At the close of a doctor’s visit, as patients head out of the exam room, they commonly utter four words that can make physicians cringe.
“Oh, by the way ...”
The ailment suddenly worth mentioning could be anything from a lingering headache to a lump in the armpit to a mole that has changed shape.
“That one thing can often be the most important thing,” Dr. Brent Laughlin, of Tulsa, says of the last-minute complaints.
To that end, he and others are part of a program designed to convert those afterthoughts into deeper conversations about personal health. It is called MDVIP, the largest provider of personalized preventive care services in the country. MDVIP-affiliated doctors in 43 states serve about 325,000 consumers who pay an average annual membership fee of $1,650 to $1,800 annually. The program requires patients to be enrolled in commercial health insurance or Medicare.
Twenty-one MDVIP-linked physicians work in Oklahoma, including nine in Tulsa.
“The health care experience today can be a frustrating one,” said Bret Jorgensen, CEO of Florida-based MDVIP. “Practices are quite busy, and primary care doctors are often in a situation where they are simply triaging to other specialists, other tests.
“It’s very hard for them to engage in other people’s health. This combines high-tech, current tools with old-school medical thinking, with a real personalized approach to people’s health.”
Laughlin, who went into private practice in 1983, joined the MDVIP family about six months ago.
“I thought this might be a fit for me,” he said. “I wasn’t tired of being a doctor. I was just tired.
“Trying to do everything with more time constraints and more patients became very difficult. I’ve found that being able to offer longer appointments … there’s just time to re-engage on a personal level, to really know. It helps so much to know the personal things that are going on in somebody’s life and how they affect health.”
The average primary care physician sees about 2,000 patients in their panel (those who come in at least once every two years), Laughlin said. Now, his panel is capped between 500 to 600.
One of his patients is Linda Devonshire, 60.
A former medical assistant, she had been a patient of Laughlin for 14 years before following him to the MDVIP model.
“When I found it he was leaving, it was a no-brainer for me,” said Devonshire, who, like her husband, Joel, pays $1,800 a year for the personalized service. “I wasn’t putting a price tag on this man. I would even pay more. I would rather give something up than to give him up.”
In addition to as-needed doctor's appointments through MDVIP, patients receive an annual comprehensive, prevention and wellness program that lasts between 90 minutes and two hours. It encompasses advanced screenings and physician counseling that focuses on heart health, emotional well-being, diabetes risk, respiratory health, quality of sleep, hearing and vision, sexual health, nutritional assessment, weight management, bone health and risk-factor analysis.
“I’m very familiar with the medical part of it, but a lot of the things he spoke about, the detail blew me away,” Devonshire said of the thoroughness of the wellness exam and consultation.
Adds Dr. John Hubner, of Tulsa: “To have an hour each year with a patient and ask them, top to bottom what’s wrong, it gives me a sense of confidence that I’m at least approaching and treating their life with the respect that it deserves.”
Hubner became the first MDVIP in Oklahoma 10 years ago. Now, he is in a practice with his younger brother, Mike, who also is affiliated with the organization.
“I went into medicine to connect with people,” John Hubner said. “I still remember Marcus Welby, and that’s how I wanted to practice, where people knew me and they could approach me and I could feel like I was actually making a difference. In the traditional model, it was becoming harder to do that. It’s a volume business.
“You need to be able to spend time with your patients and know them. That’s what this model offers. It’s a healthy way of practicing. I don’t think I could go back the other way.”
Critics of MDVIP say the annual fee can embolden patients to demand extra — sometimes unnecessary — services. Others claim the physicians can accomplish the greater good by treating more people instead of fewer.
“I’ve done the 35 years of as many patients as I could see,” Laughlin said. “If I could continue to work 10 to 12 more years, which is the plan, in the long run I will be able to take care of more patients.
“So do I retire and give up my experience and training and networks and relationships with patients and let everybody fend for themselves? Or do I refocus and let patients who see the value of prevention and continuity follow me?”
Some also say MDVIP is cost-prohibitive for many folks. Laughlin contends at $1,800 a year, it is a “bargain” for people who value medical continuity, relationships and wellness.
“That comes down to about $5 per day, which for many people is a cup of coffee,” he says. “When you break it down to that level, it’s really not that much money.”