Looking for an online doctor? Would you like to have your penile discharge treated discreetly? Well, wait no more! We’ll PAY you to see us.
Okay, that’s made up but there is a massive race to the bottom due to the competition in the online space. In fact, quite a few telehealth companies are making it rather clear in their online ads “Get Rx now!” I like it – subtle.
I got no beef with it. The US healthcare system has always been a profit-first model and no sane patient would mistake it for anything, but. The question is, is that the patient you want to offer services to?
One of the biggest business expenses has been marketing, whether directly or indirectly. A few decades ago you still had to rent the most expensive building with the best street visibility (signage) to get foot traffic.
Now, virtual companies pay a lot of money to get their services before the eyes of the right consumers. Marketing to patients is a massive business and a large telehealth company spends several thousand dollars per day on Google Ads.
In 2023, most doctors will open up a practice in some old Soviet-style building with their names written in tiny plastic letters in the building directly. Thy don’t need to market to patients because the insurance companies feed these clinics tons of patients.
The problem is that the patient you get may not be the patient you want. And I’m here to tell you that they lied to you in medical school, you are not trained to take care of everyone. You could be the world’s smartest nephrologist but if I don’t like you I don’t wanna see you and I ain’t gonna listen to you which makes both our lives difficult.
What Patients Really Want
So, what about this patient selection? The patient should be able to choose their doctor right? Well, that’s what ya think but the market forces have made it clear that most patients could care less about how and who you are, they want something cheap, something covered by insurance, and they wanted it yesterday.
Your ability to intelligently explain the difference between effusion with preserved TM mobility in a child over 6 months old is rather irrelevant to the parent if you’re not talking about the “cherry-flavored antibiotics.”
You who are reading this (don’t be offended) likely are similar to the patients above – you just want your blood test, your meds, and your MRI and you’re happy as a clam.
That doesn’t mean that all patients are like this. Some believe that they must have a buy-in with their care. And they want to see a physician (MD or DO), not just a PA, NP, DC, DVM, ND, or any other acronym they aren’t familiar with.
The Patient Demographic
In the US I guess that 10% want a healthy, long-term relationship with their physician. They will spend more time researching their physician than the next cellphone case for their iPhone 75.
They will spend the first part of the visit with some chit-chat to get to know you, and to feel you out. Then, when they feel they can trust you they will gauge your expertise and give you a chance at treating them.
The other 90% either have no money to afford a choice in their care or have the health literacy of a teenager. These aren’t bad people or bad patients but they require more handholding and they have chosen to or are forced to delegate their health responsibility to you. Do you want to take it on?
Cheap Online Clinics
Still reading? I’m sorry. But, the good news is that I’m getting to the point: why is there a race to zero in these online telehealth practices? I predicted it with a post from 2017 and I was right. Because the money in online care isn’t in the patient-doctor visits, it’s in the meds. Hence the rise of PBMs.
I just searched and there are ads for a doctor’s visit for $9.99. Plenty of $19.99’s and an a for seeing a doctor at Sesame Care for free.
It’s unlikely that you’ll get a doctor – usually it’s a PA or NP. And the clinician will assess the patient enough to determine if they can get away with prescribing them something – that’s it.
What Kind of Practice Do You Want?
Want to see someone who is there for a medication or lab test or MRI? Nothing wrong with that. Well, nothing wrong with it until something goes wrong. And that’s when all hell breaks loose because you never established rapport in the first place. But, at least the work is simple. You see them, come up with an ICD10, a procedure, an Rx, everyone is happy.
What kind of practice do you want? What kind of patients do you want? The good ones are out there but you won’t come across them if you are in the insurance world.
As these online practices are growing and they are pushing these cheap clinical algorithms on patients these patients will also be sicker and sicker. That’s not something an already-broke healthcare system can handle. Which makes the work in that system, at leat to me, even less desirable.
But when you start with someone who is empowered, has a high health literacy, understands the concept of taking responsibility, has a good support structure, has money, has time, and can vet you adequately, then you can build the kind of relationship that grows over time.
What I Want
If for no other reason than pure selfishness I, Dr. Mo, a health consumer, would like a clinician with the following characteristics:
- Someone I can trust
- Someone who is easy to communicate with
- Someone who is honest
- Someone who will listen to me
- Someone who will educate me
- An MD/DO/NP/PA who values their expertise & experience
- Someone who’ll be around for a while
- A hospital that cares about my health and not my money
- Someone who doesn’t just regurgitate what they read on uptodate.com
My own experience with my hand was an incredible insight into healthcare. And this wasn’t my first rodeo. I had a few bouts of a peritonsillar abscess, I had a clavicle fracture, and one gnarly ass headache that ended up being rather simple.
I had to search a lot for the right hand surgeon and I am very happy that I am able to climb my V8 boulders after such an extensive surgery.
Cheap care is bad care. Maybe not always but there is a floor you cannot fall through and there is a ceiling that’s unethical to break through.