What The Hell is Concierge Medicine?

How my parents’ doctor just turned into a Royal Pain in the ass

Who’s the patient?

I still have it this morning. The dull ache marking the epicenter of uncertainty in my gut where my parents’ family doctor euphamistically kicked me yesterday afternoon.

Strategically, I’d chosen a seat next to my mom instead of the end of the paper covered table offered me by the goofy nurse. I wanted to scream at her, ‘Do I look like the patient here?’ but I tightened my jaw instead. Of course, I knew, I probably looked like I needed treatment, any treatment (shock treatments perhaps?) to help me keep this train on the tracks.

But I couldn’t possibly appear as disheveled and miserable as my two parents, could I?

My dad, seated across from me in his Rollator (a fancy walker/seat combo) which doesn’t exactly lock in place anymore, is suffering from a nasty virus on top of his chronic health issues which disrupt his breathing and heart functions. He looks positively pitiful and keeps falling asleep while precariously leaning forward. Every so often I rouse him awake so he won’t tumble out of his rollator and break his hip or neck.

Reading nonverbal clues is my specialty

My mom, seated on my right, first begins telegraphing her agitation with subtle body language. Her body is turned away from me toward the empty space where the doctor will sit once he arrives. Her lips are intentionally pressed together in a thin line which emphasizes the perpendicular wrinkles reaching toward her nose. I notice she scoots further away from me and I ask her if she is comfortable. She mumbles something I don’t understand but I do understand the nonverbal cues she’s sending and I leave her be.

Except for the piped in music coming from the outer hallway, there is a short period of quiet before the storm. Then, my mom begins indicting me and my dad for perceived crimes of the past having to do with taking her to the doctor. She admonishes both me and my dad and orders us to ‘keep your mouths shut’ and not to interrupt her when she’s talking to the doctor. Both my dad and I meekly agree to ‘behave ourselves’ as we stare cautiously into each other’s faces.

Hence, the seat I’ve strategically chosen.

From here the doctor can see me as my mom speaks to him and he watches me for cues about her reality and responses to his questions. “Are you sleeping okay? How is your appetite?” I “correct” the impression she gives him wherever I need to. You see, my mom’s reality is increasingly unreliable since the terrorist, Alzheimers has taken up residence in her brain.

My parents’ doctor is good with her and it’s a profound relief to have him in their lives and the continuity of care he provides. They have been with him from the very start of his practice. They are his longest standing patients.

He is a handsome man, roughly ten years younger than me, Prada eyeglasses, hip, smart and flirty. I’ve nicknamed him ‘Dr Prada’, which I keep to myself.

I have always liked him but then, I’d always been far too easily marked by guys like him. He actually asked me for my cell number when I first arrived to care for my parents. It was couched in a reasonable way, to keep in touch with him about changes in my parents health, but was also coupled with a joke about calling me ‘for drinks’. I’m not sure why, but I’ve never let it be known that I’m married — to a woman — though I wear a wedding ring.

My dad tells him everything, has for years, so he probably already knows and is just toying with me. Whatever, he’s still a good doctor with a wealth of history and knowledge about my parents’ health and that’s my prime concern right now.

Enter stage left: Dr Prada

Finally, forty-five minutes past the appointed time our ‘knight in shining blue scrubs’ enters the room. I get a snippet of “Don’t Go Breaking My Heart” from the hallway as he closes the door.

The four of us are now squeezed into the smallest of his treatment rooms where we go through the litany of complaints and medications for both my mom and dad and suddenly the air in the room feels thinner. This is an overwhelming job. I can’t imagine being a doctor, to have an endless stream of complaining and suffering coming through my door day in and day out. No thank you very much.

We consolidate visits now for my parents since it’s supposed to be easier, in theory, but in practice it’s really a bitch to get two infirm, fragile people headed in the right direction, at the same time to an appointment on time. It’s sort of like being the ringmaster of a geriatric circus where the entire cast is on strike or blind.

I can’t quite say when Dr Prada blurted out his plans to leave the practice he’d established with two other partnering doctors or what triggered it but once he dove in to it he laid out his plans like con man, Harold Hill in The Music Man. He told us he was transitioning his practice to be a “concierge doctor”. Strike up the band, get out your wallets and follow me!

You’re kidding, right?

Huh? Leaving? Why? What the hell is concierge medicine?

By now I’m reeling and I can see my dad is too. There is panic in his eyes. I cannot see my mom’s face but I know she has understood the “leaving” part too.

All I can think of is that stupid show I’d seen snippets of where the doctor is on call at some resort. What was the name? Royal Pains?

Royal Pains is an American television drama series that ran on the USA Network from 2009 to 2016. The series is based in part on actual concierge medicine practices of independent doctors and companies.

Dr Prada doesn’t bring the tv show up but I’m betting he’s thinking of it too.

He goes on to explain where his practice will be located, which is in an area considered to be quite affluent with the likes of Lex Wexner counted among its residents. As a matter of fact, I think Mr Wexner pretty much owns the town.

Concierge medicine, also known as Retainer medicine is a fairly new concept (circa 1996) which essentially puts the doctor/patient relationship on retainer by way of annual fees and membership dues. The patient gets exclusive benefits and priority treatment and the doctor gets more money and carries a lighter patient load.

My dad plucks the 64 thousand dollar question that’s been hanging in the air over all our heads, “Well, can we still see you?”

This is where concierge medicine gets interesting, a bit tacky and possibly morally and ethically blurry if you still have a conscience.

Dr Prada’s answer, “Yes, yes you can — if you are willing to pay a membership fee. In return you’ll get all the time we need to attend to your health issues.”

In his defense, he did seem a bit sheepish about the whole business, at first but, then went on to sell what he perceived as the “positives” involved in having a concierge doctor interspersed with his complaints about the current healthcare system. No waiting, long consultations, focused and personal doctor/patient relationships. It all sounded pretty good until I realized my parents already get these things with Dr Prada but now he’s asking them to pay for it if they want to continue getting them. Four thousand dollars a year for couples.

My dad plucks the 64 thousand dollar question that’s been hanging in the air over all our heads, “Well, can we still see you?”

I coughed. Dad dropped his head. Mom didn’t flinch.

I’m the first to speak, “Well, no one could blame you for bettering your situation and making changes in your career… we wish you all the best and if my parents can afford it, I’m sure they’ll want to continue with you as their doctor.”

My dad nods. Mom doesn’t flinch.

I make a mental note to research this concept of concierge medicine though I already know I’m going to find controversial proponents on both sides of the issue. I can see Dr Prada values himself as a person and a commodity and this is not such a bad quality to have in a doctor and human being. To his credit, I can also see that he is torn about leaving patients like my parents out of the loop of exclusive medicine and healthcare for the almighty dollar.

Social class + economic class = privilege

I do the math in my head. Three hundred and sixteen dollars a month extra is what it would cost my parents to retain Dr Prada. However, I’m not sure how Medicare figures in to the scheme of things either. My dad and I will have to look at the details and his budget and see if he can even afford it before making a final decision. We have a few months before anything changes.

There is an air of extortion to this whole concept and it feels like the same old equation: money=privilege.

However, the thought of changing doctors now, in the bottom of the ninth for both my parents, leaves me feeling conflicted but hoping my dad is more willing and able to pay than not.