Uber Visits?


Here’s what is clear: Seeing several patients at once can be good for harried doctors’ finances.

As the concept of industrialized medicine gains more traction it has led to other “brilliant” ideas to treat more and more people like cattle.  Here is one that is trending: group visits.  Yes, just like shared car rides you now can share your medical visit. Insane?  Of course it is!  This is not what healthcare is about.  It should be authentic. It should be personal.  Mrs. Jones shouldn’t be talking about her vaginal itching in front of 6 other people. Mr. Smith shouldn’t be talking about his suicidal tendencies in front of an audience. 

“It’s efficient. It’s economical. It’s high-quality care when it’s done right,” says Edward Noffsinger, a California psychologist who created the model in the 1990s at Kaiser Permanente, the state’s largest health maintenance organization (HMO).

Efficient? Economical? High-quality? We are not making widgets. We don’t need W. Edwards Deming approach to healthcare.  Teaching groups of patients is one thing but treating groups of patients is another. Sure, we can always make things better but we are doing it backwards.  We are ACCEPTING the dogma that third-parties need to be part of the system and are tailoring our new and great ideas around them.  That is problem.  They need to be removed and when that happens it opens up true competition, true capitalism and truly novel ideas that actually help people instead of treating them on an assembly line.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  5 comments for “Uber Visits?

  1. RWatkins
    February 2, 2015 at 10:34 am

    I wonder what patient population would rather have a three hour group session, as opposed to an efficient, problem-oriented 20 minute visit?

  2. Kathy
    February 2, 2015 at 9:12 am

    As a risk management consultant, I was recommending group visits years ago for the right patients, as a way to increase patient education. There is research showing that patients like these and feel that they are getting more from their doctors, if it’s done right. The suggested participants are individuals with chronic illness or other situations were there is a lot of learning and need for patient understanding and cooperation. You schedule a group of similar people at the same time, and have a group discussion to share new info and answer questions, allowing for individual physical exams and discussions. The office was able to see more people with the same resources, and the patients felt they got more information and time…because they did.

    We do need informed patients…I hear physicians gripe all the time about people who don’t understand or follow instructions. This can give them an ongoing peer group. I had a one-off variation of this with my joint replacement class before hip replacement. Much information was shared, patients could hear each others’ questions and the answers and share tips with each other. Another example is childbirth class. Now we just need to develop the model for patients with ongoing issues.

    • Doug Farrago
      February 2, 2015 at 9:20 am

      I do a lecture a month, for free, on certain topics (cholesterol, etc). This is an added value to prove to my patients I am worth spending a monthly fee on. No one gets billed for these talks and Q and A sessions. It’s pure and authentic and how the free market can work.

  3. Steve O'
    February 1, 2015 at 5:41 pm

    The big money in this transition is to slough off liability onto “the informed consumer.” The shopper, and her children, bear the ongoing responsibility not to lose. Too bad for them, they shopped poorly.

  4. drhockey
    February 1, 2015 at 10:29 am

    Henry Ford invented the assembly line. Other businesses adopted that model, too. I guess it was only time before Medicine has as well. This is greatly facilitated by the EHR. Next, independent Scribes will enter the various parts of the history, followed by individual P.A.s performing various parts of the physical exam. Finally, all of the information will be funneled through the computer (IBM’s Watson) and the answer (diagnosis and treatment) will be proclaimed.
    If we are lucky, a few physicians will be retained to sign off on all of this.

    Orwell’s “1984” is getting to Medicine, but just 30-40 years later.

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