Sir Edmond, the Newest Clown of Medicine


We have a new Direct Primary Care critic. Edmond S. Weisbart, MD is a family physician in St. Louis, Mo. He is chair of the Missouri chapter of Physicians for a National Health Program.  So, right off the bat we know Sir Edmond is delusional and hates anything associated with capitalism or hard work.

What is Sir Edmond’s experience?  Well, he worked several years in “various safety net clinics” for what that is worth.  Oh, and he spent seven years as the CMO of ExpressScripts so that really must have helped him stay in touch with the common man.  Would a National Health Program need Express Scripts?

Sir Edmund decided to rip us DPC docs in the AAFP rag called Family Practice Management.  I will summarize his thoughts (with my responses in parenthesis) but go to the original article for all of his points as I had to cut a bunch of it out:

  1. DPCs exacerbate the growing physician shortage. DPC promises physicians more time with each patient, which it accomplishes by reducing physician panel size. Were the nation committed to the DPC strategy, it would take decades to “grow” enough new physicians. (Simple answer. Maybe if family medicine didn’t suck so much there would be residents wanting to go into it?  Oh, and who says the large panel sizes doctors have today is the right size?  I would say it is excessive).
  2. DPCs are essentially unregulated insurance, capitating physicians and removing vital patient protections.  Yet pure DPCs operating completely outside of the insurance industry are not as constrained by parts of HIPAA, the Health Information Technology for Economic and Clinical Health (HITECH) act, and the Affordable Care Act that protect patients’ confidential medical information. In fact, there is little preventing DPCs from selling patient data to marketers. As the DPC model grows, the demand for this high-value data will undoubtedly drive increasingly irresistible financial offers. Additionally, there is no organized strategy for driving DPC practices toward best practices, guideline adherence, public health data collection, etc. (Exactly….wrong.  We are not insurance companies. That is obvious.  We don’t sell data.  Who does?   The AAFP, the non DPC practices, employed practices, insurers and on and on.  Sir Edmund, your data is being sold right now.  You are just not getting the money for it.  And the quality metrics you mention are unproven and have done nothing to help patient care.  It is what is breaking the backs of present day family docs and you want to continue that. Not me.).
  3. DPC relies on an erosion of medical benefits. One of the key selling points of DPC is that it reduces health insurance premiums for employers. This encourages further adoption of high-deductible health plans, which have been shown in some studies to produce blanket reductions in utilization, of both needed and unnecessary care. (What the hell are you talking about?  Everyone is going for HDHPs because they can’t afford anything else. Then they never see a doctor because they can’t afford to.  Most DPC patients will each see us about 6 times a year.  This is great care.  Your system – you know the one you voted for when you voted for Obama – sucks.  You failed.)
  4. DPCs exacerbate disparities in care. Although the evidence is still emerging, DPCs may be choosing to locate in areas most able to financially support the model. (Untrue.  You use studies based on concierge care, which is a different animal.  Our practices are located everywhere.  Our patients’ incomes span the whole spectrum.  For many, we are all they have.  Also, a lot of us doctors give a ton of care away for free).

Sir Edmund is a clown who is just jealous.  I get that.  I just wish his points were valid but the dude is so clueless that it is laughable.  If you have an opinion on this then I highly recommend you leave a comment on the AAFP site because I cannot.  Why?  I refuse pay dues to them and I need to pay them to have the luxury of leaving my opinion.

All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.

Arthur Schopenhauer

Looks like we are in stage two now.  I love it.

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] 

  7 comments for “Sir Edmond, the Newest Clown of Medicine

  1. Joe Smegma
    September 17, 2016 at 9:23 pm

    Healthcare 2016. What a car full of clowns! I speak with my colleagues daily about the current model. It is a wasteland. Doctors devalued, working more to make less, providing care that is strained by time and resources. This is a shit storm. DPC and models that value true quality i.e. Time with patient, smaller panels, knowing your patient, less bureaucratic drag, actually caring. This makes a difference. Doc’s know when they are providing good , mediocre, or great care. They know this. You cannot feel good about the care you give to diabetic vasculopath with depression, back pain, and a bad marriage in 15 minutes ( and they showed up 5 minutes late). It is simply impossible. I do get angry when I hear the ivory tower tell us they know better. They are not in the trenches. This dilemma for good primary care doctors is burning them out at a historic rate. It amounts to a generation kill. Healthcare and primary care will not recover. Forever changed. For those of us who dedicated our professional lives to this noble professional and a “calling” it is beyond sad. The medical students I teach know the score. They are not choosing to be family doctors.

  2. September 17, 2016 at 11:11 am

    He’s nothing more than one of the throw-away, ancillary characters that Ayn Rand wrote about in Atlas Shrugged. “wanting to tear down something that he had neither the wit to create, nor the ability to adopt.” Exactly.
    I am perhaps a bit warped, but I find Atlas Shrugged to be a lot like “Fear and Loathing in Las Vegas” – a wildly written stereotype on reality, seen by a brilliant but over-the-top observer. The characters are darkly morbid, but hilariously criminal. Don’t forget that Ayn wrote AS on amphetamines – stuff Hunter couldn’t get his hands on. Read it and weep.
    The book abounds with evil slobs like Sir Edmund. And the question is poignant, when asking about awful folks such as Evil Ed – “If we are for life and living, what are THEY for?”

    • Pat
      September 17, 2016 at 11:53 am

      AS was the most important book I read in during medical training 😉

    • Sir Lance-a-Lot
      September 17, 2016 at 5:16 pm

      “… stuff Hunter couldn’t get his hands on.”

      I don’t think Hunter S Thompson ever had any trouble getting his hands on any particular drugs.
      Many of the drugs that are illegal or hard to get now were legal or commonly prescribed with minimal prerequisites or drama back then.

      Everyone who was anyone was on some type of amphetamine back in the fifties and sixties (Obetrol, for instance, which was renamed Adderall when prescribing amphetamines to adults fell out of style, and prescribing amphetamines for children became all the rage).

  3. Pat
    September 17, 2016 at 9:45 am

    Anyone like Sir Edmund the clown who clamors for big government to protect “the little guy” is actually practicing, and spreading the philosophy of envy, which always becomes permission for the bully. Edmund is nothing but a bully, wanting to tear down something that he had neither the wit to create, nor the ability to adopt.

  4. Michael
    September 17, 2016 at 9:37 am

    You can register for free and leave a comment. Good luck SEEING the comments on a mobile device though.

    • Doug Farrago
      September 17, 2016 at 11:24 am

      Only if you are paying member can you leave comments. I tried.

Comments are closed.