Fixing a Sick Doctor


Aaron Carroll is a pediatrician and wrote an article in the NY Times called Trapped in the System: A Sick Doctor’s Story.  He tells a tale of how much work it is to get his ulcerative colitis medicine. Let’s use his testimonial to see if my CatastrophicCare plan would work.

  • He mentions poor access.  (If he had a Direct Primary Care doctor like me then this would not be an issue)
  • The medicine is old and it’s generic. It costs about $80 for three months even though I haven’t met my deductible. But this story isn’t about money. This is about the nightmare of how hard it is for me to get the drug. (If he just pays cash and doesn’t tell his insurance then he could get his medicine easier).
  • Every three months, I run out of my medication. In order to get more, I need a new prescription. In order to get the prescription, I need to have lab testing to prove to my doctor that I don’t have anemia. (Once again, without insurance involvement and a DPC doc onboard, he is all set).
  • Let’s start with the lab testing. At various times, my insurance plan (which is excellent, by the way) changes which laboratory facilities it will cover fully. Often, these are not labs that are housed in the huge health care system for which I work. I often have to go elsewhere to have my blood drawn. If I change facilities, I have to get a new prescription for the labs, since they can’t share with one another. (A CBC for my patients is $10. End of sob story.)
  • Further, even though my lab orders are good for a year — and I need to have them drawn basically forever — the labs recognize them for only six months. So sometimes I have to get in touch with my doctor and get a new lab order. (This takes an email to get set up the next day in my office)
  •  But because the laboratory and my doctor are in completely different health care systems, the lab results won’t show up in my doctor’s electronic database. I have to beg the lab to remember to fax over the results — using paper — which it often fails to do. (I get the results the next day and tell the patient)
  • My next step is to check if the pharmacy I use is still under contract with my insurance plan. The medication I use needs to be ordered at a mail-order pharmacy, because my insurance won’t cover it at a local facility. My insurance plan has changed its mail-order pharmacy of choice more than once in the last few years, which necessitates that I inform my physician about the change. (Pay cash and all of this is irrelevant)
  • It’s at this point that I try to get in touch with my doctor, previously through a phone message, and more recently through an online site. If I’m lucky, which usually isn’t the case, the doctor will already have the lab results. If not, I have to go back to the lab and beg it again to fax over the results. If the doctor has the lab results, and they’re normal (they always are), a nurse will then call in the prescription. This usually takes a few days. (I only have 600 patients.  This scenario does not happen)

Can you see how the insurance company gets in the way?  This author’s physician sees too many patients.  It doesn’t have to be that way but since he bills insurance companies it changes the equation. That is why he is hard to get in touch with.  Once the insurer is removed, he can do DPC and real patient engagement occurs.  Once the insurer is removed, cash becomes king and prices come down.  Bureaucratic red tape is also removed and these articles do not get written.

Let’s replace Obamacare with CatastrophicCare.


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] 

  4 comments for “Fixing a Sick Doctor

  1. politovski
    October 4, 2015 at 1:42 pm

    great story. one wrinkle though: only gastroenterologists treat UC. and none of them will ever be DPC. most primary care are scared to death of using immunosuppressives, and monitoring them, so 99% of primary care will not touch this with a 40 foot cattle prod, dpc or no dpc. and it will be worse if you are on a biologic. so, i would say the moral of the story here is that it is a Charlie Foxtrot getting care from specialists….

  2. Randy
    October 4, 2015 at 9:12 am

    Aaron Carroll was a huge cheerleader for ObamaCare and was on Sirius radio many times pushing for its passage. Given that, it’s very tough to have much sympathy for him being mired in bureaucracy and facing rules that don’t make much sense. Dr. Carroll I’m sorry you have ulcerative colitis but you are also a victim of a system you helped create.

    • Perry
      October 4, 2015 at 4:36 pm

      And if he thinks it’s bad now, just wait…

    • Pat
      October 4, 2015 at 9:04 pm

      Then thanks in part to this story’s subject, the monthly premiums for myself and hundreds (?) of millions have doubled, if we could still get coverage. Courtesy of Dr. Carroll and the rest of the damn do-gooders in our industry, far more people have been harmed than have been helped. A few of us for over a decade warned about all of this, and yet a majority of voters elected to pay for health care with their neighbors’ checkbook,

      I don’t feel a bit sorry for Dr. Carroll. He’s getting what he deserves and I hope he never figures it out.

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