My semi-regular rant against the medical profession. (Really long)

The BBQ Pit
41

I agree – an awful lot of doctors simply overbook, assuming a certain number of folks will not show (but will get billed anyway) and the rest will just wait. I personally don’t see how this helps the doc at all. Presumably he’s still staying until all are seen, so why not just realistically schedule, and book for the time he’s usually there til anyway? Maybe somebody who actually works in the system can explain it.

I’ve left a number of doctors for keeping me waiting too often without an explanation other than poor planning.

I think a “Medicaid mill” is a high-volume practice that accepts Medicaid. Take five minutes to take Miss Jones’s blood pressure. Tell Miss Jones the Medicaid patient to take these pills once a day and come back next week. Lather, rinse, repeat. And multply times as many Medicaid patients you can fit into your day. Not illegal, but certainly not high-quality ethical practice of medicine IMHO. Of course, I’m told that the amount Medicaid pays a doctor doesn’t even cover the overhead if she’s doing things right.

42

Airlines do the same thing. What’s the alternative; be charging people the full amount for their seat/appointment whether they show or not?

43

I had a doctor who found a terrific solution: He alloted five minutes per appointment, and if you thought you’d need more, you booked it in advance. I never had to wait more than ten minutes to see him as a result. Granted, I had to be prepared when I went in with all my information. But it was well worth it to never have to worry about being kept waiting.

But I have learned that oftentimes, if it’s a multi-doctor practice, the junior doctors don’t necessarily have the slightest say in the overbooking mess. We left one doctor because of overbooking (and a raving bitch of an office manager), and he had to admit that he was not in a position to do anything about it because the senior doctor and the office manager didn’t want to change anything.

44

Oh, I understand that. In the case of an airline in particular, they might not have anybody on standby to buy the seat, or they might have been able to sell it to someone else.

My dentist will charge for no-shows. If I call the day before, he won’t charge, since he will move the other appts. earlier, and/or fill in with somebody who’s been trying to get seen earlier. But then, he schedules a full half to 3/4 of an hour for each patient, and he never makes us wait. So if somebody just fails to show, he’s out what he could have made on another patient.

In the case of too many doctors, though, they seem to overbook far in excess of what’s needed. If the 2:00 appt doesn’t show, well, the person with the 1:00 appt, and maybe the 12:00 as well, is probably still waiting to be seen anyway. It’s not as if the doctor is going to be hanging around doing nothing. So he’ll probably get paid for the time twice, once for the patient he saw and once for the patient he didn’t see.

45

I had an endo my last pregnancy who I am sure is an idiot and in it for just the money. He scheduled appointments what seemed like ungodly frequently and yet refused to alter my doses even when they clearly needed it. He used the appointments to yell at me and ignored my test results. I even had to get my OB to have talks with him. This time I swore to myself I would not see him. I did need another and found a decent one. Now, my new doctor has not spoken ill of my old, but was incredulous when I described the treatment that was prescribed last time and when it was confirmed by the medical records, he shook his head, the same way I would if a client talked about using the cup holder in their PC. The new doctor also gave me good advice on how to adjust my dosage so I would have some flexibility.

The last straw with the old one is how he tried to milk me for more appointments when for six weeks after birth, I had perfectly normal tests results everyday and perfectly normal results for the longer range tests, and he acted like I was delusional for not wanting to continue seeing him as frequently as I did while pregnant.

Biggirl, i hope you have as good luck with your next endo as I do with my current one.

46

I have a bad endo story. A friend of mine was seeing hers for what he figured was hyperthyroidism, or hypertension, or something. He just couldn’t seem to figure it out. Her complaints to him were: increasing blood pressure, sleeplessness (she’d wake at 2 AM for the day), unexplained weight gain, fatigue, and rosacea. The endo (supposedly the best in her area) kept testing her thyroid stimulating hormone and T4 levels, and her serum glucose levels, and dicking around with her thyroxine doses and telling her to diet. This went on for at least a year with no real improvement – most symptoms just got worse and worse.

Then one night we were chatting online and I was saying something about the moon being full, and she was saying something about how she couldn’t get over it, she kept telling her endo that her face was swollen and he wouldn’t pay attention. My memory of basic physiology was triggered and I told her to ask him for some serum and urine cortisol levels – just to insist on it as something that her crazy friend wanted. She did have to insist, too.

She had Cushing’s all right (by that time, even with the fat pad between her shoulders), resulting in the moon face that tweaked me, and as it turned out, she had adrenalcortical carcinoma, a big baseball-sized one, and was dead within two years after the usual horrible struggle associated with a terrible prognosis.

I asked her if she’d ever asked the endo why he didn’t think of Cushing’s. He told her merely that she “looked good on paper.”

47

I hear you Biggirl cuz I have had a tough time with endos. I’ve had a wonky thyroid for over 30 years, first under- then over- active and I’ve been through a couple of endos in that time. My last doc said that there are not enough new endos graduating every year to cover the ‘diabetic epidemic’ (his words). I learned to schedule the first appointment of the day (7 a.m.) and show up at 6:30. Awfully early, but I’m out by 8:30a.m.

The real cure for me was to get my internist to assume my care. I get my blood work done yearly and she adjusts my meds as needed. I’m stable now and really don’t need the hassle of this specialist and I dread ever needing to return to him.

48

I once waited, IIRC, 2+ hours in severe respiratory distress from an asthma attack… at the time I did not know I have asthma; I thought I was sick. But I could barely walk. After two hours, still sitting in the waiting room, I picked up my cell phone and called my doctor’s office (mere feet away, but seriously, I could NOT get up and walk over there and give the recep a rash of shit; I wasn’t getting enough O2.) I said, “Um, yeah, my appointment was for 10:15, it’s now nearly 12:30 and I still can’t breathe. Is the doctor really planning on seeing me today or should I just shuffle on over to the ER?” The recep hung up on me… but five minutes later, they were calling me back to the exam room. Where they completely mucked up a nebulizer treatment, gave me a scrip for albuterol and not one single word of explanation about what asthma is, what causes it, how to manage it and how to recognize the signs when one is in big trouble. I had to do my own research on the internet to find all that out. Needless to say, I don’t go to that doctor anymore. I don’t go to any, unless I’m convinced that I’m dying, because it’s not worth the frustration to me to keep changing docs until I find one who will treat me like a human being instead of a billable bar code with bad lungs.

49

Wow. Allow me to thank my lucky stars again that I have a great doctor. Of course, she isn’t taking new patients - in fact, the only reason I squeaked in is that she treats my parents also. Not only has she been keeping my dad alive for years, but two days ago when I went in feeling really crappy, I showed up at 8 to wait for any time she could squeeze me in and her 8:00 was late, so I was out by 8:20.

50

I guess somebody has to take the other side of the situation. So-here’s what really goes on behind the scenes.

Patients are scheduled say every 15 minutes.

9:00-Patient #1 is scheduled at 9:00. She doesn’t show. She has an HMO so I can’t bill her.

9:15-Patient #2 is scheduled for 9:15. She shows up at 9:20 but she has changed insurance plans. She has to go out to her car to get her insurance card and takes another 10 minutes.

9:30-my nurse takes patient #2 back. I see her at 9:30 and finish at 9:45.

9:45-my 9:30 patient has decided she needs to go to the bathroom. My nurse checks in the 9:45 patient which takes 5 minutes.

9:50-the 9:30 patient is out of the bathroom. I see her from 9:50-10:05.

10:05-I go in to see my 9:45 patient. She is on her cellphone. I wait for 5 minutes for her to say “the doctor is here now-no I really have to hang up-no I can’t talk now”.

10:10-I see my 9:45 patient. This takes from 10:10-10:25. As I leave, she says "by the way, my husband is completely out of all of his medications and we are flying to Cancun in 2 hours so I need two prescriptions for each of his medications, one to fill now, and an extra to bring with him. My receptionist pulls his chart and I write out 2 copies of each of his twelve medications. This takes from 10:25-10:35.

10:35-I go in to see my 10:00 patient. I apologize for being late. I see her from 10:35-10:50.

10:50-I go in to see my 10:15 patient. The nurse interrupts with an urgent call from the ER. I have a patient who needs to be admitted. I spend 15 minutes assessing the situation and calling in orders.

11:05-I go back in to see my 10:15 patient. I see her from 10:15-10:30. As I am leaving, she casually mentions “while I am here, I forgot to mention this chest pain I’ve had for the past two days. I’m sure it’s nothing and we can discuss it when I come back”. I assure her that it is NOT nothing. I get my nurse to get an EKG while I see my 10:30 patient.

11:10-I see my 10:30 patient. I let her vent for 5 minutes about how I am wasting her time by making her wait, then try to make sure all of her questions are answered. She leaves happy at 11:30.

11:30-I go back to my 10:15 patient, who has an abnormal EKG. I have a nurse call an ambulance to take her to the hospital. The nurse calls for a cardiac care bed. They ask to speak with me. I get on the telephone and am told “the charge nurse will be right with you”.

11:35-I get frustrated and ask my nurse to hold on for me while I try to see patients.

11:35-I go in to see my 10:45 patient. I start talking to her and I am called out of the room because the charge nurse is now on the telephone.

11:40-I speak to the charge nurse, get the bed, write orders for the admission, and speak to the EMTs. The patient is taken off y ambulance.

11:55-I return to my 10:45 patient. I see her from 11:55-12:10.

12:10-the nurse stops me to tell me that a patient who came in for a blood pressure check just has to talk to me for a second. I put her in a room and find out that she has symptoms of a bladder infection. I ask my nurse to get a urine sample.

12:15-I return to the 11:00 patient. I see her from 12:15-12:30.

12:30-I check the urine under the microscope and write a prescription for antibiotics and review them with the patient.

12:35-I see my 11:15 patient. She is scheduled for 45 minutes for a full physical. However, she doesn’t speak any English and her daughter who was translating has stepped out to have a smoke. I send somebody to find her.

12:40-I see my 11:15 patient. This takes from 12:40-1:25.

1:25-I sit down to lunch, which is scheduled from 12:00-1:30 usually. I realize that I will not be paid for 2 patients this AM, the first one who didn’t show up, and the one I admitted, which must be charged as an admission so that I am only paid for the hospital work and not anything done in the office (Medicare rules). In addition, I will be paying overtime to my staff who had to work through lunch hour.

In all the above time, I have not:
-gone to the bathroom
-made any personal telephone calls
-been on the computer
-sat down except when talking to patients

Last year I made less than my receptionist. The only way to make more is to increase volume but I can’t increase the hours without increasing the overtime. The insurance companies tell me how much I will be paid regardless of what I charge. Everybody just tells me that the only option is to be more efficient, ie spend less time with the patients, and to book them closer together.

Anyway, that it just the other side of the coin on a very frustrating day. :frowning:

51

BTW, I also forgot that after finishing patients at 6:00 PM, I spend an hour reviewing lab results and an hour and a half on the telephone to patients discussing the results. I am not paid for any of this time. At 8:30 I finally leave to see my hospital patients.

52

psychobunny, that is exactly why I have entered the public sector. Too many days like what you described.

The public sector has headaches of its own, but I can take the necessary time, not worry about coding or billing, and my patients don’t have anyplace else they have to be, as a rule (treating inmates has an upside).

53

So why do you let your staff allow only 15 minutes for each patient? Obviously, whoever does the scheduling has not allowed for the fact that you must take calls, that some patients will take more than 15 minutes, and that some patients will be late for whatever reason. You didn’t even allow for 5 minutes between patients to write prescriptions, walk between exam rooms, and review the next patient’s chart. When is your official last appointment? 5:45? Can’t be, since by 1:30 you’re already an hour and a half behind schedule. Did you have more patients scheduled from 1:30 on? How many? Did you end up taking only 5 minutes for lunch? Or did your 1:30 patient wait until 3:00?

In your morning, the plan was to see four patients per hour from 9 to 11:15, then one more patient for 45 minutes. You actually saw 8 patients from 9:00 to 12:35, about 210 minutes. Could have been 9 if the first one showed up on time. If you had scheduled 25 minutes per patient, you could have seen the first seven from 9:00 to noon. Take a half hour to eat, catch up on paperwork, etc. Start the 8th patient at 12:30. Say that’s the one who needs double the time, so the 9th patient is at 1:20. Then you can see 7 or 8 more 25-minute patients until about 5:30. Did you see more than 16 patients in your sample day?

Schedule your last morning appointment for 11:30. Schedule your first p.m. appointment no earlier than 12:30. Are patients still going to run late, have human problems, etc? Sure. But maybe if Mrs. Jones hasn’t had to sit for an hour and a half waiting for you she may not need to use the bathroom as soon as she stands up. Maybe several of your patients WILL only take 10 or 15 minutes, but that will help you keep up with these delays. Maybe you won’t have to take 5 minutes to listen to your patient bitch about being kept waiting. Maybe you won’t have to pay your staff overtime for working through lunch.

Schedule for people, not robots.

54

The solution is obvious. Schedule only old prisoners who don’t speak English well.

Because it’s the patient’s fault that they have to wait 5 hours even though they showed up on time and we all need to STFU and not bitch about it.

55

I read an article some time back about a highly-paid lawyer or somesuch who charged his doctor his hourly rate for making him wait 3 hours. He took him to court and won!

I don’t think doctors should have a private “one doctor” pratice. It just seems silly to think that a guy can make rounds at a hospital, dealing with surprises and emergencies and maintain a schedule in his office (with surprises and emergencies). You can’t be two places at once, and you shouldn’t tell people you can.

My MIL had a 7:00 PM appointment earlier this week (last appointment of the day), and she didn’t get out of there until 9:30 PM. WTF. Oh…and it is a geriatric practice, of course. Everyone is on Medicare, everyone’s old, etc. It must be a million times harder for a sick old person to deal with the lame-ass scheduling than it is for the rest of us. Plus, so many old folks don’t drive, so a friend or family member is inconvenienced, as well.

56

I’m really glad to read you post psychobunny – it helps me understand why I sat there in respiratory distress for a couple of hours. The only thing I’d suggest is that doctors INSIST that their office staff COMMUNICATE. Don’t check me in and let me sit there for three hours. Once an hour, some phone monkey/recep should go out and say, Hey, the doc is backed up, anyone need to reschedule? 95% of the times I get pissed off about something, it’s a communication issue. It’s not knowing all that which makes people mad. And being threatened to be penalized if you just leave because, you know, you have to work to get paid and nobody gets paid sitting in the doctor’s office.

57

My physician sees patients every 25 minutes so that he has enough time to review labs, do paperwork, etc. between patients. I also usually do not wait over 10 minutes to see him, and sometimes I wait less. I think the longest wait was 40 minutes. Since I know that he keeps very close to his schedule I make doubly sure I am not late and try to arrive at least a few minutes early.

Also, just because reviewing lab results is not a fee generating activity, doesn’t mean you are not paid for it. It is part of patient care. Are you telling me that you are reviewing lab work for patients whom you do not see?

58

I think it makes a lot more sense (but not more money) to do it this way. I don’t appreciate the 15 minute visit, especially when 5-10 minutes of it is spent waiting in the examination room. I don’t like the doctor to assume that he can examine me and answer questions, write prescriptions, and review reports in 5 minutes.

59

OTOH, most of my visits are about 5 minutes of the doctors time with me. I usually know pretty much what is going on and am there for a very specific reason, like I need a tetanus shot because I had a dirty wound and it has been more than five years since my last shot or, my elbow hurts and is not healing. The first, I got the shot after he made sure the wound was not festering and instructed me on signs that it needed his attention, the second, he examined my arm, figured out what movements were exacerbating the pain and prescribed me a wrist brace to use until the elbow healed, which it did in a couple of weeks after I started using the brace.

The flip side is a recent visit where the issue was that i felt tired and sick, and had no idea why. He had to order a lot of tests and examined me very carefully. It turned out I had a UTI and was passing stones, neither of which were obvious at that early stage. I spent quite a bit of time not with the doctor but in the exam room either waiting for him or his nurse to come back and either order or do the next test. At no time was I frustrated with the wait because I knew that the situation was unusual and someone periodically checked to see if I was ok.

Both office staff and policies are key. A polite responsive staff can make even a long wait bearable. I get those at my OB sometimes, for the usual reason of an emergency is playing havoc on his schedule. I also get somewhat rushed appointments there, but the reason is explained and I am given the opportunity to bring up issues that might require more time.

But in the case of the OP incompetence and distraction by the doctor was exacerbated by unresponsive staff, and probably bad scheduling policy.