As America approaches its 250th anniversary, Dr. Kat Lindley, Texas family physician and Director of the Fellows at the Independent Medical Alliance, shares her journey from practicing inside the system to opening her own direct primary care practice. After years in university settings, health clinics, and a rural care center, she saw the same pattern everywhere: insurance companies, pharmacy benefit managers, and government protocols crowding the exam room while the one person who matters most, the patient, got lost in the noise.
Dr. Lindley’s answer is a return to medicine’s roots. In her practice, she and the patient make every decision together, the arrangement she argues the nation’s founders envisioned, with patient, family, and faith at the center of care. Her prescription is straightforward: promote independent practice, teach patients what care actually costs outside the insurance maze, and get back to one doctor and one patient in charge of every healthcare decision.
Check out these related resources from IMA below, followed by the full video transcript.
Transcript
Dr. Kat Lindley: My name is Dr. Kat Lindley, and I’m a family physician in Texas. I’m also Director of the Fellows at the Independent Medical Alliance and Fellow in Family Medicine.
My journey to where I am today took several years. For many years I practiced within the system: at a university setting, different health clinics, and a rural health care center. And at one point I decided that I wanted to open my own private practice. I didn’t want to do that from the beginning. I was a little bit resistant, because I figured being my own boss has its own headaches.
But what I realized along the way is that the system itself is really set up for failure, because you have different agencies almost in the room with the patient and yourself. You have the insurance companies dictating what you have to do, the pharmacy benefit managers deciding what type of medications patients can have, and the government with the protocols and things like that. And in all of this, there’s so much noise, but the one person who gets lost is the patient.
When I opened my own practice, I opened it in a small town. It was really a challenge for me, but also a learning curve to realize how the system is broken. The first day I opened the practice, I actually stayed in my office by myself until five o’clock, and I didn’t have any patients at the time. And it dawned on me a few days into it: why am I doing this? Why am I staying in the office if I don’t have the patients?
I’ve developed a practice where essentially the patient can always reach out to me. They can be seen in the office; we can do phone calls, whatever makes most sense for myself and the patient. And they’re the ones that really should be in charge of their healthcare. They are the ones that should be challenging the doctors on things that are happening when it comes to their healthcare.
The system itself is really not set up that way. The system currently promotes corporate practice of medicine, where you have many physicians who have left private practice and are part of a healthcare system. Once you’re part of a healthcare system, the system itself tells you what you’re supposed to do. You’re supposed to refer patients to their places for radiology, or if they have certain insurance, you can only send them to this pharmacy. And many times patients are left struggling to figure out what they’re supposed to do.
I would say that the best way that we can approach the current healthcare system in the United States is to promote more independent practices like my own. Mine is direct primary care. It’s the patient and myself. We make all the decisions together. And I always give examples of how you can get blood work and radiology outside of the system for much cheaper than if you use your insurance and deductible. Those are the things that patients need to learn, and those are the things that the system should actually teach the patients. A lot of times patients have to spend a lot of money on their care. And then you have a family of four with deductibles and things like that, and it gets really, really expensive. I think we have forgotten that medicine itself is supposed to be a decision-making process between patient and physician.
What can we do? How do we make the system better? That’s something that I get asked often. And I feel the best way to do that is for people to take charge of their health. You have to understand the struggles you’re going through. And there are many different policies that we can work on, but what we must work on the most is creating an environment where the physician can be independent so that the patient and physician can make decisions on their own without interference from the insurance or the government, the Centers for Medicare and Medicaid, and others. Because in all this quest to make things “better,” and I’ll put quotation marks around “better,” I’m not sure it is better. We have lost the sense of who is the most important. And at the center of healthcare and medicine is always the patient.
This is a very special time in the history of this country. We are about to celebrate 250 years of the Constitution and American history. I would say that the vision that our forefathers had when it comes to medicine is for the patient, the family, and our faith to be at the center of healthcare. And as we all know, it’s really not. Right now we’re struggling with different, I like to call them, third parties in the examining rooms with us when we’re making these decisions. And that’s not what it was ever meant to be.
What we need to do is celebrate the pioneering spirit of this country and go back to our roots. And our roots are doctor and patient making decisions for the bettering of the patient, for their healthcare, for the good lifestyle they want to have. We have seen in these past couple of years the return of eating better foods, and taking accountability. And the same has to happen in medicine. We need to get back to one doctor, your family doctor, your internal medicine doctor, who knows you, who knows your family, and who shares your values. And we need to get back to that time when only the two of you are the ones in charge of your healthcare and the healthcare decision-making.
