This is what medical care should be like

Moving to a new city always means finding a new doctor, dentist, car mechanic, dry cleaner, etc. I've been using Yelp for all this and it hasn't failed me once.

I decided it was time for a physical so I looked on Yelp and found a doctor with good reviews. I called and was told he couldn't see a new patient until May! Back on Yelp, I found another doctor who was part of the Metropolitan Medical Group. All the reviews for the group and each of the doctors in it were great, so I gave them a call.

I'd never heard of anything like this before: they call themselves a boutique medical group. For a small annual fee, they offer:

SAME DAY appointments. No kidding.
Email and phone communication with your doctor
Personal attention. You are never rushed
Online tools. Register online, medical history questionnaires, prescription renewals, email appointments, and more.
Prescriptions are sent right to your pharmacy of choice, no need to take in the slip and then wait.
Feeling sick? Email your doctor, pick up medicine at the pharmacy an hour later
Friendly and knowledgeable office staff
Random little things like sheets on the exam bed (no butcher paper) and leopard print robes :)

I walked in, went straight into the doctor's office, had a solid one hour physical, and felt more comfortable with this doctor than with any I've had in my life. Incredibly painless. A few hours later, I got an email from my doctor listing some of the things he had recommended for me. I replied with a question and he answered.

I can't believe that having personal attention, less waiting, and email communication is something worth blogging about. But sadly our health care system is terrible, even for us lucky enough to have insurance. The crazy thing is, answering questions via email actually saves the doctor time and should let them treat people faster. It's just being smart.

I highly recommend Metropolitan Medical Group to anyone looking for a doctor in San Francisco. To do: cut back on coffee, cut back on diet soda, increase water intake, sleep more regular hours, get to the gym more. Nothing I didn't know, but it does make a difference to hear it from a professional.

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Mar 05, 2009

Kenny Eller said...

Great post bro! The only scary part is a potential misdiagnosis with the email (Feeling Sick bullet). Otherwise, rocks!

Meghan O'Connor said...

hmmmm, as a healthcare provider I find this fascinating. So you have to pay extra for this group, eh? somethings I think are extraordinary and some I think actually do happen in real life too. I call all my pts back the same day and if its urgent I will get them in the same day too. I like to think I dont rush. I call in prescriptions to peoples pharmacies.

But there are things I"m totally jealous- real clothe sheets and leopard print robes?!?! Heck I'd take anything other than paper! (in fact, so would my friend- here's one of her blog postngs http://myfirstyearofpractice.blogspot.com/2009/02/story-of-my-pap.html) It could really make a difference making pts feel comfy! I also like the online stuff. Someday we'll all be there, little by little we're moving to electronic charting...

though I disagree with "feeling sick, email your doc and pick up the RX" very hard and I dont think good care to dx over email or the phone. (and unfortunately you cant bill for it either, which means your doc doesnt get paid for their time, which is how a practice survives financially- but I guess thats where the annual fee comes in, eh?) And believe it or not, emailing pts scares me because unfortunately we live in a litigious (sp?) society where malpractice (rather than good care) rules, meaning we practice defensive medicine. makes me scared that i'd get sued over an email. sad, but true.

really interesting posting. makes me think more about my job... my life.... I'm so curious. I wonder how the docs like working there. if its more satisfying or less? hmmm.....

Sachin Agarwal said...

Ok yeah, I agree you wouldn't actually just want to email your doctor when you're sick and bypass their assessments. I think that's pointed out as an advantage of their service for people who tend to have the same illness frequently, and so they feel comfortable getting the same treatment again and again.

But aside from that, this clinic did raise some interesting thoughts about health care. I was curious to find out more about their business model, but the receptionist wouldn't give me straight answers (particularly when i asked what the insurance companies thought about this). I think care providers aren't allowed to charge patients anything additional for services when they take insurance (other than co-payments). So if they wanted to provide better service, add better technology, more time per patient, it's purely at the cost of the doctor. So collecting an annual fee seems like a neat little scheme to work around this. It's like how merchants can pass credit card fees on to the consumer, but they can add "convenience" or "handling" fees if they want.

The idea of getting sued makes total sense. When you speak to someone in person, you have some level of understanding with them. You can tell if they comprehended your advice and are going to take action as you suggested. Something over email can easily be misunderstood (don't be sarcastic in the email!) and could definitely lead to some major issues. Very interesting...

Overall the atmosphere of the office was really amazing. Very high quality, clean, professional, organized, computerized, modern, and efficient. The doctor I had was one of the newer ones in the group and he said he enjoyed his position. His only complaint was all the robes came in patterns that his male patients didn't like. I didn't mind leopard print at all.

After reading my post, Roy sent me this article:

http://www.nytimes.com/2005/07/31/business/yourmoney/31doctor.html

It's a totally different scale (much more expensive!) but the idea is the same. I (we) demand great service when we go out to eat and in other areas. But we have no choice when it comes to medical care. I feel like I could get better care in India in some respects (instant house calls, lots of attention, etc). I guess in India it comes down to who has the money, so that's not a good way to go either.

Mar 06, 2009

Mr. Cheeks said...

Time out... how did you pay for this? was it covered though insurance, or was it out-of-pocket?

Adam Rodriguez said...

this is how the Mayo Clinic works too. Since it's known as a "destination" for healthcare, it's built around getting you in and out and taking care of everything at once. If you have people flying from around the world to get a variety of checkups, you can't tell them to come back in a few weeks for that appointment.

Often, you see one doctor and then end up with several other appts. At most places, you then have to schedule those appointments for days or weeks later. At Mayo, you just walk down to that specialty and go to that appointment right away. There's a reason people go there for medical care.

There's a rule for doctors at Mayo, that if a patient needs to see them, they have to see that patient THAT DAY. Interesting way of doing things, and as a corporation they don't seem to be hurting for cash so it seems to work.

@cheeks: It was covered by insurance except for the (minimal) annual fee to join the group.

Shelley Binkley MD said...

Yes I'm very curious, have you rec'd the bill yet? What is the "small annual fee"?

vijay said...

Great post Sachin. This has caught the attention of medtweeps & medbloggers :)

Jen McCabe said...

Hey Sachin -

Tweeted this Posterous :)...one question from Twitter above (@healthewoman). Of course, we could all just wait until Monday and give Metropolitan Medical Group a call to find out the $, which I'll add to my calendar, so you don't have to divulge.

Awesome post. Thanks for sharing this!

Chris Darling said...

Sachin, sounds like a common sense approach to streamlining care & client service via simple communication tools that serve both provider & consumer. Like others wondering about fees.

Mar 07, 2009

Thank you all for your interest in this post. The fee for this medical group is $99 per year. When you factor in all the time saved, better service, and overall convenience, it's a tiny fee. Of course, those under hardship can't afford this, and ideally this quality of service would just be standard practice.

With regards to being able to email your doctor: this might be a financial loss to the physician since they can't bill for it. But it's a huge win in terms of efficiency, throughput, and quality of service. I don't know enough about the financials of all this, but I'll say that I wish we determined what care should be given based on what's best for the system, and not old billing practices.

Here's a review on yelp I read which helped convince me to join, and summed up the potential time savings:

So here's my experience in a nutshell: I called the office and they said I could come in pretty much any time that day. I scheduled the appointment for an hour from my call. They emailed me a confirmation message and a link to fill out all that annoying first-visit paperwork online. 10 minutes later the form was filled out. 45 minutes after that, I was in the waiting room. One minute after that, I was in Dr. Timothy Chen's office. After a calming, helpful 20 minutes with the doctor, I was done. And on my way out, he gave me his business card and said "call or email me anytime with questions."

So about an hour and a half from having a lot of stress and no doctor, I was virtually stress-free and had a doctor I could contact anytime. If that's not worth $99 a year, I don't know what is.

Daniel Schildt said...

Wonders of private healthcare… or what? Too bad there is huge problems in public healthcare as they could learn much from these kind of companies who make things more powerful by using today tech to get things done. Still, would be great if email would be more secure since I'm not that comfortable for using unencrypted connection for talking about possible health issues (not that it couldn't be done, just that it shouldn't).

Still, end of day this looks nice package that certainly would be worth of yearly fee. But wonder what? It's not only that, since you are required to pay for all of the insurance (and that's not very cheap thing to pay overall). Maybe I don't have a clue of how healthcare system works in USA (I'm from Finland)… anyway.

Mar 16, 2009

Andrew Diamond said...

Hey Sachin et al.....I just ran across this great post and discussion. I'm one of the doctors who works at Metropolitan Medical Group, and it's really exciting to see everybody talking about what we're doing. Thanks for spreading the word!

I think I speak for all of my colleagues when I say that we're really happy with the practice we've created---we love our patients, and love providing the kind of in-depth, personalized, convenient care that our structure makes possible.

One thing I should clarify...we don't just dole out drugs to whoever asks. We read all our emails carefully, and if we think a patient needs to be evaluated in the office, we bring 'em in for an appointment (usually that same day). On the other hand, if a well-known patient just needs a prescription for an asthma inhaler renewed, then we'll take care of that electronically without an office visit. Get the idea? It's all pretty rational.

If you guys have any questions, we're happy to talk to you! You can write to me directly (adiamond@metropolitan.md), or call our office at (415)-291-0480.

[I just signed up to join this discussion, so I guess it's time to start writing something interesting on my posterus. I'll work on that...]

@Andrew: Thanks for bringing expertise to this thread. I'd love your further thoughts on Metropolitan Medical Group. How can Metropolitan provide great care when other heath organizations can't / choose not to? What should be the role of boutique medicine (if that term is accurate) in the larger health care system? We could all use a practitioner's viewpoint on these issues, especially since health care is one of the planks in Obama's agenda.

Perhaps a good subject for your own Posterous blog?

@Mr. Cheeks: Great suggestion; I'll get crackin.'

I don't know a single health care practitioner who would actually choose not to provide great care. It's just that most of us are practicing in badly broken systems that really constrain the way we work---and this is especially true in primary care practices. In school, we don't get any training in how to run business, fix large systems, etc. We only get taught how to take care of people.

At Metropolitan, we've decided to make a fresh start, to teach ourselves some things about business, and to get really creative with the way we run our practice. We certainly aren't alone---a lot of docs are trying to do similar things all over the country.

As for the role of boutique medicine in the larger health care system....who knows? We want to be a guiding light, though. We hope that the things we learn, the tools we build, and the standards we develop will be very widely applicable. And I'll say this: we don't want to be an "exclusive" boutique operation. We want to keep our fees low so that we can be widely accessible---like, to all of you! That's the whole reason we're doing it. We want to fix health care in America (or at least help).

Jun 29, 2009

Laura said...

Metropolitan Medical Group has changed it's name to One Medical Group. They are simply the best primary care providers in San Francisco - read their website for more info: www.onemedical.md

Oct 30, 2009

Medical Spa MD said...

You had me at 'same day treatment'.

Sachin’s Posterous

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