Guest guest Posted October 6, 2009 Report Share Posted October 6, 2009 Nothing surprises me, about the short-shrift given to patients by doctors, anymore. However, I feel compelled to reply to this little rant, to sort of offer a defense of the unknown M.D. ... First of all, my office tends to be cold, and I generally do not make anybody take his shirt off, unless he tells me he is worried about a rash, or I expect to see something in the skin. Shoulders can usually be examined through thin fabric. Of course, the breast exam is difficult to do through a bra, and women have to suffer a brief chill. I try to turn-on a heater, and even the little floor lamp gives off enough heat to be more humane. Men get off easy -- hernia checks and even prostate checks can be done, without requiring complete disrobing ... As for the actual time with a patient: I generally schedule 45 minutes to see a man for an annual general exam, and 60 minutes for a woman. Most of the time is spent in talking -- interview, P.M.H. , interval history ... counseling about screening options. The actual exam can usually be done in 10-15 minutes, unless physical incapacities serve to impede the dorsal lithotomy position, or the patient is Parkinsonian, or terribly shy. I almost never make a patient wait more than 10-15 minutes in our lobby, since I broke out of the hamster wheel. I don't know how much it is really worth, to me, in annual income, to get away from opening 15 visits per day with the sentence, "I'm sorry I made you wait so long ..." -- that was usually 20-45 minutes ... Sometimes, just for the fun of it, I pull an early patient out of the "waiting room", escort them into the examining room, and say "I'm sorry to be so early", and then burst out in crazy laughter. That is worth a lot, to me ... However, that said, I have still received passionately-angry letters from patients, irate to see the E.O.B. for a 99214 ($104 gross charge, then chiseled-down for people with contracted-insurance deals ... I have come to hate the word "adjustment" ... I proudly offer a 15% discount for un-insured people, if they pay cash within 30 days of the service) ... anyway, these irate patients have complained that I only spent 10 minutes with them, which is maybe the way they remember that, but damn -- I am looking at the clock on my Dell monitor, keeping an eye on the time before my next scheduled appointment, and documenting actual, measured time-with-patient spent in every progress note (it is a line in my minimal general template ...). Maybe those patients are confusing the memory of their visit with me, getting it mixed-up with a visit they had with some other doctor; I don't know. I have sent them a copy of my progress notes ... This has not really led to any dramatic turn-arounds, though. Somebody in my residency once told me, "never believe more than half of what any patient tells you, about the work done by the previous doctor ...". Rian Mintek, M.D. -- proud to be giving patients good, personal care in Michigan, even when they don't always seem to appreciate it ... I ran across two former pts of mine today and asked how they were doing. They both had stories to share of their new ‘medical home’ experiences that I wanted to pass along. One, a man in his 60s, related that he has had 2 annual physicals with his doctor, and during the second one, he complained of his shoulder being sore. That was the first time the doctor had seen him with his shirt removed. The second, a woman in her late 50s with hypothyroidism and hypertension, stated she has been to her doctor’s office 4 times, and has had total conversation time with her doctor of about 3 minutes over those 4 visits. This last time, she decided she should go in to get checked out as her medications, given for a year of refills, were going to run out and she thought it would be time to check labs, look at her neck, listen to her heart, etc. After waiting in the waiting room for 40 minutes after her appointment time, she was taken back to an exam room by the nurse. The nurse began writing out the scripts for the doctor to sign off, and had to leave to answer a phone call. After sitting in the room for another 15 minutes, the doctor rushed in. Asked why she was there, wrote out the scripts and sent her on her way. Not even an inkling of an examination – no touch whatsoever. I am just amazed at how overworked and detached/distracted docs can be. Eads, MDPinnacle Family MedicineColorado Springs, Coloradowww.PinnacleFamilyMedicine.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 6, 2009 Report Share Posted October 6, 2009 My EMR logs the time I personally started the consult with the patient and the time it finishes, and put this on the bill. a lot, to me ... However, that said, I have still received passionately-angry letters from patients, irate to see the E.O.B. for a 99214 ($104 gross charge, then chiseled-down for people with contracted-insurance deals ... I have come to hate the word " adjustment " ... I proudly offer a 15% discount for un-insured people, if they pay cash within 30 days of the service) ... anyway, these irate patients have complained that I only spent 10 minutes with them, which is maybe the way they -- Graham Chiuhttp://www.synapsedirect.com Synapse - the use from anywhere EMR. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 6, 2009 Report Share Posted October 6, 2009 Hampster wheel medicine: Dr Star sees a patient with CP. He does an appropriate Hx and PE but also spends time to listen to the stressors in the patient's life. After 20 min, they determine that this is likely stress related but agree together (shared decision making) that they should do further testing to ensure it's not cardiac related. Dr Crap sees the same pt and spends 5 min. He/she is short, interrupts, and hands the pt an order for a cardiac test. So shouldn't Dr Star get paid more? Of course he/she should. But in our hampster wheel system, they both get paid the same. The point is our current system rewards procedures and volume so that's what you get. The only way you can make more money (? a marker for " success " ) as an FP is to see more patients or do more things. No monetary reward is given for quality (though some painful, misguided attempts are being made), thinking, or listening. So what do people expect from this system? If 5 min with the physician is inadequate, don't blame the physician. Each system produces exactly what it is designed to produce. You can't make a stamping machine grow roses. Craig (preaching to the choir) Ross > > I ran across two former pts of mine today and asked how they were doing. > They both had stories to share of their new 'medical home' experiences that > I wanted to pass along. > > > > One, a man in his 60s, related that he has had 2 annual physicals with his > doctor, and during the second one, he complained of his shoulder being sore. > That was the first time the doctor had seen him with his shirt removed. > > > > The second, a woman in her late 50s with hypothyroidism and hypertension, > stated she has been to her doctor's office 4 times, and has had total > conversation time with her doctor of about 3 minutes over those 4 visits. > This last time, she decided she should go in to get checked out as her > medications, given for a year of refills, were going to run out and she > thought it would be time to check labs, look at her neck, listen to her > heart, etc. After waiting in the waiting room for 40 minutes after her > appointment time, she was taken back to an exam room by the nurse. The > nurse began writing out the scripts for the doctor to sign off, and had to > leave to answer a phone call. After sitting in the room for another 15 > minutes, the doctor rushed in. Asked why she was there, wrote out the > scripts and sent her on her way. Not even an inkling of an examination - no > touch whatsoever. > > > > I am just amazed at how overworked and detached/distracted docs can be. > > > > Eads, MD > > Pinnacle Family Medicine > > Colorado Springs, Colorado > > www.PinnacleFamilyMedicine.com > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 6, 2009 Report Share Posted October 6, 2009 So, did they both say they missed you terribly and come running back to the practice? Or, did they stay with the low quality experience because taking good care of people actually costs time and money? Ben Subject: pt storiesTo: Date: Monday, October 5, 2009, 10:42 PM I ran across two former pts of mine today and asked how they were doing. They both had stories to share of their new ‘medical home’ experiences that I wanted to pass along. One, a man in his 60s, related that he has had 2 annual physicals with his doctor, and during the second one, he complained of his shoulder being sore. That was the first time the doctor had seen him with his shirt removed. The second, a woman in her late 50s with hypothyroidism and hypertension, stated she has been to her doctor’s office 4 times, and has had total conversation time with her doctor of about 3 minutes over those 4 visits. This last time, she decided she should go in to get checked out as her medications, given for a year of refills, were going to run out and she thought it would be time to check labs, look at her neck, listen to her heart, etc. After waiting in the waiting room for 40 minutes after her appointment time, she was taken back to an exam room by the nurse. The nurse began writing out the scripts for the doctor to sign off, and had to leave to answer a phone call. After sitting in the room for another 15 minutes, the doctor rushed in. Asked why she was there, wrote out the scripts and sent her on her way. Not even an inkling of an examination – no touch whatsoever. I am just amazed at how overworked and detached/distracted docs can be. Eads, MD Pinnacle Family Medicine Colorado Springs, Colorado www.PinnacleFamilyM edicine.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 6, 2009 Report Share Posted October 6, 2009 Fire away. Hope it stimulates some discussion with your patients. > > > > I ran across two former pts of mine today and asked how they were doing. > > They both had stories to share of their new 'medical home' experiences that > > I wanted to pass along. > > > > > > > > One, a man in his 60s, related that he has had 2 annual physicals with his > > doctor, and during the second one, he complained of his shoulder being sore. > > That was the first time the doctor had seen him with his shirt removed. > > > > > > > > The second, a woman in her late 50s with hypothyroidism and hypertension, > > stated she has been to her doctor's office 4 times, and has had total > > conversation time with her doctor of about 3 minutes over those 4 visits. > > This last time, she decided she should go in to get checked out as her > > medications, given for a year of refills, were going to run out and she > > thought it would be time to check labs, look at her neck, listen to her > > heart, etc. After waiting in the waiting room for 40 minutes after her > > appointment time, she was taken back to an exam room by the nurse. The > > nurse began writing out the scripts for the doctor to sign off, and had to > > leave to answer a phone call. After sitting in the room for another 15 > > minutes, the doctor rushed in. Asked why she was there, wrote out the > > scripts and sent her on her way. Not even an inkling of an examination - no > > touch whatsoever. > > > > > > > > I am just amazed at how overworked and detached/distracted docs can be. > > > > > > > > Eads, MD > > > > Pinnacle Family Medicine > > > > Colorado Springs, Colorado > > > > www.PinnacleFamilyMedicine.com > > > > > > > ------------------------------------ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 6, 2009 Report Share Posted October 6, 2009 Great point! Better care should mean less testing and more brain function. So mod 1: Dr Star knows his patient and has shared decision making. They decide that it is likely gastritic/dyspesia. H2 blocker and antacids are rx'ed. Dr Star is available 24/7 so the patient is comfortable with this plan. Pt is informed of " red flag " symptoms and when to call 911. Dr Star calls the patient the next day and he's doing great. The patient emails Dr Star a week later saying he's still feeling great. One month later, the sx still have not returned and further testing is unnecessary. DR STar and Dr Crab still get paid the same. In fact, Dr Crab may get paid more b/c Dr Crab does treadmill testing. CR > > > > > > I ran across two former pts of mine today and asked how they were doing. > > > They both had stories to share of their new 'medical home' experiences > > that > > > I wanted to pass along. > > > > > > > > > > > > One, a man in his 60s, related that he has had 2 annual physicals with > > his > > > doctor, and during the second one, he complained of his shoulder being > > sore. > > > That was the first time the doctor had seen him with his shirt removed. > > > > > > > > > > > > The second, a woman in her late 50s with hypothyroidism and hypertension, > > > stated she has been to her doctor's office 4 times, and has had total > > > conversation time with her doctor of about 3 minutes over those 4 visits. > > > This last time, she decided she should go in to get checked out as her > > > medications, given for a year of refills, were going to run out and she > > > thought it would be time to check labs, look at her neck, listen to her > > > heart, etc. After waiting in the waiting room for 40 minutes after her > > > appointment time, she was taken back to an exam room by the nurse. The > > > nurse began writing out the scripts for the doctor to sign off, and had > > to > > > leave to answer a phone call. After sitting in the room for another 15 > > > minutes, the doctor rushed in. Asked why she was there, wrote out the > > > scripts and sent her on her way. Not even an inkling of an examination - > > no > > > touch whatsoever. > > > > > > > > > > > > I am just amazed at how overworked and detached/distracted docs can be. > > > > > > > > > > > > Eads, MD > > > > > > Pinnacle Family Medicine > > > > > > Colorado Springs, Colorado > > > > > > www.PinnacleFamilyMedicine.com > > > > > > > > > > > > > -- > Graham Chiu > http://www.synapsedirect.com > Synapse - the use from anywhere EMR. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 8, 2009 Report Share Posted October 8, 2009 > > So, did they both say they missed you terribly and come running back to the practice? >  > Or, did they stay with the low quality experience because taking good care of people actually costs time and money? >  > Ben Interesting point. I think pt.'s value cost savings over better care/more compassionate care. Sad state of things. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 8, 2009 Report Share Posted October 8, 2009 They are both staying with their miserable situations because that’s what their insurance gives them. From: [mailto: ] On Behalf Of Ben Brewer Sent: Tuesday, October 06, 2009 12:35 PM To: Subject: Re: pt stories So, did they both say they missed you terribly and come running back to the practice? Or, did they stay with the low quality experience because taking good care of people actually costs time and money? Ben Subject: pt stories To: Date: Monday, October 5, 2009, 10:42 PM I ran across two former pts of mine today and asked how they were doing. They both had stories to share of their new ‘medical home’ experiences that I wanted to pass along. One, a man in his 60s, related that he has had 2 annual physicals with his doctor, and during the second one, he complained of his shoulder being sore. That was the first time the doctor had seen him with his shirt removed. The second, a woman in her late 50s with hypothyroidism and hypertension, stated she has been to her doctor’s office 4 times, and has had total conversation time with her doctor of about 3 minutes over those 4 visits. This last time, she decided she should go in to get checked out as her medications, given for a year of refills, were going to run out and she thought it would be time to check labs, look at her neck, listen to her heart, etc. After waiting in the waiting room for 40 minutes after her appointment time, she was taken back to an exam room by the nurse. The nurse began writing out the scripts for the doctor to sign off, and had to leave to answer a phone call. After sitting in the room for another 15 minutes, the doctor rushed in. Asked why she was there, wrote out the scripts and sent her on her way. Not even an inkling of an examination – no touch whatsoever. I am just amazed at how overworked and detached/distracted docs can be. Eads, MD Pinnacle Family Medicine Colorado Springs, Colorado www.PinnacleFamilyM edicine.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 8, 2009 Report Share Posted October 8, 2009 I guess that you get what you pay for. José from The Barrio. From: [mailto: ] On Behalf Of Eads Sent: Thursday, October 08, 2009 4:33 PM To: Subject: RE: pt stories They are both staying with their miserable situations because that’s what their insurance gives them. From: [mailto: ] On Behalf Of Ben Brewer Sent: Tuesday, October 06, 2009 12:35 PM To: Subject: Re: pt stories So, did they both say they missed you terribly and come running back to the practice? Or, did they stay with the low quality experience because taking good care of people actually costs time and money? Ben Subject: pt stories To: Date: Monday, October 5, 2009, 10:42 PM I ran across two former pts of mine today and asked how they were doing. They both had stories to share of their new ‘medical home’ experiences that I wanted to pass along. One, a man in his 60s, related that he has had 2 annual physicals with his doctor, and during the second one, he complained of his shoulder being sore. That was the first time the doctor had seen him with his shirt removed. The second, a woman in her late 50s with hypothyroidism and hypertension, stated she has been to her doctor’s office 4 times, and has had total conversation time with her doctor of about 3 minutes over those 4 visits. This last time, she decided she should go in to get checked out as her medications, given for a year of refills, were going to run out and she thought it would be time to check labs, look at her neck, listen to her heart, etc. After waiting in the waiting room for 40 minutes after her appointment time, she was taken back to an exam room by the nurse. The nurse began writing out the scripts for the doctor to sign off, and had to leave to answer a phone call. After sitting in the room for another 15 minutes, the doctor rushed in. Asked why she was there, wrote out the scripts and sent her on her way. Not even an inkling of an examination – no touch whatsoever. I am just amazed at how overworked and detached/distracted docs can be. Eads, MD Pinnacle Family Medicine Colorado Springs, Colorado www.PinnacleFamilyM edicine.com Quote Link to comment Share on other sites More sharing options...
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