By Dr. Paul Ehrlich
When my father was basically the only pediatrician in a Long Island town in the 1950s, he frequently visited his patients at home, and I tagged along to watch, which laid the foundation for my own patient ethic. Truth be told, it could also be exciting because some of his patients were the kids of famous entertainers, although they were just anxious parents when I met them for the most part.
I was reminded of my affection for this now-forgotten way of medical practice the other day at a street fair in my New York neighborhood at a booth for a new business called Pager.com, which will send a doctor to your home for a fee, plus other costs that can be submitted for reimbursement. In time it may be directly billable to insurers. For now, those on call are all emergency department physicians on their days off. They are paid per transaction, but are guaranteed an hourly rate for their shift if volume isn’t high enough. This is a long way from the $5 cash-on-the-barrelhead visits Dr. Lenny used to make.
Each call is subject to a bit of phone triage to determine whether the case warrants a trip to an emergency room so as not to waste valuable time. It certainly makes sense to do things this way if it means keeping patients out of emergency rooms for minor ailments—in spite of what a certain former U.S. President once said, universal access to emergency rooms is not “health care.” Low-grade fevers and very sore throats maybe. Flu shots. A few stiches. Pains and sprains, perhaps.
I have been struggling a bit to figure out how this fits in with my own practice. Certainly ER specialists are very good at treating critical asthma attacks, but a diligent allergist has his patients so well controlled that emergencies are very rare. I take phone calls from my service from patients when I’m not technically “on duty” because I think there are often solutions short of the emergency room regardless, and why shouldn’t I save the system the hundreds or thousands of dollars it would otherwise cost? ER doctors probably don’t know the little tricks I have up my sleeve, like hydrating a bronchoconstricted asthma patient to loosen up the phlegm.
Anaphylaxis from food allergies or bee stings? No parent should ever hesitate from the epi-and-emergency-room protocol that we have been drumming into their heads for all these years. Besides, as I have previously written, there is an ongoing dispute between allergists and ER doctors over how to define and treat anaphylaxis. I don’t think we are well served by bringing that argument into the home.
On a broader level, I am not a fan of anything that smacks of concierge medicine. Segmentation of medicine by income may be inevitable, but that doesn’t mean I have to like it. I notice from the biographical material that accompanies pager.com, uber (the car service app) is in its pedigree. But where uber may have a leveling effect on the business of urban transportation, I’ll reserve judgment on what Pager can do for medical practice. Doctors aren’t cab drivers.