Health care for older adults in need of intervention

Have you ever longed for the good old days — when your doctor would sit and listen to you, actually look you in the eye, do some hands-on care, and knew your family history? He, almost always male, was the general practitioner who took care of most of your needs, but who did not hesitate to send you to Baltimore to see a specialist when your health demanded it.

I like that title of "general practitioner," because it sounds like someone in charge!


Of course, in the good old days, our health care was not driven by the profit margins of insurance companies; rather, the doctor could assess the need of each patient and treat accordingly. His only time constraints were those imposed by the number of patients lined up at his door and not time limits by insurance companies for 15 minutes or less per patient. As we age, that kind of time with a doctor is probably not sufficient.

Many of the doctors I go to are glued to the computer screen or are flipping through pages in my folder. They are so busy with the paperwork/computer screen that they have little time for hands-on care or for listening to the patient. I sympathize with the doctors who are caught between wanting to do the "right thing" for patients and the insurance companies that dictate their livelihood — what tests they must perform and how many minutes they may spend per patient.

In a recent talk to a group of older adults, Dr. Stephen Schimpff, retired CEO of the University of Maryland Medical Center, told the group that primary care physicians are seeing twice as many patients each day as they did 20 years ago, primarily because of low reimbursements per visit. Note the name change from GP to PCP, sounding like the result of the latest computer requirements.

Schimpff further said that "what we need is a single doctor who will spend time with you, listen, and sort things out." He believes that the primary care physician can take care of 90 percent of most medical needs if permitted the time to do so. From his lips to the insurance companies' ears to make this happen!

But because this model does not happen, the newest rage for those who can afford it is Direct Primary Care, according to Schimpff, where the patient, not the insurance company, is the customer. The patient pays a membership fee, perhaps $1,500 a month, for the doctor to be available to that patient 24/7 by phone or e-mail and to treat that patient promptly.

That promptness does not happen in most PCP offices precisely because they are over-booked. And, if one cannot afford a DPC, how does one choose among the PCPs to find a good one, if indeed, they are accepting new patients.

Let us be grateful for the medical profession, the PCPs and all the specialists. But, as older adults, we may need to wrest control from the insurance companies — whom we pay — to get our health care back.

Hermine Saunders writes from Westminster.