The Secret About Your Appointment: Why a Simple Question Becomes Another Visit

Sep 29

3 min read

Modern corporate healthcare has a problem, and it has come up with a frustrating solution. Most healthcare systems run on a fee-for-service model, which means they make money by billing for services, but not every useful part of medical care is easy to bill for. That might be calling your doctor because you were prescribed a medication two weeks ago but were too nervous to start it until now, asking the question you forgot while you were sitting face-to-face, or finding out what to do next after the first thing your doctor recommended did not work. These questions matter, and most doctors are happy to answer them. The problem is that a healthcare system usually makes more money from another scheduled visit than it does from a phone call, a video call, or a secure message. And when a doctor's time is already packed into the day, lost time becomes lost money.

I can already hear someone saying, "My doctor has a secure messaging system. I can send them a message any time I want." That is absolutely true. The strange part is that healthcare systems have made it easier for patients to send messages without always giving doctors more time to answer them. Your doctor's paid schedule is likely already full of office visits, while labs need to be reviewed, prescriptions need to be renewed, notes need to be finished, and messages keep arriving. That is a pretty good explanation for why your doctor may look perpetually tired. In that kind of system, "come in for a visit" can become the easiest answer to almost any question. It turns something that might have been handled with a short conversation into another appointment, another drive, another wait, and sometimes another copay.

I know what this feels like because I was one of those doctors. I worked in a system where the schedule rewarded the number of visits completed far more clearly than the time spent answering the questions that happened between them. I remember sitting across from a patient with a simple question who had been told it would be "faster" to make an appointment. Faster than sending a message or making a phone call? Somehow, that had become the system. I remember thinking, "This isn't sustainable," and "This is wrong," far too often. I cannot speak for every physician, but eventually I decided I did not want to keep practicing that way.

And here is an interesting irony: healthcare has already figured out how to make physician access easier when someone's time is considered especially valuable. Executive-health and concierge medicine programs are often built around longer visits, easier scheduling, and more direct access to physicians. The idea is not complicated. If someone is busy, important decisions need to be made quickly, and delays have a cost, then making it easier to reach a doctor makes sense.

The odd part is that those same benefits are often treated like luxuries when everyone else wants them.

That is one reason a growing number of physicians are moving toward direct primary care. In many ways, direct primary care is affordable concierge care: it brings many of those same benefits, including more time, easier access, and a closer relationship with your physician, at a much more approachable cost. If you want to learn more about how direct primary care makes concierge medicine affordable, you can read my article comparing the two or see how HealthWinds membership works. As a concierge doctor, I do not have to decide whether your question deserves an appointment based on whether an insurance company will pay for the conversation. Sometimes you need a visit. Sometimes you need an exam. And sometimes you just need to ask the doctor who already knows your story, "What do I do next?"

Sometimes good medical care really is just having enough time to ask your doctor one more question, and having a system that gives your doctor enough time to answer it.

Dr. Sharma is a board-certified family medicine physician and the founder of HealthWinds, a virtual-first family medicine practice serving DuPage County and the surrounding Chicago suburbs. He brings over 15 years of family medicine experience with Duly Health and Care and Loyola Medicine's MacNeal Hospital, among others. He sees patients ages five and up, with longer visits and direct access built around a membership model rather than insurance.

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