Concierge doctor on personal responsibility and giving back

hires-steven-knopeI had a great interview with Dr. Steven Knope yesterday. Dr. Knope, author of “Concierge Medicine: A New System to Get the Best Healthcare,” is one of the pioneers of the concierge medicine movement, a model in which patients pay what amount to retainer fees monthly or annually for certain guaranteed services from doctors as well as discounts on other services. 

I’ll post the whole piece up here once it’s published, but I just finished transcribing his answer to a question about  personal responsibility and giving back to the community that I thought was particularly interesting. Here it is:

The first part of my career, the first 10 years, I took care of people with emphysema who smoked. People who were diabetics who refused to lose 10 or 15 pounds. Sedentary. Everybody wanted a pill. Everybody was on an HMO. Everybody wanted someone to fix them and they virtually wanted to do nothing for themselves, as a general statement. I remember the first time this dawned on me that this was really kind of a self defeatist approach. I had a woman that I was seeing free of charge who had lost her insurance, that I was seeing at 3 o’clock in the morning for an exacerbation of emphysema, and she continued to smoke. I came in at 3 o’clock in the morning and I was exhausted. I had seen 40 patients the day before and was going to see 40 the next and I said, “Look, we have to have a come-to-Jesus talk here. If you want me to treat you free of charge when you’ve lost insurance and you want me to get up at 3 o’clock in the morning and be at your bedside, I think it’s perfectly reasonable for me to ask you to stop smoking, and if you don’t do that, then I’m going to ask you to waste another doctor’s time. I’m not helping you by promoting this kind of behavior. You’re not helping me. And, frankly, you’re just taking advantage of my good will.” Though that may horrify some doctors, the lady quit smoking and she stayed in my practice. I think that unless people have skin in the game, unless they’re paying for their care, unless they’re investing in their health, people don’t really value things that are free to them. Now when I hear about a World War II vet or a Navy Seal or somebody who is getting crappy medical care and they are these incredibly responsible individuals who helped us both enjoy these wonderful freedoms, those are the kind of people I really want to seek out and say, “What can I do for you? I owe you. I was never in the military. It should be my honor to take care of you and help you for your service.” I don’t think that fits in with traditional physician philosophies. It probably rubs a few people the wrong way. I just think I’m probably going to get better results this way as opposed to playing the victim role and the enabler role.

One point to make here is that concierge doctors often get a bad rap as being “elitist” because some annual contracts are expensive. Here’s a guy, though, whose practice is split evenly between paying patients and indigent/poor patients, some of whom are veterans who are not receiving the respect they deserve from our society.

I’ll post his comments on Congress’ and Obama’s health care “reform” proposals a little later.

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