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The Royal Treatment

'Boutique medicine' is personalized care for those who can afford it

SUNDAY, Dec. 1, 2002 (HealthDayNews) -- Dr. Kitha Griffin didn't like what she saw when she got out of medical school and joined her first dermatology practice.

Patients hustled in and out of examination rooms. Constant haggling with insurance companies. No time to get to know the people who trusted her to give them thorough care.

So Griffin joined a small but growing number of doctors who've said good-bye to overburdened practices and opened small, boutique-style offices that cater to far fewer patients.

Griffin's office in an Atlanta high-rise has marble floors and a staff that dresses in Donna Karan designer clothes. Griffin does all procedures herself -- from taking vital signs to laser treatments -- rather than having nurses perform them. And she spends at least 40 minutes with each patient.

Called "boutique medicine" or "concierge care," several dozen of these practices have popped up in major metropolitan areas around the United States in the last several years. Many promise on-time appointments, access to physicians day or night by cell phone or pager, and guaranteed same-day or next-day appointments.

Some have patients who pay by the appointment and procedure. Others charge a yearly retainer that can range from an estimated $900 to $20,000.

This apparent elitism is raising eyebrows among some ethics experts and physicians. They say boutique medicine is another symptom of the growing chasm between the care given to the rich and to the poor.

Others say boutique medicine isn't a sound solution to the unhappiness of doctors and patients frustrated with the managed care system. If every doctor took that tack, the medical system would break down, they say.

The American Medical Association (AMA) currently takes no position on boutique medicine, but its Council on Ethical and Judicial Affairs is investigating the trend.

Dr. Yank D. Koble Jr., president of the AMA, says he has no problem with such practices. He says the terms "boutique medicine" and "concierge care" are largely media inventions.

Throughout medical history, patients have had all sorts of financial agreements with their doctors, and fee-for-service has been around forever, he says.

"The same ethical principals apply to all of these relationships, which is to provide the best medical information and care for the patient they can," says Koble. "As long as this is maintained, I'm not too concerned by it."

For Griffin, it took only a couple of months after finishing her studies to decide the frenetic pace of a large practice wasn't for her. At the office where she worked, the doctors felt pressured by managed care providers to see a high volume of patients, she says.

The practice needed several staff members just to handle the paperwork and constant back-and-forth between the doctors and insurance companies.

It felt like "conveyor-belt" medicine -- and she didn't want a part of it.

"It was not what I went into medicine for," Griffin says. "If a patient comes in with a list of 10 questions, I should be able to get to all 10."

At her new office, which includes valet parking, patients pay in advance for service. She charges $150 to $205 for an office visit, a bit higher than the average in her area. Her procedures are comparably priced, she says.

If patients want to seek insurance reimbursement afterward, they can.

Griffin has heard the charges that her kind of practice caters to the wealthy, but she says she's comfortable with her decision.

"I would rather be a good service to some patients than a poor service to lots of patients," she says. "You pay to get your hair done, your nails, your waxings. Why not pay to see your doctor? That's the way I feel about it."

Koble doesn't envision the number of "boutique medicine" practices increasing dramatically. "It's probably self-limiting," he says.

One other point to keep in mind: What people are really paying for is convenience and attention, not necessarily better care, Koble says. There's no guarantee that the doctors who open such practices are better than other doctors.

And finally, he adds, to stay healthy, the most important things people can do are keep their weight down, exercise and stay away from smoking -- not chatting with your doctor.

"These are the things that really pay off," Koble says.

What To Do

To learn more about boutique medicine, read this article from the Association of American Medical Colleges. Two doctors debate the pros and cons of boutique medicine at Physician's Weekly.

SOURCES: Kitha Griffin, M.D., dermatologist, Atlanta; Yank D. Koble Jr., M.D., endocrinologist, Jacksonville, Fla., president, American Medical Association, Chicago
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