Below find excerpts of an email sent by a faithful reader.  I have included the whole text, but broken it down to respond to each point accordingly.

I have really enjoyed your blog postings and the sensitivity you showed toward patients. But, your new venture is a real turn off, and makes it hard for me to want to read your posts anymore.

I have been waiting for this.  Expecting it.  I knew that when I changed my practice model there would be anger and disappointment.  For this reason, I have gone to the trouble of telling each patient face to face in the office when they come in for an appointment.

This has been my decision.  I will own up to it.  I won’t hide behind a formal letter or slink out of the room.  If patients are upset, I will soak in the anger and accept it.  I owe that much.

So far I have received mostly understanding with a smattering of joy and disappointment.  My patients know me very well, they don’t believe I mean them harm.

My dear reader, sometimes you have to look eye to eye to see into some one’s soul.  A blog, unfortunately, does not allow for that.

As a patient (not yours), it seems like you are abandoning patients who do not have the money to pay your new fees for which you will take no insurance. Instead of staying in the trenches and finding the insurance battle with them, you seem to be washing your hands of it and leaving them on their own. Onward to people with disposable incomes to pay for handholding.

On the contrary, I’m still taking insurance.  For fifty percent of my practice: nursing home, hospice, and palliative care there will be no extra charge.   These are some of the most difficult and high risk patients.  I will continue to stay in the trenches and battle for them.

I am changing, however, my outpatient primary care practice.  I will charge a yearly fee along with billing insurance.  The yearly fee pays for uncovered services like home care, cell phone access, and prolonged visits.  I believe this is a fair trade off.

My perception may well be wrong. Perhaps I did not listen carefully enough to your explanations. I want to believe that you are who you appeared to be, a great, caring physician. But, I thought that you might like to know that at least one of your loyal blog followers doubts that now. Take care.

I would like to think that I am still perceived as a great, caring physician.  I would also hope to be viewed as a strong patient advocate.  But the problem is, I can’t protect my patients from the ridiculous, pervasive stupidity of medicare and our modern day insurance Goliath.

I can keep bending, and giving, and finding ways to work around the vicious beast.  Or, I can choose to step out of the lion’s den.  I will not be an enabler of this broken system.

Change will only come when doctors and patients alike are willing to stand up and say enough is enough.

I am in the unique position to do just that.

Jordan Grumet is an internal medicine physician and founder, CrisisMD.  He blogs at In My Humble Opinion.