ONE PATIENT'S STORY

The pain started while he was playing tennis. X-rays showed an inflamed joint. 

It’ll get better, his doctor said. 

But the pain persisted. An injection didn't help. He visited more doctors, got x-rays, PT, blood draws. He had an MRI, more PT. Five years after that tennis match, he sat on my exam table telling his story. He could no longer run or play pickleball. He had just turned 50.  

The man had good insurance. He has personal resources. One friend suggested the Mayo Clinic. 

Another suggested concierge medicine. 

I am a general internist. I'm not a joint expert. But because of my training and two decades of clinical experience, I have familiarity with most conditions. And I’m always curious. Why didn’t that work? Is it just the one joint? What are other clues?  

I called my favorite orthopedic surgeon. “What are we missing?” I said. The orthopod suggested a second injection; this didn’t work, either. 

The physical therapist messaged me. “His joints are pretty stiff,” she reported.   

I sent him to a rheumatologist. 

We finally had a working diagnosis. The patient started treatment. It had taken five years and two months to move things forward.  

Patients can get "lost" in the healthcare system due to insurance delays, too-long wait times, and dropped communication, among other factors. 

Concierge medicine is a newer practice model that addresses some of these big challenges. Because concierge practices are directly funded by patient fees rather than insurance reimbursement, concierge physicians have greater control over matters like how to allocate their time. Many limit their practice size to just a few hundred patients, as compared to traditional primary care panels, which serve thousands.   

Some practices have a particular focus. At Sequoia Project, I’m focused on exercise and eating well, with a practice model that prioritizes communication. I connect with everyone on the patient’s team, from the physical therapist to specialty physicians to family members when needed, and above all, I keep in touch with patients, keeping us atop any active issues. Similarly, patients appreciate messaging me as their concerns arise. 

Seattle-area concierge practices charge anywhere from $135 per month per patient to tens of thousands of dollars for a yearlong contract. Many practices are full with a waiting list. With the current challenges mainstream primary care practices are experiencing, policy experts are watching closely to see whether the concierge model may indeed address concerns with the current system, and perhaps with better health outcomes to boot. 

Last weekend, my patient’s family was home for the holidays. He messaged to say he’d played three games of pickleball. I could feel the relief coming through his words. 

The joint was better than it had been in a while, he said. He was delighted, and grateful. 

December 26, 2023