How’s this disparity? On May 11, the New York Times penned a lengthy piece on how, even with the recession, “Concierge Docs” (where well funded types pay a lot of money each year to have more personal relationship with their physician) were still doing bang-up business. On May 12, the New York Times penned another lengthy piece about hospitals setting up clinics in supermarkets and other stores to reach patients who do not need ER treatment.  This is not purely for altruistic purposes, of course. Apparently, their most desirable consumer is women of childbearing age. Presumably if she gets treated well at the walk in clinic at Wal-Mart, she will decide to pop out a kid at the affiliated hospital.

Business model aside, I am kind of intrigued by these so-called  retail clinics. It really fills a void for people who cannot afford health insurance (at one of the clinics profiled, the cost for a routine physical was $30).  In the article, of course the Doctors interviewed waxed poetically about the importance of a one-on-one relationship between patient and doctor that does not exist at these clinics—the Primary Care physician knows their patient’s medical needs.  Each and every patient.

I have  seen my PCP once in the four times I have gone into her office. The only time I did get my actual Doc, she looked like she wanted to kill me for actually nabbing her for the appointment. Her disinterest in my medical needs was astounding.

Isn’t that what those Concierge Docs are for, anyway?  For a whole lot of money a year, that Doc promises to not have more than 600 patients per year so that the Doctor can have a much more personal relationship with the patient. If a doctor with 600 patients a year is considered a high-priced Concierge Doc, would a regular plain old PCP know the medical needs of a patient load that reaches into the thousands?

Decent piece by Natasha Singer in the New York Times today about dermatologists offering preferred treatment (and faster appointments) to
cosmetic enhancement patients.  It
relates the story of a Dallas woman who went to a derm to check a suspicious
mole on her foot. The derm took two minutes to look at the mole and tell her it
was nothing, then proceeded to try to sell her from his product line. The
woman, being a smart cookie, sought a second opinion.  The mole turned out to be a melanoma.  NICE.

When clients with a potentially life threatening disease
like cancer are given short shrift because the MD can make more off of Botox,
there is something extremely wrong. Patients with conditions that require a
doctor’s care, like cancer, psoriasis and even cystic acne, should be able to
see an attentive physician in a timely manner.

Scroll through the comments.  Amazing to see how tough it’s been for many people to get a
timely appointment for real medical concerns.

We all know stress can be a killer–literally. But it can also impact your skin.

The Dermatology Times has a bunch of nifty pieces on stress and skin diseases (ranging from acne to psoriasis) noting that in recent years, scientists are seeing a closer connection between the central nervous system, the endocrine system and the immune system and how stress can impact the skin’s barrier function.

In one study cited, psoriasis sufferers who listened to meditation tapes in addition to receiving PUVA therapy cleared twice as quickly as those who received PUVA therapy alone, leading a University of Rochester researcher to say that mindful meditation is an easy and useful tool to help combat skin ailments. In a separate piece about managing stress, one Doc is quoted saying that derms are not as likely to recommend yoga, meditation or tai chi as they are to simply prescribe a topical or oral antibiotic.

An interesting note–the patients were usually stressed out by their skin disorder, which was partially caused by stress, creating a vicious circle of stress exacerbating the condition and the condition exacerbating the stress. Phew. Just. Calm. Down!

I hope that more derms will advise their patients to take part in some stress-relieving form of exercise or meditation in addition to the usual topical antibiotics. One thing that did concern me was that one of the docs uses an example of a psoriasis patient he successfully treated with a topical treatment and a prescription for 50 mgs of Zoloft. While this particular doc was also a clinical psychiatrist, I don’t want my derm to write out a prescription for any anti-depressant or anti-anxiety meds. I would have preferred to see the results with a prescription for a yoga class three times a week.

I applaud that researchers are spending more time looking at stress its impact on skin disorders, but I hope that they examine non-pharmaceutical techniques to beat it, and not just shove one more pill down the throat of an over-prescribed nation.