esophagus from long term reflux (Barrett’s esophagitis).
Five Steps for Cancer-Safe Grilling
1. Marinate: Studies suggest that marinating meat before grilling can decrease formation of carcinogens.
2. Pre-Cook: If you are grilling larger cuts, you can reduce the time your meat is exposed to flame by partially cooking it in a microwave, oven or stove first.
3. Go Lean: Trimming the fat off your meat can reduce flare-ups and charring. Cook your meat in the center of the grill and make sure to flip frequently.
4. Mix It Up: Cutting meat into smaller portions and mixing them with vegetables can shorten cooking time.
5. Go Green: Grilling of vegetables and fruits produces no carcinogens. So, add veggies and cut down the amount of meats.
Kylie Vannaman MD