Texting is the new house calls.
I never met my mom’s dad, but I think about him when I go to the doctor. And when I didn’t.
He hired and mentored my pediatrician, Dr. May Ling Lie Shuck, over the objections of partners who thought a Jewish doctor from Baltimore named Manes Hecht was diversity enough for their practice.
At Johns Hopkins, he studied under and remained lifelong friends with Dr. Helen Taussig, who founded the field of pediatric cardiology and developed a treatment for blue baby syndrome.
As his 1973 Jewish News obituary notes, Dr. Hecht came to Detroit to head up the Rheumatic Fever Clinic at Children’s Hospital following his tour of duty as a World War II medical captain; in Detroit, he was president of the Detroit Pediatric Society and a founding staff member of Sinai Hospital.
Yet for all this rarefied work, what really sustained Grandpa Manes over 40 years practicing medicine, even as his own health faltered, was the routine and the relationships. He saw patients at his office in the Fisher Building, then later the Huntington Woods Professional Building, walking home for lunch and carrying a leather doctor bag for evening house calls.
Dr. Hecht would no doubt disapprove that I went 20 years without having a doctor. Dr. Shuck retired around the time I got chest hair (I hope coincidentally). After that, I was lucky and stupid enough to get by with a bottle of hydrogen peroxide, Flinstone’s chewables and the occasional Z-pack.
I am pleased, as I think he would be, that my stupid luck (caveman behavior vs. caveman vitamins) eventually brought me to direct primary care.
At first, direct, primary and care sounded to me like three random words stuck together to make ever more refrigerator magnet poetry for the medical industrial complex.
To my pleasant surprise (and good health), direct primary care is an antidote to much of what causes us to spend nearly 20% of our gross domestic product on healthcare and get mostly stress, strain and stratification.
It’s simpler to describe how direct primary care works than how — let me count the ways — traditional fee-for-service, even with “good” insurance, does not:
I am a member of Plum Health Direct Primary Care. Membership costs $49 a month. Raquel Orlich is my doctor.
I guess she’s other people’s doctor too. But I can call, email or text (from my $50/month phone) Dr. Orlich anytime I’m having an issue and, if she can’t solve it remotely, she can always see me that day or the following.
At one point, there were some balloons celebrating Dr. Orlich’s 300th patient. Ultimately, she’ll have around 500. That seems like a lot, I thought, especially compared to my prior impression that I was her only patient.
The average family physician has 2,400 patients. They see 24 a day, each for about 20 minutes, about half of which might be spent on “charting” their electronic medical records. But it has to be face-to-face (or face-to-chart) or it won’t be billable to insurance.
Direct Primary Care does not accept insurance. At first, paying dollars (or HSA or FSA or Bitcoins or sea shells) directly for healthcare seems inefficient when you have employer-provided coverage. Until you realize there’s no co-pay, co-insurance, deductible, out-of-pocket maximum, pharmacy benefits management company, in-network, out-of-network, preauthorizations, pre-existing conditions, pre-notifications, death panels, etc.
And, as is typical with direct primary care, there is no cost for visits to Plum Health.
My kids are now Plum Health members for $10/month each, following A Tale of Two Splinters:
Before direct primary care, Judah got a splinter in his foot that I couldn’t get out. We did the responsible (parental and, it seemed, financial) thing and took him to Beaumont Urgent Care. After waiting around with a weekend crowd whose issues were conspicuously more urgent, if not ER gruesome, they got the splinter out, took our insurance information and sent us on our way.
Then — dog with preexisting condition of being dog bites man with high-deductible plan — we got a bill for over $500. When I called to inquire, the nice lady on the phone reassured me that the “actual” cost was some $1200, but Blue Cross Beaumont synergy something something you’re welcome.
Not wanting to be left out, Phoebe got a splinter in her finger recently. We texted “Dr. Raquel.” She wrote me right back with her availability. I brought Phoebe to the office at Michigan and Trumbull. Free street parking. Splinter gone. Respectable Band-Aid selection. No charge. And now Phoebe wants to be either a doctor or Great Dane when she grows up.
Grandpa Manes (whose great grandchildren will be caught up on their shots by the end of the month) loved chamber music. Perhaps it reminded him of what he aspired to in his doctor-patient relationships. Not composing or conducting — not virtuosic solo performance — but creating space and tuning your ear as much as your expertise to the pursuit of humble, healthy harmony.