Re: Musings (or rant)

[Guest guest]

Charge for your services – like refills,

phone visits, etc. Let pts know this may not be covered by their insurance,

and their option is to come in to the office for these services.

A. Eads, M.D.

Pinnacle Family Medicine, PLLC

phone fax

P.O.

Box 7275

Woodland

Park, CO 80863

www.PinnacleFamilyMedicine.com

From:

[mailto: ] On

Behalf Of Jacques Guillot

Sent: Saturday, February 16, 2008

11:59 AM

To: IMP message list server

Subject:

Musings (or rant)

Hello, all.

Can a rant be called a musing if I write it after my BP has returned from the

stratosphere?

I have more of a standard practice, but with IMP leanings. Therefore,

some of my practice stressors might apply less to many of you due to the ways

you have geared your practices.

In any case, there is a great example of how much unpaid work we do. If I

shut down the practice for a couple of days, even a half day, just did not show

up ... the world would explode. Calls would not be returned.

Refills would not be given. Questions would not be answered. There

would be a stack of paperwork on my return measured in several

centimeters. How much do I get paid for such a quantity of labor, time,

and risk? Nothing.

I am limited by space and time - three exam rooms shared by two doctors (we

alternate half days with half day out of office on hospital or nursing home

rounds). Too busy to keep up, much less take time for comprehensive

planning to address optimum management strategies. Not enough space

capacity to see everyone that could be seen, therefore, willing to do more by

phone than I'd otherwise prefer.

My biggest complaint - patients treat it like I am on full time retainer.

See me one time for $65 for a sinus infection and then call me any time for the

next three years for free advice, refills for things a specialist has treated

you (and been paid) for. Don't forget - free 24 hour on-call coverage for

more free care.

Once I had a repeat call from a father for colleague's peds patient for pink

eye. Had a call two weeks earlier for the child's brother. I asked

him when they had last seen Dr. ----. Had not been in 6 or 12

months. Could not go to office due to work and school. I tried to

calmly explain this was a courtesy service for emergencies, not for patients'

total convenience. We have office hours too, and he would have to see his

doctor there. Da nerve!

Thanks for listening. I look forward to some comments.

Jacques Guillot, MD

[Guest guest]

I use a cell phone for on call coverage. It stresses that it's my emergency line. Granted, I'm not that busy yet, but I've already had my share of patients I would not want to have in my practice anyhow (both for insurance reasons, and for many other reasons). There are two philosophies for me: 1. Deal with these patients that are demanding, etc.to build my practice (been open 4 months now, have about 100 charts-mostly children with Medicaid, some Medicare patients, maybe 10% private insurance, 10% cash) and eventually "train" them after they get attached to me (which many do, but in the end, people follow their insurance, not their doctor-MOST of the time-because MONEY rules)2. NOT deal with the annoyances-NOT return the message on my cell phone stating their "sinus" infection is not better after one day of therapy or they need a "refill" on their Xanax, NOT call patient back, and make them realize that it was NOT an emergency

Thoughts?Jacques Guillot wrote: Hello, all.Can a rant be called a musing if I write it after my BP has returned from the stratosphere?I have more of a standard practice, but with IMP leanings. Therefore, some of my practice stressors might apply less to many of you due to the ways you have geared your practices. In any case, there is a great example of how much unpaid work we do. If I shut down the practice for a couple of days, even a half day, just did not show up ... the world would

explode. Calls would not be returned. Refills would not be given. Questions would not be answered. There would be a stack of paperwork on my return measured in several centimeters. How much do I get paid for such a quantity of labor, time, and risk? Nothing. I am limited by space and time - three exam rooms shared by two doctors (we alternate half days with half day out of office on hospital or nursing home rounds). Too busy to keep up, much less take time for comprehensive planning to address optimum management strategies. Not enough space capacity to see everyone that could be seen, therefore, willing to do more by phone than I'd otherwise prefer. My biggest complaint - patients treat it like I am on full time retainer. See me one time for $65 for a sinus infection and then call me any time for the next three years for free advice, refills for things a specialist has treated you (and been paid)

for. Don't forget - free 24 hour on-call coverage for more free care. Once I had a repeat call from a father for colleague's peds patient for pink eye. Had a call two weeks earlier for the child's brother. I asked him when they had last seen Dr. ----. Had not been in 6 or 12 months. Could not go to office due to work and school. I tried to calmly explain this was a courtesy service for emergencies, not for patients' total convenience. We have office hours too, and he would have to see his doctor there. Da nerve! Thanks for listening. I look forward to some comments.Jacques Guillot, MD

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[Guest guest]

Always deliver what you promise.

Recent study 80% of "emergency calls" to a residency program WERE an emergency, but pt didn't realize it.

If you play passive aggressive with the phone, they won't come back.

I agree with -- people don't call NOW after 3 years unless IS an emergency.

But suggest compromise -- would put on phone message that refills for regular medications will be handled during regular office hours (and don't start after me that you gave them enough refills for next visit -- MANY pharmacists fax me prescription refills when I've given refills to pts at last appt, AND MANY pharmacists "refill" #30/2 refills as only 2 months -- rots, doesn't it?).

Regards,

Matt in Western PA

Re: Musings (or rant)

People do not understand our lives or what we do we get so upset but these are largely people who are looking to get in touch with someone and all they know is that they got another *#*%*!! machine which mentioned another number so they call it.Years ago i worked in a place where people would call me up and say "I am bringing my daughter right over!!"Ok but i am in my kitchen... They thought since i was on call that i was at the hospitalIt is cultureplus TV plus what people have come to expect in health care.Put a smile in your voice and tell them something that starts with YEsyes i can see you tomorrow this is my emergency phone give me a call between 8 and 8 30 tomorrow and i can tell you when i can see youWhen you INCREASE your access the demand will decrease.we promise.

On Feb 18, 2008 4:32 PM, Annie Skaggs <askaggsfayettefamilymed> wrote:

I have tried the passive-aggressive approach of not returning calls and found that I get a much better result by being direct: take the call (or return the call if it went to voicemail) and firmly but politely explain why it is not appropriate to interrupt me with cell phone calls for things that are not emergencies. If I don't call, that seems to provoke a frenzy of calls from people who have become afraid that I'm not getting their messages.

Annie

From: [mailto: ] On Behalf Of Chirag PatelSent: Monday, February 18, 2008 11:54 AMTo: Subject: Re: Musings (or rant)

I use a cell phone for on call coverage. It stresses that it's my emergency line. Granted, I'm not that busy yet, but I've already had my share of patients I would not want to have in my practice anyhow (both for insurance reasons, and for many other reasons). There are two philosophies for me: 1. Deal with these patients that are demanding, etc.to build my practice (been open 4 months now, have about 100 charts-mostly children with Medicaid, some Medicare patients, maybe 10% private insurance, 10% cash) and eventually "train" them after they get attached to me (which many do, but in the end, people follow their insurance, not their doctor-MOST of the time-because MONEY rules)2. NOT deal with the annoyances-NOT return the message on my cell phone stating their "sinus" infection is not better after one day of therapy or they need a "refill" on their Xanax, NOT call patient back, and make them realize that it was NOT an emergency Thoughts?Jacques Guillot <jacques.guillotgmail> wrote:

Hello, all.Can a rant be called a musing if I write it after my BP has returned from the stratosphere?I have more of a standard practice, but with IMP leanings. Therefore, some of my practice stressors might apply less to many of you due to the ways you have geared your practices.In any case, there is a great example of how much unpaid work we do. If I shut down the practice for a couple of days, even a half day, just did not show up ... the world would explode. Calls would not be returned. Refills would not be given. Questions would not be answered. There would be a stack of paperwork on my return measured in several centimeters. How much do I get paid for such a quantity of labor, time, and risk? Nothing.I am limited by space and time - three exam rooms shared by two doctors (we alternate half days with half day out of office on hospital or nursing home rounds). Too busy to keep up, much less take time for comprehensive planning to address optimum management strategies. Not enough space capacity to see everyone that could be seen, therefore, willing to do more by phone than I'd otherwise prefer. My biggest complaint - patients treat it like I am on full time retainer. See me one time for $65 for a sinus infection and then call me any time for the next three years for free advice, refills for things a specialist has treated you (and been paid) for. Don't forget - free 24 hour on-call coverage for more free care. Once I had a repeat call from a father for colleague's peds patient for pink eye. Had a call two weeks earlier for the child's brother. I asked him when they had last seen Dr. ----. Had not been in 6 or 12 months. Could not go to office due to work and school. I tried to calmly explain this was a courtesy service for emergencies, not for patients' total convenience. We have office hours too, and he would have to see his doctor there. Da nerve!Thanks for listening. I look forward to some comments.Jacques Guillot, MD

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