Are doctors really that busy?

Factual Questions
21

[QUOTE=vetbridge]
My doctor uses a mini tape recorder that he dictates into while he is examining patients. An employee later transcribes to the chart.
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It helps if they actually look at the chart when seeing you. Granted this was my dentist, but on my last visit I said very clearly that I won’t floss or use washes, and I will brush my teeth once in the morning. That is why I put myself on a three-month visit schedule instead of six. Next time I go in, during his 30-second glance at my teeth, he suggested I use a wash. :smack:

My doc on the other hand takes time to sit down and talk, takes the notes on her laptop as we talk, and walks out to print out prescriptions at the central desk. I like her. :slight_smile:

22

[QUOTE=Kalhoun]
Would any of you pay more to guarantee a comfortable length of time with the doctor and an appointment that was actually kept? I tend to think I would.
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In fact, my grandmother just did this. Doctors were hard to come by in Kingston, Ontario… unless you went to a private practice doctor (e.g. one who isn’t part of the Medicare system.) Her doctor caps the number of patients she sees and spends a lot of time with her patients. My grandmother pays about $200 a month but gets much more attentive care that most family doctors, who rush you in and out at top speed so they can bill the government for the maximum possible number of visits. It’s worth it at her age and in her condition.

23

[QUOTE=psychobunny]
Sorry to be so disillusioned, but sometimes it seems like doctors get so little respect. I may spend 15 minutes with you, but are you including the time I spend reviewing your records and results, calling you back with the results, calling a specialist to beg him to get you in earlier for a procedure, and calling the insurance company to get that procedure approved, when you add up the total time I spend on your care?
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I would be if the medical professionals were actually doing some or any of those things. My sleep specialist reviews my file once he walks into the room. While I sit. And watch him read it on the laptop in the exam room. He is completely unaware of my history, or when treating my daughter, her history. How do I know? I constantly have to remind him of what my history IS, what the last thing that was done is, and so on.

My Dr. has never, ever called me back. In fact, he didn’t call me at all after my first sleep study to discuss the results. He simply ordered a second study. After the second study, he never called me at all to discuss THOSE results. He simply ordered a CPAP machine. Know how I knew? The company that delivers them called me.

He has a person whose job it is to contact insurance companies. In fact, I cannot think of a single doctor I’ve met in the last 15 years who makes their own calls to insurance providers.

Another example, so we don’t just think it’s one bad apple? Sure. I broke my back in 2000. I decided from the afternoon of the accident that I would own everything about my case. I would own my personal set of films, and own all written records. Easy enough to do, the Federal Government now guarantees that my records are my property. Every shot taken, I got a dupe.

First Dr. could not figure out why I wasn’t healing so I went to a second one. I told them, make sure you get ALL of the films, ok? The nurse for Doc #2 was mighty haughty about it. OH yes Mr. Toons, we will have all of your films". I knew better. I showed up with my entire set in an envelope. That same nurse walked in, saw me holding them and said, " Dr. Jonesy will review your films first before meeting you". I informed her that A) Those films were my property and would not leave my sight, and B) Since it was a first consult, Dr. Jonesy would pay me the respect of examining MY films in front of ME. She was furious and argued. So, I put my coat on. Who needs to be yelled at when the nurse blew it and didn’t order my films?

Dr. Jonesy caught me in the hallway, apologized for his nurse and asked permission to see the films. We walked, and tried to work on my case.

Another large practice- and yet they couldn’t be bothered to order in my films from the library. We all have these stories, and the sameness is appalling, not comforting. Utter lack of respect. Utter lack of professionalism. Utter disinterest.

We are, truly, A Billable Unit.

I believe what you have said, no doubt you are extremely conscientious. Just know that you are in a small minority.

24

I don’t need to spend more time with my doctor. My only complaint is - if I’m on time for my appointment, you damn well can be, too. I hate waiting.

25

[QUOTE=psychobunny]
It would be nice to spend more time with patients. Unfortunately, the only legal way to do this is to opt out of insurance entirely and have what is called a “boutique” practice
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My doctor (in my post above) does this with us (and other patients) under full insurance without any opt-outs, and no extra fees or workarounds. I don’t know the details of how she runs her internal billing, but she seems very successful without having to do impersonal high-volume churn.

She works in a partnership with a few other docs in a private practice though, and they make their own administrative policy as a result, without the overhead of a larger hospital. They are smaller scale, so in-depth procedures (MRIs and the like) get referred out since they don’t have the equipment and labs on site. Could this be the difference?

26

[QUOTE=solkoe]
An alternate approach would be to pay the doctor per patient not per visit. A doctor might be restricted to a few hundred patients and be paid whether they see you or not. Then its to the doctor’s advantage to keep them healthy so they have more time for themselves. Quality over quantity.
I’m not an expert and have no idea if this is workable but I thought I would throw it out there for discussion.
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That was basically the Dutch healthcare system.
People below a certain income brackets would be “Sick Fund Patients”. A GP wouldn’t want too much of those in his circle of patients, because a few patients with a lot of complaints might easily take up a whole chunck of his time, and he wouldn’t be paid any more for them then base level. Patients above a certain income bracket would be “private patients” and for them the doctor would be reimbursed per treatment. There was, among the Sick Fund Patients, some resentment that “private patients” would receive better care and more respect. But realistically speaking, that wasn’t the case.

They changed the Dutch healthcare system 2 years ago, but I don’t know enough to describe what changed.

27

[QUOTE=niblet_head]
How do docs keep all that information straight? Who they saw, why they saw them, what follow-ups are needed. I know there’s charts, but still… How do they focus on a patient when they just saw 20 and they have 20 more to go?

Not a snarky question, I really am curious!
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My doc seemed to be not listening, but fussing at his desk. Then I realized he had a glass top on his desk, and a monitor bositioned under it, with a keyboard drawer in his lap.
He was happily taking computer notes while we talked, not looking at me most of the time. Usually I feel they don’t care about me when they just take notes on a clipboard, but this was too much. I never went to him again.

28

Living in Canada, where health-care is public, this is all a little terrifying. Maybe this happens here, too, but whatever the case, I’ve never run into a situation like this. My doctors have given me all the time I’ve needed in examining me, building up a relationship, explaining what they’re doing and why, and in letting me know what they think might be wrong.

29

[QUOTE=titorian]
He was happily taking computer notes while we talked, not looking at me most of the time. Usually I feel they don’t care about me when they just take notes on a clipboard, but this was too much. I never went to him again.
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I’m sorry, but what exactly are you expecting in terms of taking notes? For the doctor to perfectly remember all of the salient points of the visit perfectly and to transcribe those onto the chart later? Not only will that doctor probably forget half of what he or she meant to write, that visit will take up twice the time it otherwise would have. If you’re willing to pay twice what you currently pay for a primary care visit, by all means, go ahead, the option is there with “boutique” doctors.

30

[QUOTE=psychobunny]
It would be nice to spend more time with patients. Unfortunately, the only legal way to do this is to opt out of insurance entirely and have what is called a “boutique” practice, where patients pay cash to see a doctor and spend time with her. However, the patients who have the disposable income to do this are not necessarily the ones who really need the extra time.

Medicine is one of the few areas where it doesn’t matter what you charge; the insurance companies/government in the US decide what you will be paid and you are forbidden to bill the patient extra, even if the patient wants to pay more for more time.

How do I deal? I spend a lot of time with my patients. As a consequence, according to my accountant I actually made less than my receptionist last year. All I hear, over and over again, is that I have to be more efficient, and see more patients in less time in order to make any money. If I were a hairdresser, or a plumber, and I took more time on one job, or the client wanted extra services, I could charge $75 instead of a usual $50. With Medicare, it doesn’t matter whether the patient has one complaint or twenty, or whether I charge $50 or $75, they will pay me their $37 and I am forbidden to bill the patient more than their $10 or so copayment. Lawyers charge for telephone time; the hours I spend on the telephone talking with patients are considered part of the visit described above.

Sorry to be so disillusioned, but sometimes it seems like doctors get so little respect. I may spend 15 minutes with you, but are you including the time I spend reviewing your records and results, calling you back with the results, calling a specialist to beg him to get you in earlier for a procedure, and calling the insurance company to get that procedure approved, when you add up the total time I spend on your care?
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This doesn’t apply to the majority of situations, when someone just needs a routine visit and there’s no specialist to call, no procedures to schedule, or anything like that. Perhaps you’re more ethical than the majority of your colleagues, but in my experience the rush is because they’ve scheduled five different appointments for the same time slot.

I once saw an eye specialist who worked in his own private practice, alone. He had three exam rooms there. The first time I went he had seven people scheduled for a 2:00 appointment. I walked out at four and rescheduled; when I finally did see him, he spent about five and a half minutes with me - I timed it. And, no, there was no “reviewing my record” or scheduling further appointments.

31

I work in OB-GYN in a very, very, busy hospital and I can say with confidence that our Docs are very busy. I am also frequently impressed with the Docs memories, but I usually assume the case is a stand out in their mind for some reason. No one could remember all that stuff!

Our Docs see the hospitalized patients between 7 to 8 am and then go to their clinics where they see their scheduled patients. Sometimes they come back during their lunch hour and sometimes return again in the evening for a final round, usuall about 7 pm. They don’t usually see every patient during their second and third rounds- just the ones who are having trouble or need extra attention. Of course, being OB-GYNs, they are frequently called to a delivery that can disrupt their schedule. None of our Docs would hesitate to come right away from the clinic or from home if a problem required them to do so.

A couple of the high risk maternal-fetal medicine folks are kinda guff sometimes. I allow them some slack for this because they deal with some pretty nasty problems and I think the gruffness and/or alloofness they sometimes show is a way to separate themselves from some of the devastating defects and problems they encounter. After 15 years in OB-GYN (most with these high risk Docs), I still encounter cases that leave my head swimming on occasion. I often wish I could write about some of the more unusual things I’ve seen at work, but several reasons prevent me from doing so. Fortunately, my sister is also a nurse so we can speak privately to clear our minds of difficult cases.

32

[QUOTE=FutureEMT1]
Me: I have Kaiser. They are non-profit. I think they are great. They run tests just because they are curious.

Women: Are you out of your damn mind? Kaiser killed my sister. She had cancer and they kept telling her that it was nothing. Then she died. Those bastards killed my sister.
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Joke told to me by a patient: Why was Jesus born in a manger?

Because he had Kaiser.