Remember going to the bank to get cash before the ATM? The long lines, the having to have a checking account AND a check, the getting to the window only to find out that something was amiss, or getting in a line that someone else was in who definitely had something amiss and watching the other line move much quicker. Sure, there were some good aspects (I used to get a sucker when I went with my mom) but for the most part getting money was a bit of a hassle. The other option was to cash a check by going to that little booth in the grocery store where they know who you were and would trust that you weren’t going to bounce a check THIS time. I remember that there was list of people in the booth as well, under the heading DO NOT CASH THESE PEOPLE’S CHECKS.

My experiences with money not been like this for years. I do not have a personal banker but have a personal relationship with my wife who handles the accounts. I have taken to “money machines” like a duck to water. We no longer have a bank in town. Partly this was because my efforts at using a checking account have never been good (I bounced my medical school admissions check because they held it for 4 months). Partly this is because we have found that using a combination of technology, distance banking, and local support when needed (to buy a home, for example) has suited us and our lifestyle.

Kevin Grumbach gave an outstanding plenary entitled “Family Doctors, Family Farmers, and ATMs” that I had the pleasure of hearing in 2007. In it he points out that farmers markets are looking to add relationship to food (which is a topic for another day) and that ATMs have taken out some of that relationship out of money. The key as a physician is to determine when the patient needs that relationship and to provide the right care at the right time for the right person. The key as a patient is to ask for care that is appropriate to his or her situation. Stand in line when appropriate, but go to the ATM sometimes too. The key for the folks who pay my bills is not to make me make people stand in line to get my care when it isn’t necessary. In the words of Kevin Grumbach:

If we can devise a primary care ATM—an automated triage machine—that can take a brief checklist history from a woman with dysuria, pop out a cup for a urine specimen that the machine will automatically interpret, and then print out a prescription for an antibiotic if everything points to an uncomplicated case of cystitis, all the better. Believe it or not, there are some patients with dysuria who don’t find a 3 hour expedition consisting of traveling to their beloved family physician’s office, waiting in the office to be seen, being seen, waiting for their urinalysis result, and traveling back home or to work, to be an approach that optimizes their experience of the medical home. Many patients in this situation would gladly trade a personal encounter with their physician for a more convenient method for addressing their urgent care need.

I am happy to report that 5 years later we are on the brink of providing this type of service and patients seem to want this type of care. If only the payors would all cooperate.

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