How to be my doctor: Part one of a rant in two parts.

The BBQ Pit
21

I suppose I should mention that I am employed by the Evil Health Insurance Empire (EHIE) before I start.

Lissener you blaming the EHIE for rising health costs and late patients is bullshit. I’ve been in the business for years, I’ve been a patient all my life, and my college roomate was a doctor. Every point of the insurance-patient-doctor triangle is blaming the other for the rising costs, increased delays, and sinking quality; pointing fingers and saying “they’re making huge profits!!!”

It’s horseshit.

Yeah, a doctor makes a shitload of money per hour. They ALSO have a shitload of expense, including your paycheck, Lissener. And malpractice insurance, which they can’t avoid, and rent/mortage on the office, and supplies, and… The insurance companies make a shitload of money, but they also have to pay salaries. If they’re a non-profit company (and many still are) they may have severe constraints on them. Insurance companies are sued as often as doctors and thus must keep a small army of lawyers on hand just to stay in business. Over the last couple of decades various government interest have caved to the demands of a half-educated public and required insurance companies to pay for treatments of dubious or unproven worth, which costs money and drives up your premiums.

(As an example - bone marrow transplants for advanced breast cancer promoted as a “last hope” on the basis of one study, which three years ago was discovered to be fraudulent. In truth, its no better and no worse than what was used before, just a fuck of a lot more expensive AND with a higher death rate - but insurance companies are required to pay for it in many states)

The ONLY people I see making money in medicine these days are the drug/device companies. But that’s just my opinion.

I absolutely believe Billy’s scheduling problems. Now, when they ask me for a phone number I just give them my cellphone without telling them it’s a cellphone. I used to go to a dentist who’s office staff were brain dead. I would say “I need either a very early morning appointment, or a late in the day appointment” and the fucking bimbo behind the desk would say “OK - how about noon?” When I did manage to get an early/late appointment they would reschedule me three days before but not call me! Then bill me as a no-show when I showed up at the “wrong” time. Now, while I am not filthy rich I do have a few bucks in the bank, enough so that when I had some dental stuff done I could afford to pay up front the entire amount not covered by my insurance. The husband and I both repeatedly told the office that. EVERY FUCKING TIME they would bill us for a TENTH the cost and tell us we were on a god-damned PAYMENT PLAN at 23% interest. FUCK! My god-damned credit card is only 19%! I can down with the CASH IN HAND, waved it in the fucking face of the office staff and the dentist and told him I could pay up front, I didn’t want to be on a god-damned payment plan, and he would either take the cash and fix the fucking bill or talk to my lawyer next.

I fired him, of course.

Anyhow, my current dentist has a busy office, takes my insurance, is happy to have me pay however I want, his office staff have IQ’s in the three digit range, they call me on whatever phone I ask them to call me on if there’s a change, and I get occassional rides in the dentist guy’s airplane (it is a very cool plane!) at no additional charge (“Of course you can ride in it - you help pay for it”) I almost look forward to getting my teeth scraped every six months.

22

Oh, wait, I’m not done yet.

EYE DOCTORS. Puh-LEEZE!!! I have eye problems - like, I can’t see shit without glasses. I went through years of bullshit like “I’m sorry your vision is still fuzzy but with your eyes you can’t expect 20/20” Excuse me? My eyes are shit but they aren’t THAT bad! I would be told my insurance would pay for some collection of fucking bullshit tinsel-made frames that would BREAK all the fucking time. Yes, picture it folks - I’m driving down the road and glasses would spontaneously disassemble. Thank god that never happened while I was flying a plane (and, in case you’re wondering, I do carry spares with me just in case). Stupid office bimbos saying “buy these frames, they’re so dainty and feminine” and try to push plastic lenses that are so fragile they require a laboratory of cleansing fluids and special silk cleaning clothes woven by cross-eyed virgin monks by the light of the moon to avoid stratches. Huh? I don’t sit in a fucking parlor all day! “Can I have some sort of anti-scratch coating put on those?” “Your insurance doesn’t cover that” “OK, I’m employed, I have money, do it”. Or maybe “Can I have glass, since it does scratch if I sneeze on it” “Your insurance doesn’t cover it…”

FUCK!

I go to Billy’s eye doctor now. No insurance at his office - they’ll stamp any forms you bring in, but you deal with the insurance company not him. A hassle? Not anymore - I dropped my vision “coverage” because it was horseshit. I now have clear vision. I have frames that don’t break every third week. The doc thoroughly tested my eyes, took the considerable time and patience to adjust my prescription, and - wonder of wonders! - sat down and talked to me about how my eyes were and how I can expect them to change over the next 10-20 years. He discussed what I did in my daily life, both work and fun. He said I did NOT need bifocals (yet). Said, in fact, that given my activity pattern I should get a pair of reading glasses for close work and have a “distance vision” pair for driving and flying. He is the ONLY eye doctor I ever had (other than the FAA guy) who picked up that I was colorblind during a routine examination. It wasn’t cheap but I see clearly, the damn glasses fit, and I’m very happy.

Oh, those FAA flight physicals - cash on the barrel, no insurance coverage, but damn I’m in and out on time with no hassles. Why is that? These guys aren’t superhuman, they aren’t government employees, they’re regular docs who have undergone a certification course.

Now all I have to do is find a new GP, because my current one will be retiring in the near future (he’s pushing 70). But I’m not hopeful. Went to one potential candidate with a skin infection, to which I am prone for some reason no one can figure out. Well, he asked if I had diabetes, which is a perfectly logical and reasonable question in those circumstances since diabetics frequently have such problems. I told him I didn’t have diabetes. He expressed disbelief and asked when I had last been checked. I told six months prior at my FAA flight physical (“You fly? But you wear glasses. Your husband lets you do this? Don’t you know this is dangerous?” - yeah, I felt real good about this guy starting around then…) He then asked how many of my relatives had diabetes. I said none. He said he didn’t believe me and said “sometimes they call it “the sugar” or --” Excuse me, doctor, my relatives are fairly well educated and they know what the fuck diabetes is, and they refer to it by name, and I tell you I have no blood relatives with diabetes of ANY sort, not a one. He asked if I was adopted. I said no. More expressions of disbelief.

Schedules me for a fasting blood test. I am not excited by this. I will have to take a day off work. And, oh yeah, I am a bitch from hell prior to breakfast (as soon as I said that he went “Aha! You have blood sugar problem! This test will show what’s wrong!”) so my long-suffering husband will have to put up with me until the test is done. But I fast and wind up in the office glowering, stomach growling, having my arm stabbed ("NO! I do not want to fucking WATCH you stick a needle in my arm, bitch! I am NOT looking!)

The test came back. Despite my surly mood, my blood sugar was spang in the normal range. “This test must be wrong, you have to take it again.” NO, YOU FUCKING MORON!!! I DON’T HAVE GODDAMED DIABETES SO JUST MAYBE YOU SHOULD START CONSIDERING OTHER POSSIBILITIES, ASSHOLE!!!

Fired him.

Went to my old dermatologist, who is both old and inconvenient to get to. Eventually got the problem resolved. Goddamned staph infections. Ick.

>sigh<

Anyhow, I hate going to the fucking doctor.

23

You know, Lissener, you must be right. I must just be a malcontent with a chip on my shoulder. I couldn’t possibly be bitching because I’m really interested in my healthcare and want what I pay for to be the best I can afford. All healthcare is probably just hunkey-dorey.

SO you’ll need to start writing some letters to the Mount Sinai School of Medicine because they also have an erroneous view of the quality of medical care.

The article referenced points out (as have I, in my OP) that there is a remarkable disparity in the way the medical community does business compared to the real world, where many companies, (like mine) have adopted the Six Sigma approach to doing business. You’ll need to talk to these malcontents (oh, and I believe some of them may even be “rubinesque”- don’t sugarcoat it, it’s “fat”.) with “chips on their shoulders”, because they apparently have bogus sceintific studies which say that the health care industry is, er, bad. Set them straight, girl! One line in particular caught my eye:

My company is at about four sigma. We’re struggling to get to five. The medical profession as a whole is at somewhat less than one. That, by the way, is dramatically less efficient than the post office.

It’s not just me, it’s not just the doctors I see, it’s everywhere.

I know those idiots at Mount Sinai couldn’t possibly know as much as you, Lissener, so get out there and set them straight.

B.

24

Let me say first that I agree with a lot of the OP. Doctors need to realize that we are in a service profession. In my office we highlight the number that people want to be called on and we always put cellphone numbers in the chart if the patient wants it. Now, here is how you can help me, your doctor, stay on time and not have a nervous breakdown.

1)Turn OFF the damn cellphone! I am trying to give you my undivided attention for your 15 minutes-I don’t need to listen to you ask your kids when they will be home, who they are going out with, what they want for dinner, etc.

2)Be on time for your appointment. When you are 15 minutes late everybody gets pushed back.

3)Bring a list if you have a lot of questions. I will try to answer as many as I can. If I know your questions at the beginning I can prioritize. I am not happy when as I am leaving you say “Oh, I remember the other thing I wanted to tell you about-I’ve been having these chest pains.” This means I return to the room and start over. While you are at it-tell my staff why you are coming in-we book double slots for things like chest or stomach pain, or for people with a lot of concerns, if you tell us why you are coming we can give you the right amount of time.

4)Don’t ask me to see your spouse or kid who came along with you. I made you an appointment-If you told me he/she needed to be seen too we could have allowed time.

5)Don’t wait to call until you are out of medication. I get over a hundred medication refill requests a day. I HATE having to make patients wait because you are out of your pills and decided to call from the pharmacy. Our policy is 24 hours’ notice-all prescriptions are ALWAYS called in the same day.

6)This is not a walk-in clinic. If you are that sick please call and we will find you an appointment. If you are having chest pain we may direct you to the ER. I am sorry your insurance makes you pay $50 for an ER visit but if you come here I will be sitting with you until the ambulance comes and you will end up at the ER anyway. Meanwhile, my other patients will be waiting.

7)I know you are busy-give me a reasonable time frame to call back. My staff tells you I make telephone calls at lunch and after work-let me know where you will be then. I cannot honor all requests for patients who need to be called between 3 and 3:15.

8)Do not call with an emergency then try to get a full physical. I schedule a solid hour for a physical. I know I am booked 3 months in advance-that is so that you can get in when you are sick. I am happy to treat your cold-but if I do your PAP smear at the same time then I will again be behind all day. I know you have to wait for routine visits-but I need to be able to see you that day if you are sick.

9)Do not ask me to backdate referrals. This is illegal and it does not endear me to you.

10)Do not lie to me. If you are not taking your medication please say so. This saves a lot of unnecessary testing to find out why it is not working. I know when you have been drinking or smoking too-don’t think you are fooling me.

11)For families-do not ask me to do a test without telling the family member. I will not do drug testing on teenagers without telling them and I will not test a patient for memory loss without him knowing. My responsibility is to my patient.

12)Don’t swear at my staff. They are doing their best. They spend hours trying to get your referrals approved-it is not their fault if you want to see a doctor who is not on your insurance or have a test that is not appropriate. If I feel you need it-trust me-I will be on the phone myself calling for approval.

13)Acknowledge the time I actually spend on your care. I know I spent 15 minutes face to face with you, but I spent another 15 reviewing your results with you on the telephone, calling a specialist to try to arrange a visit the next day, getting the report from the specialist etc. My lawyer charges for all telephone calls-I do not. All the time I spend doing your paperwork is not compensated at all.

If you do the above, I promise to:
Try to see you as close as possible to your appointment time.
Address all your concerns at each appointment.
Call or send a letter with all lab and test results.
Fill all prescription refills within 24 hours.
Answer all telephone calls the same day.
See you the same day if you are very sick, or within 48 hours for something milder, like a cold.
Provide you with detailed information about any tests or diagnoses.
Be your advocate with your health insurance and fight on your behalf for appropriate care.
Be your DOCTOR-not just your “health care provider”-and constantly nag you to stop smoking, exercise more, and lose weight, but in the nicest way I can.

Sorry this is so long-something tells me this Doc is close to burnout:D

25

Dang, Psycho! Where do you practice? You sound like you’re just what I’m looking for.
I’m near Chicago, and I’d be willing to travel anything up to 200 mile round trip to get to you.

b.

26

Sorry-would love to treat you but:

  1. I am near Washington DC
    2)My practice is closed to new patients

:frowning:

27

Generally speaking Optimologists usually run on time. They see fewer people and their exams always take the same amount of time, plus a little bit of wiggle room.

Hell my Optimologist, whom I love and my parents see too, is a nice guy who is willing to chat with you for as long as he can get away with it (usually until his next appointment). I think it has to do with being a doctor in a field where your patients are never in pain, and you always produce almost instant results.

The problem with GPs is that unless you know whats wrong with you, it can take forever for them to figure out what’s wrong with you. And since you can’t predict how long each patient will take you get later and later as the day goes on. Which is why you always make GP appointments for first thing in the morning.

About the labs… I thought the labs couldn’t release the information to anyone but your doctor or you personally (and to make it easy they just send them to the doctor)… so I wouldn’t expect the lab to contact you (and if they did, it wouldn’t help they don’t know your general health and what values would be bad). But the doctor’s office not calling your cell is just lazy. I’d go in and tell them you changed your home phone number and give them the cell number. That way they can ONLY contact you on your cell. Problem solved.

One last thing: The sleep apnea… IS a serious matter, especially if the person who has it is over weight. I’m not sure how it translates into you loosing weight… but stopping breathing for any length of time is a bad thing.

Good luck on finding a good GP… (Just pray you never need an orthapedic surgeon!)