General Medical Center stays independent

When General Medical Center opened its doors on East Battlefield in 1978, it was an innovative practice, unique not only in southwest Missouri but in much of the United States.

Its location and some of the personnel have changed over the years, but the founding philosophy of patient service has remained the same.

The freestanding clinic, which is not associated with a hospital, serves walk-in patients with non-serious emergencies such as upper respiratory infections, simple fractures or lacerations.

According to Dr. L.D. Atkinson, who acquired the clinic in 1981 after working there for two years, sick patients often had to wait several days to see their own doctor. Urgent medical needs were often treated at emergency rooms when a family doctor was not available. Atkinson said that the General Medical Center was created to address these needs and at first served 80 or more patients daily, often until 11 p.m.

Patient load

As the idea caught on, other clinics began offering walk-in services and late hours. Patient load dropped to between 40 and 60 a day.

Now at his 1308 N. Glenstone location, about half that number of patients see Atkinson as their primary care physician.

He also has added industrial medicine to his practice.

"We no longer stay open on weekends because I'm the only doctor here, but I will stay open until my last patient leaves," he said. "My number one concern is to be available to the patient."

In order to maintain the freedom to practice as he chooses, Dr. Atkinson said he does not accept insurance or belong to an HMO or PPO.

However, he still accepts workers' compensation and Medicare patients.

"A visit here costs $72 we are not meant for people who can't afford medical care. The people who come here usually pay us, file their insurance and get their money back," he said.

Insurance

Atkinson said that if he accepted insurance, the clinic would have to increase prices by 30 percent, due to collection issues. "We tried it on a limited basis for about six months," he said. "Ten percent of people actually paid us. The rest would file with their company and get the money paid to them, but never send it on to us. They were getting paid to be sick."

"We're kind of bucking the HMO and PPO trend here," he said.

Atkinson said he believes that when a clinic signs up with an insurance company, it has to do things the way the company wants it to.

"You can't critique the insurance company. And I don't agree with the gatekeeper philosophy that keeps the general practitioner from referring a patient to an appropriate specialist, " he said.

Atkinson believes decisions should be between the patient and his doctor, and the insurance company should not be involved.

Drug screenings

The center now works with more than 500 companies that send employment candidates for urine drug screenings.

Atkinson, a certified medical review officer, said labs send him the test results to review, and his job "is to be a stopgap to protect the rights of the donors. If a test is positive, I talk to the donor and seek a medical explanation. It there is one, the test is filed as negative. But if the person is dangerous at their job (as in prescription codeine cough medication use), then I have to consider the safety issues as well." Atkinson agrees with testing, because "we aren't winning the war on drugs, and testing allows companies to determine if someone would be a good and safe employee."

Future of health care

Regarding the future of health care insurance, Atkinson pointed out that while his business dropped when HMOs and PPOs first became popular, people who are members of HMOs are now coming in to see him instead of their own doctors "because they can't get tests they want or the care they want any other way. They believe in me because I'm not part of an HMO. They're tired of being sick and the money doesn't matter."

Atkinson said he feels that many patients and physicians are unhappy with HMOs.

Either HMOs "are going to go by the wayside, which is unlikely," he said, "or they are going to have to straighten up their act."

Insurance companies

"A lot of doctors are now punching the clock for the insurance companies," Atkinson said.

"Ten years ago I could send patients to a specialist at any time, but no one wants to stretch their schedule for patients. They want to have a more normal life, and I can't blame them, but it is different."

Atkinson believes that although doctors are still committed to patient care, the quality of care has changed. Universal health care, he said, would help with minor problems, with his type of work being covered.

However, he cites English and Canadian government-controlled health care programs as strong examples of how government imposes age limits, or enforces waiting lists for expensive procedures.

He said it is his understanding that some Canadians come to the States for medical care they cannot receive in their own country.

Locally, he said,"Carnahan scared us to death when his health care bill almost passed. It would have made doctors like me, who don't work in groups, illegal. The language of the bill gave the state power to tell you where you would work and who you would work with no one really knew about that, and it could happen again."