Doctortutes Part II

I got a lot of feedback on the last piece I wrote on this subject  before; -not here on the blog, but through Facebook and e-mail. A lot of my sick friends were intrigued and thinking about giving it a try.

That had not been my intention.

I had planned to slam the whole practice. However, as my one experience with it had been mostly positive, I couldn't.  I can't report dishonestly and slam something that kind-of worked for me.

But this is the conversation I have been having with my friends:  Say you do ask a question of a doctortute over the internet and you get some suggestions/ ideas:  What are the next steps?  I remember after #29 contacted me through this blog with a suggestion that I be tested for dysautonomia, #25 was VERY suspicious when I  told the story to him and raised (again) the dysautonomia question. "Where did this come from" he asked.

"From you. Remember very first time you saw a (small) seizure, you said that looks like some kind of autonomic dysfunction. Don't you remember?" (and it was exactly what he said).  Isn't dysautonomia the same thing?  He reluctantly  agreed.

And said he would write the referral to the dysautonmia research lab here in town.

And didn't

So although 29 was not a doctortute, the end result would probably be much the same if she had been: 

Nothing happened.

You see, most doctors have largish egos. And if you go to your doctor and say "this random MD on the Internet who didn't examine me suggested I might have X " (which you didn't think of), most doctors will be (in turn):

a. Insulted

b. Skeptical

c. Defensive

d. Stubborn

 

...and will probably refuse to follow the doctortute's advice -no matter how sound-  for one or more of the above reasons.

So really, doctortutes may ultimately add to the confusion and frustration many of us experience in trying to find a correct diagnosis, instead of helping it.

 

Something I forgot to mention in my initial post on doctortutes is the high-class version of the profession. Now obviously, these aren't known as "doctortutes" either (although maybe they should be). They prefer to call themselves "concierge doctors" or  "boutique doctors". They charge an annual retainer plus their time  and deliver sterling and individualized service for those who can afford the thousands of dollars a year they cost.  Reading the articles on these types of practices, see a NYTimes piece here  and another interesting article here, the winning formula seems to be a direct money connection between  the doctor and patient (client?  ...john?).  No insurance. No Medicaid. No medicare. This had many advantages for the doctor:  They can cut down on administration staff for starters.  Also, because they are getting a much higher return per patient, they need much fewer patients to break even. This in turn means even less overhead costs: fewer nursing staff and smaller office space.

Win for the doctor.

 

The patients seem to get what they pay for: No waiting! Fast, individualized service, doctor management of outside players, such as test facilities, specialists and  hospitals. And house calls!

I also suspect if a paying-through-the-nose patient presents with an unusual or difficult to diagnose condition, the doctortute won't say "I can't help" or "see a shrink".  Presumably the doctortute, aware of how his bread is buttered, will actually advocate for the patient with specialists and dig until he gets to the bottom of the problem. This may cost the client big bucks, but I'm guessing most have it to spend.

Win for the patient.

(and so further increases the divide between the "Haves" and the "Haves-nots")

 

Of course one cannot write an article on doctortutes without mentioning the ultimate doctortute of our time: Dr. Conrad Murray.  As everyone in the universe, and probably a few without knows:  Dr Murray was Michael Jackson's personal physician and was being paid 1.8 million per year by the entertainment company AEG Live to take care of their investment: i.e. Michael Jackson.

I was thinking about this today in the shower (I get all my best thinking done in there) and it struck me that the pressure on Dr Murray must have been staggering;  -although it was considerably less than the pressure on Mr. Jackson.  Let's think about the some of the numbers:  50 concerts, 750,000 tickets sold for a (guesstimated) £56 billion, and then all the sales from the inevitable post-concert CDs and DVDs. Huge amounts of money  and livelihoods centered around the ability of a single person to get up there and perform his heart out again and again and again. For fifty concerts. Not to mention the planning, rehearsals,  travel and promotion time.

And it was Dr Murray's job to ensure MJ could do it.  AEG Live, the doctor's employer, paid him well: 150,000 per month plus expenses to keep MJ performing.  I can only imagine they had  him under a fair amount of pressure to perform this mission to their standards.  And they aren't medically trained.

Then, as we all know,  Michael Jackson died. Suddenly a lot of people were out of work or were out huge sums of money. Dr Conrad, for his part,  was immediately under a ginormous cloud of suspicion, which has never lifted and has had his name dragged through the mud in the media.

Over the next few months, AEG Live went into overdrive: They produced the memorial service. They announced the rehearsal concert footage and sold the movie rights for a large sum. They announced refunds for the tickets sold, but also said that fans could choose NOT to request a refund, but instead to request the original ticket sent to them. For the full price.

Genius.  Sell the tickets for full price without putting on a show.  Cash in on fan zeal and grief for the price of a piece of paper (plus P&P).  And NOBODY seems to have questioned or criticized this. There is no released data that I could find on how many fans took the refund and how many chose the world's most overpriced memento.  I would really love to know. Mind you, if only 10% of them chose to receive the tickets, that would have put AEG Live well into the black for their initial investment in MJ (estimated to be about $25 million US dollars -note most  other figures are in Sterling). Add in the insurance (£17 million), the  movie deal (£35 million) and the MJ exhibit at the O2 Area in London (£17.50 sterling for a standard adult ticket, £56.50 for the "VIP package"), and  they are turning quite a nice profit on the whole sorry business, with very little further outlay.

While in the meantime,  Dr Murray has lost his shirt, is unemployable, universally hated and facing criminal charges.  Hmmm.  In retrospect, maybe Dr Murray should have charged more for his services.  Because although he clearly wasn't calling the shots, he was the one left holding the (doctor's) bag.

Let his story serve as a warning to all budding doctortutes out there.

Comments

[yanub]

It's a good point about Dr. Murray. He was being paid, not to keep Jackson healthy, but to keep him performing.

And a good point about whether you can get your own doctor to act on advice given by other doctors. Goodness knows they like to make up their minds without reference to anyone outside of their own noggins, including the patient.

[fridawrites]

Yes, good point. In my case, I knew I couldn't change my regular physician's mind--but the response did make me immediately change doctors. That doctor was also amenable to me asking, "should we also exclude x blood disorder since my mom had it and I'm having problems?"

Concierge doctors--my last internist went to that. While he didn't drop anyone who still used insurance, it just occurred to me that's when the medical relationship went to hell (I was not a concierge patient).

[queen-slug]

Oddly my doc would listen to me if I suggested a test or referral. When I decided I needed to be checked for this condition called EDS that I read about on some blogs & then went & checked out on EDNF he listened. I told him I discovered a condition on the net & he agreed I had a HCTD & said he was sorry he had missed it & that he'd blown off the pain I was having.

[One Sick Mother]

Yanub,

At first I was all angry at Dr Murray, then I got to thinking that he was being paid to do a job, and probably under a lot of pressure. This is where the 'doctortute" thing falls down, because eventually it may come to a toss-up between medical ethics and one's liveihood. Especially if the doctortute has only one patient.

I really don't think AEG Live is fully blameless in all of this, either (nor was Jackson himself, likely).

Frida,

Good point about changing doctors. That is (almost) always an option. Sorry your internist became a doctortute. It stinks how you were treated because of it.

Q-S,
You are right. Some doctors are secure enough not to be threatened by it. My primary guy is like that, as is the rheumy. Unfortunately, they don't know enough to write the referral!

OSM