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Searching For The Family Doctor

9 December 2010 No Comment

Sir Author Conan Doyle based Sherlock Holmes on Dr. Joseph Bell, a doctor for whom he worked.   Bell was renown for his power of observations and deductive reasoning.  He was highly sought after and Queen Victoria was one of his patients.  House, the character on the TV show by the same name, was based on Holmes, who oddly enough was based upon Dr. Bell.  

On a side note, the new BBC production of Sherlock ROCKS.

We all hope for a Dr. Bell when we see a physician — someone with extraordinary skills of both observation and reasoning to investigate our ailments and discover their true origins and cures.

One regret I have about our move from NY has been leaving behind our family practice physician Benjamen Kligler at the Continuum Center for Health & Healing.  We would see Dr Kligler together as a family.  He understood how breastfeeding difficulties with Theory effected Tara’s sleeping; how stress from being laid-off effected our health.  He worked with us to design a vaccine schedule that mapped to our concerns and particular lifestyle.  He was thoughtful, patient, reflective, and empathetic.

Once in San Francisco, we searched the entire city for an evidence based MD who also practiced integrative medicine, both in the sense of being able to leverage modalities outside of the very traditional conventional medicine canon, and in the sense of having a holistic view of our family and how the health of the individuals of our family are affected by the whole.  I want a physician who is a health detective, not a lesser human version of an expert system.   After all, that is the benefit of human intelligence and what it is we should be paying for – what really protects your health.

When we moved to the Bay Area I assumed that we would be blessed with a wealth of practices like The Continuum, particularly in the North Bay with its educated progressive young families. Unfortunately, this does not seem to be the case.  Indeed it seems like you are forced to choose here between a conventional medical practice with all the things we all hate about them, and an alternative care practice that does not have the same biomedical resources that a physician has at his or her disposal.  There are several promising practitioners in the City but en route to interview one of them, Tara and I decided driving an hour with two kids in the car, one potentially sick, was not a viable option.

Researching medical practitioners is not an easy task.  Beyond things like Yelp, there does not seem to be a go to place to provide comprehensive and apples to apples comparisons of medical practitioners.  As the following NPR show notes, reviews are eschewed by the outliers.  But there is more than peer-review to choosing a doctor.  It is hard to ascertain where someone went to Medical School, where they did their residency.  And there certainly is an absence of data on outcomes.  So how is one to judge?

So, we have settled on a patchwork of providers for our family’s health at the cost of having any one individual having purview of the entire family dynamic.  Theory and Win are going to Pediatric Alternatives where they see a naturopath.  Tara is relying on her midwives for care.  Tara and I are seeing a chiropractor named Dr. Pike to keep our backs healthy and for craniosacral therapy. And I am still searching for a physician.

I contacted UCSF’s Osher Center for Integrative Medicine, but no one on their staff would serve as a primary care physician nor a family practice physician.  How disappointing.  I cannot understand how you can practice integrative medicine without having a comprehensive view of your patient.  I guess they mean “Integrative” only in the sense of the modalities, not in the model of patient care.  .

One individual physician who attracted our attention was Dr. Bradly Jacobs at Cavallo Point.  He practices a comprehensive and focused form of patient care but not family practice.  So I may end up using him as my primary care physician.

Unfortunately, both Pediatric Alternatives and Dr. Brad charge a hefty concierge medical fee- a flat fee you pay for the privilege of gaining any access to them at all.   Without getting into a lengthy debate about the pros and cons of having market-driven forces in the medical space, I find the current situation very frustrating.  We need to pay out of pocket a huge amount to try to get the care that we think is pedestrian.

The whole system seems like a game.  Check out this article in the NY Times about using your FSA to pay for concierge fees.  Getting reimbursed seems to depend more on “FSA friendly” billing  practices than it does on the nature of the care provided.  What a joke. .   The truth is, we are paying out more to get the kind of care that will keep us healthy and save both the insurance companies and the public money in the long run.  Why make it such a game to use the FSA account to pay for the expense – as it is ultimately for medical care.

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