For the sake of civility let me end offer this. Many before Jay, including myself, have toyed with concepts of uncluttered practice models and the holy grail that is the high touch/high tech boundary. Elusive, it is. So, give it a go, Jay, and good luck. In the end clinical ennui will probably get you, if fame does not. Otherwise I shall be hushed and chastened if Dr Parkinson is still doing this even 2 years from now. In the meantime, let us all be careful about bashing those boots on the ground who work against the machine from the inside, day in and day out. The modern hospital setting is the most complicated human working environment on earth and will not come into order easily, if ever. If it were otherwise, M$ or Google would have done it already.

BTW- I love this website. Thanks Mr H and keep up the good fight.

DZA MD

“I am not young enough to know everything.”

-Oscar Wilde

I must apologize for the terse and cranky nature of my comment. Up all night with critically ill patients does that to me. And ad hominen attacks are simply unacceptable, and it is valid to reply in kind. So let us start fresh.

Yes, young people do get sick. Usually from self-limited illnesses that their mothers could once handle. The demographic you serve has a mortality rate of between 2 and 10% of that of the general population and a fraction of a percent of the highest risk population (the elderly). While I share your dismay with the over treatment of the old and dying (personally, I share Ex-Colorado Governor Richard Lamm’s point of view that the frail dying elderly actually have a moral “duty” to die, which is why he is an ex-governor), few if any, of your patients are seriously ill. And when you walk into your first hot leuk, DKA, HIV w an OI, or septic cirrhotic GI bleeder, please let me know how you plan on handling it…a 911 call would seem your only real option and yet a very cost effective and safe disposition from your perspective, no? and then you simply walk on to your next “case”. Of course, now that patient is in my world. And yes, I did create the current insurance company/ greedy clinician brinkmanship fee-for service arms race, but I so rarely get credit. You are too perceptive and kind. ( BTW- I have been on salary my entire career).

In regards to concierge practice…I just glanced at your (very eye candyish) web site. Just exactly what is NOT concierge about it? Cash only, and if one is actually ill, a list of other doctors (pick me!) to go to. Buena suerte persona enferma!

And, you may as well know, I was bucking the system before your were a blastocyte, beginning with a medical school Grand Rounds Expose on the morally bancrupt policies of the AMA, to open forums on the medical-industrial complex, getting black balled for calling out physician executives, to one of the most famous hacks in medical lore (http://picasaweb.google.com/mike.dematteo/Funny/photo#5130812848713903442).
(FTR-I am not actually admitting to being mike dematteo md (( I wish!)), but he was kind enough to host my stuff)

So, lighten up. And hurry up and diagnose those sniffles and rashes before they go away!

As a matter of fact, I am not a covered entity under federal HIPAA laws. The definition of a covered entity under HIPAA is very, very specific and the federal government has a flow chart to determine if you are a covered entity. It can be found here:

http://www.cms.hhs.gov/HIPAAGenInfo/Downloads/CoveredEntitycharts.pdf

I still have to abide by NY state privacy laws where HIPAA regulations do not preempt them. NY state does have privacy laws as well (most of which are preempted by federal HIPAA laws). NY State has a very informative (albeit a little confusing) webpage devoted to what state laws apply and where federal HIPAA laws apply. HIPAA solely regulates those individuals who transmit private health information to another entity such as insurance companies, research institutions, etc.) The proof of me not breaking any privacy laws in NY State is found here:

http://www.nyhealth.gov/nysdoh/hipaa/hipaa_preemption_charts.htm

Thank you for your concern.

DZA MD…You are absolutely correct. Young people don’t need doctors. They never get sick! Just because the demographic I’m treating doesn’t need to see the doctor as much as 30 year combat veterans, they still see a doctor on average about 3 times a year. It’s just the nature of life sir. No demographic is immune to needing a doctor. Some simply need it more than others. If you think that the only point to being a physician is to prolong the lives of the elderly who use the healthcare system to it’s capacity, then I don’t even know why I’m addressing this issue with you. I’d also appreciate it if you could tell me how my practice is a concierge practice. You must not have read up on the real issues of my practice. It’s not the house calls nor the technology. It’s much more about taking care of my patients ensuring they don’t get screwed by the Industry that profits from keeping cash paying customers in the dark…and that’s an industry you, as a veteran physician, helped create. I wish there were more physicians who were fighting for more transparency in healthcare prices back when you were my age. If so, 50 million people across America might not be in such a bad situation.

/30 year combat veteran (ED/Hospitalist)