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Marcus Welby: Where are you ?
Old 08-02-2009, 04:45 AM   #1
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Marcus Welby: Where are you ?

I know there are a million reasons why we can't do it the old Marcus Welby way, BUT, what are the reasons we can and should go back to the simplicity of the Welby way. A doc, his/her nurse and / or receptionist and that's it. We've as a society dug ourselves a healthcare hole that we seemingly can't get out of. Is there a 'Voluntary Simplicity' book for medicine/healthcare.
Sometimes the best solutions are the simple ones solved by he simplest of minds.
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Old 08-02-2009, 06:49 AM   #2
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Could be that life expectency (in the US) has been extended since the series started in 1969.

Using the info at:

Life Expectancy by Age, 18502004 — Infoplease.com

A white male (for example) had an expected lifespan of 67.94 years.
By 2004, it went up to 75.7 years.

Assuming some extension of life is due to the medical profession, which year would you wanted to be born in? (the Welby era or the age of being well ?)
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Old 08-02-2009, 07:06 AM   #3
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Today Marcus would be sued out of existence before completing his second season. His was not a litigious era - this one is.
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Old 08-02-2009, 07:50 AM   #4
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I agree that it would be nice not to have the big business aspect of medicine however times have changed. If the sole practitioner goes on vacation, who covers his/her practice? People want doctors available immediately if not seven days a week, at least six days a week and evenings, too. And answering the phone all night. And the doc better not get sick. Ever. Insurance form processing takes about 3 people, which raises costs. It is more efficient for a group to share costs for the large office staff for the paperwork, maintaining a lab and expensive diagnostic equipment. And don't forget that the staff wants a full benefits plan commensurate with anything offered by the hospitals and competing group practices. And if you are in your office, who is visiting your hospitalized patients and the patients who are in nursing homes? And who would want to be "on-call" all the time as opposed to sharing this duty with other members of a large group practice? The sole practitioner has to keep up not just on new things in medicine but also be a CFO, IT and HR guru, and lawyer.
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Old 08-02-2009, 09:18 AM   #5
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Interesting points, WhoDaresWins. Ironically, everyone wants a Marcus Welby as their doc; always available , compassionate, spends whatever time you need with you, and operates in YOUR best interest. What is also interesting is the huge growth of the medical-industrial complex ie., new drugs, equipment, technology, computerization etc. But have we gotten our bang for our buck..I don't think so. Have our morbidity and mortality rates relative to our advances really kept pace with what we spend relative to countries with far less resources. We are producing and using drugs, but are these drugs and the research that support them always operating in the patients best interest. Since pharmaceuticals don't generally do or support research on older drugs; do we REALLY know weather or not they would do an equal if not better results. The PhD's doing the research are paid by the drug companies. Is fish oil, aspirin,exercise,weight loss, inexpensive beta blockers,low fat diet equal to all the Lipitor and Plavix we prescribe.
Does everyone need a CT scan or MRI for back pain. I know someone will mention the lawsuit aspect of not ordering tests and the issue of "standard of care", but do we not see that our demands as a society have in many ways led to the increase in costs.
Those with "good" insurance rush to the doc at the first sign of any malady, even a sore thoat that started this morning as opposed to first trying some old time solutions such as salt water gargles and acetaminophen; no we want Azthromycin or God forbid DEMAND of the doc Levaquin since their co-worker is taking it
Relatively few with insurance are pushing for reform (now) , they see no particular urgency. Congress by the way for the most part is in this group. But the moment a person has no insurance or loses a friend or family member suddenly they become advocates.
I think everyone should have access to the same health care plan as Congress. I didn't say free care. The rates should be on the same level that Congress pays, no more, no less. Why is this such a complex concept. We've been dealing with this health care issue for years now, and you'ud think with all the "brilliant" minds we have we'd have come up with a solution by now. We have auto, life, disability,home insurances and we don't seem to have such difficulty figuring it out. Buffett owns Geico and seems to be doing OK, in thefree market...competition is GOOD. If a business can't compete it gets out of the business, Duh...

PS: By the way, all health professionals want a raise every year, where does this money come from ?
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Old 08-02-2009, 09:29 AM   #6
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I had a practice like that for over 10 years, just me and an assistant, sharing space with two other colleagues in similar situations. Back in around 1980 it was feasible and if not lucrative, it paid enough. In some ways that was one of my favorite career memories.

But even then there were distant rumbles of change. The HMOs were just starting to flex their muscles and negotiating hard with employers. Harsh rules were put in place about referrals, "allowable tests" and similar dictums. But since my natural practice style was pretty restrained I could live with that. The, in the face of roaring inflation, their reimbursement rates started dropping fast. I thought I'd better regroup before it was too late, and rejoined an academic group, a setting in which I have remained ever since, climbing the seniority ladder and working my way around. It was a good move.

Take heart a little: a revival of the old primary medical group is being studied and discussed with some of the elements of Marcus Welby. We'll see, but I'll be long retired by the time this takes hold, if it ever does.
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Old 08-02-2009, 09:37 AM   #7
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... but I'll be long retired by the time this takes hold, if it ever does the chances of this taking hold are about as likely as my retirement percentage reaching 100%.
Rich, I corrected your typo.
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Old 08-02-2009, 09:43 AM   #8
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Rich, I corrected your typo.
Hmm... you bring up a good point. With this prospect on the horizon it might not be a bad idea to hold off. I wouldn't want to rush through a decision this important. I could easily have 5-10 more years of practice left in me.

How old was Marcus when he went off the air?
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Old 08-02-2009, 09:56 AM   #9
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I heard a story on NPR a few months back about a doc who is in private practice and takes only cash patients. An office visit is about 50 bucks. The doc got sick of the insurance paperwork hassles and decided this was the best way for him. The patients love it--it is almost as cheap/convenient as the Urgent Care clinic, but they can see their regular doctor this way and he can write prescriptions.

I don't know if he is on call or if he just asks his patients for go to the ER for emergencies.
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Old 08-02-2009, 11:15 AM   #10
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I say we shouldn't stop there; we should go back to "Father Knows Best."

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Old 08-02-2009, 01:16 PM   #11
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Ha,ha! Yes, Marcus Welby has gone the way of Father Knows Best and Opie and Donna Reed and My Three Sons.
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Old 08-02-2009, 03:31 PM   #12
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I was partial to his sidekick....
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Old 08-02-2009, 07:12 PM   #13
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Marcus Welby's business model just wouldn't fly nowadays. Marcus must now document his continuing medical education on an annual basis, provide or pay for 24 hour coverage, and cover higher fixed costs. Young people find him fuddy duddy and want to be seen by the nonexistent nurse practitioner. His portfolio severely diminished, he takes on an excessive number of patients, mostly in his own age group, many of them shuttling between specialist services and his practice and returning with 14 drugs Marcus has never heard of. His handwriting is now completely illegible and his prescription error rate is rising, and he can't turn on one of those newfangled computers. He's missing important diagnoses and behaving inappropriately (calling female patients "dear") and comes under review by his state professional body for inappropriate behaviour. His liability insurance becomes unaffordable, and he loses his licence and his credibility in the community. It is a sad end to an illustrious career.

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Old 08-02-2009, 08:01 PM   #14
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Hey - I have an American Passport - surely such a practice exists in some mythical land - of course I may have difficulty learning the language.

heh heh heh - I thought medical tourism was alive and well - ok ok so maybe not yet at the Marcus Welby level. But I still believe the Saint's will make the Superbowl - any season now. .
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Old 08-02-2009, 09:09 PM   #15
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Marcus Welby's business model just wouldn't fly nowadays. Marcus must now document his continuing medical education on an annual basis, provide or pay for 24 hour coverage, and cover higher fixed costs. Young people find him fuddy duddy and want to be seen by the nonexistent nurse practitioner. His portfolio severely diminished, he takes on an excessive number of patients, mostly in his own age group, many of them shuttling between specialist services and his practice and returning with 14 drugs Marcus has never heard of. His handwriting is now completely illegible and his prescription error rate is rising, and he can't turn on one of those newfangled computers. He's missing important diagnoses and behaving inappropriately (calling female patients "dear") and comes under review by his state professional body for inappropriate behaviour. His liability insurance becomes unaffordable, and he loses his licence and his credibility in the community. It is a sad end to an illustrious career.


Sad but true.
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Old 08-04-2009, 08:16 PM   #16
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Marcus Welby according to my math was 62 when the show aired in 1969. I came home on leave from the USAF around October that year and remember my Mother telling me she had to watch the show. I watched it with her and was hooked myself. I grew up in a small town in Alabama and we had many doctors like Marcus Welby. I would love to see those days return but I doubt I will ever see it. oldtrig
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Old 08-05-2009, 02:38 PM   #17
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Marcus Welby according to my math was 62 when the show aired in 1969.
Now that I think of it, the TV show may have influenced my career choice in subtle ways. Although I eventually went into a specialty that is as unlike Marcus Welby's as it's possible to be.
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Old 08-05-2009, 03:20 PM   #18
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Marcus Welby's business model just wouldn't fly nowadays. Marcus must now document his continuing medical education on an annual basis, provide or pay for 24 hour coverage, and cover higher fixed costs. Young people find him fuddy duddy and want to be seen by the nonexistent nurse practitioner. His portfolio severely diminished, he takes on an excessive number of patients, mostly in his own age group, many of them shuttling between specialist services and his practice and returning with 14 drugs Marcus has never heard of. His handwriting is now completely illegible and his prescription error rate is rising, and he can't turn on one of those newfangled computers. He's missing important diagnoses and behaving inappropriately (calling female patients "dear") and comes under review by his state professional body for inappropriate behaviour. His liability insurance becomes unaffordable, and he loses his licence and his credibility in the community. It is a sad end to an illustrious career.


How True !!
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Old 08-06-2009, 04:06 PM   #19
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I would love a cash basis doc. I would also be willing to pay a monthly "capital fee" to help pay for the things that have to go into an up-to-date office or clinic. I would much rather have my monthly premium actually go to something that would be beneficial rather than to pay the insurance claims processors, customer service reps, CEO's, etc.

I realize I would still need to pay a premium for catostrophic care but I would much rather have my health insurance and health care costs be a lot more like my auto insurance and my auto maintenance costs. I just paid $800 in parts and labor for 100,000 mile maintenance on my Volvo (with 132,000 miles, oops!). It was a substantial cost but it was a direct transaction between my local mechanic and online parts supplier with no overhead charges factored in for the insurance industry.
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