Medical Rant #1: Doctors

The BBQ Pit
21

I was with you right up until your first sentence.

Nope, it doesn’t. Our livelihood does not depend, for the most part, on customer service. This is particularly true for specialists and sub-specialists, but reasonably true in general.

It should, but it doesn’t. I never got paid a penny more for expert care rendered to a delighted patient than I did for screwing up or being rude or making someone wait unnecessarily while I piddled with something else (I hope I’ve done a lot more of the former, but I’m just making the point…).

The good news is, it’s changing. Our ED and the Hospital with which we contract does pay attention to every complaint and does hold us accountable for patient satisfaction scores when it’s contract time.

Like every physician, I do worry that we never get to a point where an incompetent but delightful and service-oriented physician is held up as a better model than a competent one with lousy service. But of course the two are not mutually exclusive and the day when a fabulously talented sub-specialist gets to be an a$$hole needs to be behind us.

Make your complaint known to the physician, to his or her umbrella organization, and to whatever corporate entity it is under which he or she works.

Angie’s list? Zagat’s? I’m not so sure, but Ok, I guess. There are a lot of wacko, difficult patients out there, and they tend to be overpopulated in the cohort of people with complaints, but I guess that’s true for all unfiltered public-opinion polls, so have at it.

For effective change, take the time to right a letter, and send it. I’m of the opinion many jerks don’t even know they are jerks. Some have literally never been told. So tell 'em.

22

I’ve found my kids’ specialists to be nothing but kind, knowledgeable, and intelligent (I may be biased because of her recent successful open heart surgery)… but finding a family practitioner for us adults? Impossible. These “lesser” (for want of a better word?) docs seem, as a group, to be rude, unkind, have marginal communication skills, and think their patients are all either lying, dumb as a post, or some combination thereof. Which is very annoying when your IQ is mensa level.

Also damning is the fact that two doctors now have seen symptoms in us adults, which we were able to correctly diagnose by looking up the symptoms online, and grossly misdiagnosed them. One situation resulted in my waiting two months for an incredibly painful boil the size of a ping-pong ball to magically go away on its own because my then-doc misdiagnosed it as a muscular hematoma. I had to talk the doc into lancing the damn thing after I’d finally had a biopsy (which my then-doctor had tried valiantly to talk me out of) which proved the lump to be a terrible infection. The doc didn’t even automatically schedule me for a lancing after the biopsy results. That’s just one story of our struggles with physicians.

And this was after putting an ad on Craigslist searching for a doctor who is kind, intelligent, and who will listen to their patients. This was one of the docs who was recommended to me. I won’t even go into the experiences I had while still searching for a doc. (Well it’s still going on) It’s just freakin sad how low the market’s expectations/standards must be for doctors.

Oh and before anyone thinks I just don’t like doctors at all, our previous doc (whom we went to for three years) was great. He’d majored in English for his bachelor’s degree, and is a very smart, well-rounded individual. He talks with patients about their condition and attempts to educate them about their health. Most importantly, he listens to patient’s descriptions of problems and will evaluate patient’s thoughts of what the condition might be, allowing them to see exactly how he came to his diagnosis and why it is or isn’t what the patient suspects it to be. He is up on the latest research. He moved his practice out of town; otherwise, we’d still be seeing him.

Urgh, I thought I was the only one. Is there any other way around this frustration? Does Angie’s list cost money to join?

23

Isn’t bad bedside manner a risk factor for malpractice suits?

24

For all you staff ladies out there who juggle doctors’ schedules, I commend you for what must be a very difficult juggling act. However, I have just one request. . .

When I call and ask if Doctor is running late, please tell me the truth. I have better things to do than sit around your waiting room reading Business Week or Golf magazines. When I lived in St. Louis I had a wonderful OB/GYN, but, as could be well understood, he consistently ran late. I couldn’t make the first appointment of the day because I had to be at work. But if I made the last appointment of the day, 4:30, and he was running an hour (or often more) late, I could actually finish out my day at work and not have to take any time off for personal reasons. The staff in his office was wonderful. They knew the routine. I would call at 4:00 and ask how late Dr. Becker was running and they would tell me, “He’s behind by at least an hour. Call back at 5:00 for an update.” It was awesome because it worked out for everyone!

On the other hand, I have (or will have had, I’m going to be finding a new doctor, in part because of this) an endocrinologist who is also consistently late. I have spent anywhere from an hour to two hours waiting around in her waiting room to be called in for my appointment. I tried the ‘call and ask how late she’s running’ thing with them, and every single time her staff would lie to me. “She’s running on time, come on in.” I only work 10 minutes away, so I’d be there within 15 minutes of that phone call, right on time for my appointment – and sit in her waiting room for more than an hour. She could not possibly have lost more than an hour when only 15 minutes had elapsed.

Sua, mazel tov on your new baby! I’m very glad to read that he’s not in any real danger from his murmur or early delivery. Way to go, HS2!

25

Be sure to report the deadbeat doctors to their college (or whatever supervising body they are subject to). Enough reports from enough patients, and something might be one, and if a patient suffers, that patient might be able to call the college’s file as evidence.

26

I guess that how you interpret this scenario will depend on what chain of causation you find most compelling.

I’m a stickler for punctuality. If my appointment is for 10, then i’m there by 9.50, at the latest. And this applies to everything, whether it be a doctor or a lunch date or whatever. But if, for example, i make 5 visits to my doctor, and the doctor is at least 20 minutes late for every single one of them, then maybe even i will start to think that i can arrive a bit later.

What i’m saying, i guess, is that maybe your patients think it’s “no big deal” to be 15 or 20 minutes late because that is exactly how they have been treated when they arrived on time.

27

Some doctors have: it’s called “concierge medicine”. You pay extra up front, for the privilege of being one of relatively few patients, faster service, etc.

http://www.boston.com/news/nation/articles/2005/04/15/no_patient_rush_to_concierge_practices/

Two of the three doctors in my primary care doc’s practice have done this already. My doctor has not.

Yet.

She is, however, considering it. And when that happens, I’ll have to find a new doctor, as I don’t happen to have 1500 dollars lying around to spend on medical care OVER AND ABOVE the costs associated wit hthe actual visits.

Re the OP: One missed phone call I could forgive. But the pattern you’ve described is unforgivable. I’d suggest you report this person to the hospital and to the state medical licensing board.

28

Help me out here. We walked away from outpatient treatment by our first pediatric cardiologist because of poor customer service. Isn’t the loss of our business going to affect her bottom line?

Sua

29

Except when it happens - routinely - when you are the first scheduled appointment of the day (and you show up on time). Can’t blame those annoying other patients for that.

Another flaw in the theory is that on several occasions we have arrived for the first scheduled appointment of the day, as the office opens, to find another patient there (or arriving soon after us) - in a single doctor office. Understandable if one of the patients is there for a examination or procedure in which the physician won’t be involved, or won’t be involved until the lengthy examination is done. Not understandable if both patients are there to see the freaking doc. Then it’s deliberate overbooking.

Sua

30

Only by the cost of one patient. She probably has tons who aren’t going to walk off. And I hate to say it, but lots of people (especially when they’re worried about their baby with heart trouble) will put up with a lot of garbage (real or perceived) from a doctor.

I used to work in a pediatric cardiology office and the waiting period for a non-emergency appointment* was at least a month for our least-popular doctor, probably two for the most popular. Pediatric cardiologists, at least in my experience, are in high demand. Someone is going to put up with the jerks because they don’t think they have a choice or don’t expect to be treated well.

Side note: I had one woman call in to tell me about her baby born with a heart condition, and asking questions about the doctors in our office. Then she asked which one I would recommend, and I said they were all good (sort of true), but Dr. So-and-So had been in the field for over 30 years and so had seen everything, and Dr. Young-So-and-So was very popular and very good at working with the family. She asked me if Dr. “Young” ran on time. I said no, frankly he never did; he was so popular that he had a big patient load, he (and the other doctors) had a lot of urgent visits squeezed into their schedules**, and that a lot of the time, he’d spend extra time and effort in explaining to a family exactly what was wrong with their child’s heart, what the options were, and making sure they understood and had their questions answered. And, that when Dr. “Young” saw her child, he’d do the same for her. She made the appointment with him.

Scheduling is tough, too. There have been clinic days in the office I work in (where I don’t handle scheduling except for research patients) where we had 3 urgent walk-in appointments of patients with detached retinas, and I apologize to the patient I’m dealing with, telling him this, only to learn during the exam that he’s got one as well! Other days they might have a dozen or so patients - a very light day - scheduled and maybe half of the patients call to reschedule or don’t bother showing.

  • Yes, there is such a thing of course. I seethed whenever chronic no-show parents would call in to schedule an appointment NOW because their needs-one-visit-a-year kid needed: forms for disability for the doctor to complete/sports clearance/form requesting bus service/fill in the blank, and they would balk at any mention of a wait, saying “My child has a heart condition!” I would barely restrain myself from snarling “So does every other patient on this schedule.”

** If we reduced their regular patient load, that would push regular visits back even further into the future. It’s a balancing act.

31

Amen to that. I work in a pediatric clinic with a number of doctors, and whenever we’re running late (which is often), I explained to parents that emergencies can happen and that they can be sure that if and when it’s their child with the issue, they’ll get the best care possible.

Don’t get me wrong - I realize how frustrating it is waiting with an antsy 15 month old in the office for an extended period of time (been there, done that), but it’s often the price we have to pay to get good care.

32

I work at a hospital serving an underpriviledged population, and patients in our outpatient clinics (especially surgery) get booked up to the tune of 4-6 patients per hour. That means that that first-of-the day 9:00am appointment? Three to five other souls have one, too. The hospital asks the doctors to spend about 15 minutes per appointment with the patient. At the county hospital down the road, we advise our referrals to take their breakfast and lunch with them because they will likely wait 4-5 hours.

Doctors arrive late because of meetings, because they were rounding in the ED, because they happened to be on-call or frankly, simply because some are tardy asshats. Sometimes the MA doesn’t get the test results the MD needed and they get backed up. Sometimes it’s like described above, a chatty patient or a more serious situation than anticipated.

This I will say: Even the biggest, most conceited asses that I work with here will stop and listen to a patient who expresses concern about their care. Truth is, you work in healthcare and it’s like any other job: occasionally you forget that you are working with and for someone’s child, someone’s mother and you need to find that center.

There was an oncologist here who was the only one for about a year. She was constantly overbooked, overworked, on-call and working on eight cups of coffee and no sleep. One day, a lady told her, not kindly, that she was a horrible doctor and there was no way in hell she would let her near her again. She was flabbergasted, because she was just trying to keep her head above water. Since that day, she takes time to explain procedures and follows up on negligence by staff. Her patients love her now, and all because the one lady took the time to call her on her behavior. We’re all just human, not mind-readers. Express yourself, and you might be surprised at the results.