Massive change is coming to your local doctor's office...and not a moment too soon.

It amazes me that I have to talk to (1) a receptionist with no medical training and tell her why I want to see the doctor; then (2) the front desk nurse (?), who performs triage and would just as soon have you come in next month, unless you can convince her you are about to die; then (3) the nurse in the examining room who wants to know why you're there and then writes down stuff that when the doctor reads it back to you sounds like someone else altogether. THEN to get test results, the nurse calls and tells me to tell her exactly where I am going to be the rest of the day, and if I'm not at my desk when the doctor calls sometime in the next 6 hours, then I'm SOL [s**t out of luck] because I had my 15 seconds of fame and have to start all over again.

Yes, dears, I know doctors are busy packing as many of us into their day as possible, but that doesn't make it right. I'm a licensed professional also, and if I made my clients talk to the receptionist and then my secretary and have to tell both of them why they deserve some of my time and have to beg for it, then when I gave them an appointment 2 or 3 weeks hence, made them wait because I was triple booked and made them then tell my secretary all over again what they wanted and then when I arrived in the room to ignore them and read from the notes what they supposedly need from me? THEN made them run the same gantlet again 2 weeks later to get the answers and help they want? Hello?? I wouldn't have customers/clients very long. Transpose this kind of customer service onto any human interaction, and it appears downright absurd.

There are doctors who treat the patient instead of making us jump through hoops, but they are increasingly harder to find. Indeed this is becoming a 'customer service' issue, as it should be. Hey, I still remember when doctors made house calls, and I'm not THAT old. Something's got to give, and I have to tell you some of the downright nasty, condescending and angry posts I've seen from MDs on this site and others make me fear for their patients.

God bless the good docs; the rest of you, deploy your high IQ somewhere else. Please.

The clinics have regular hours, they take no call, they participate vith few or no insurances, sure as hell not Medicaid, they have no hospital burdens, they expect to be paid at the time of service.

Sounds like a good deal, I'm going to turn my office into a walk-in. I'll throw away my pager, I'll tell my Medicaid recipients to show up with a credit card or go somewhere else.

You're quite frankly INSANE if you don't think that patients, and the entitlement mentality that has been inculcated by our culture over the years, have a LOT to do with the new doctor/patient dynamic. Don't kid yourself, and please don't act as if all (or most) patients are saints, and all (or most) physicians are jerks.

"You're quite frankly INSANE if you don't think that patients, and the entitlement mentality that has been inculcated by our culture over the years, have a LOT to do with the new doctor/patient dynamic. Don't kid yourself, and please don't act as if all (or most) patients are saints, and all (or most) physicians are jerks."

Gee, thanks for the speedy and inexpensive diagnosis of my mental state. 'Entitlement mentality?' ah, you must mean the DOCTOR's entitlement mentality, and yes, that is indeed a big problem here: to be entitled to screw up without responsibility while making a lot of money and looking down on the sine qua non of the income [patients]. No, some docs don't make a lot of money, but there seems to be an assumption among too many posting MDs that they are entitled [there's that word again] to make a cool half million a year and treat patients as an inconvenience in the widget factory. These are the docs who bitch-post that all that's needed to fix the system is to cap med mal damages. You know why I post here? Because I can't tell my unpleasant doctors how I feel, because they would take it out on me. Now THAT's a problem.

Well, anonymous, posting above, why are you wasting your time posting here and cooling your apparently overheated heels in your doctor's office? Please put your money where your mouth is or at least where you think it will buy you what you want. Paying with any kind of insurance is not paying with cash. It is the company scrip' of the present age, and unfortunately it isn't exactly negotiable, as you seem to conveniently forget.

See a doctor who gives you the time you think you need and deserve, and be prepared to pay in full for that in turn. It sounds as if you are the ideal patient for a concierge-type private practice. Squealing and moaning about not getting all the attention you want while not being willing to pay out isn't exactly acknowledging your own responsibility in the exchange.

CHenry

Gee, it seems like I touched a nerve here. All these anonymous posters jumping on my post, all these non-sequiturs, all this anti-MD hostility that just has to be worked out.
Anon 12:29-None of us wants our patients to wait forever, and I agree that there are some docs that never seem to be able to run on schedule. In my office, I aim for 30-45 minutes door to door, and when I can't keep to this, it's generally because of a true emergency or unforeseen circumstances. Since many of my patients started out as these types of urgent cases, they generally understand that medicine and surgery do not run like their beauty shops or dentists, where timing is much more predictable. If your doc persists in abusing you by keeping you waiting, you can manage him by calling before you go for your visit to see if he's running late so you don't waste your time. Or you can find another doctor. Or you can keep going back for more abuse and then complain about it here. It's your choice. You respond to my statements with the pithy retort:"Not true." I'm not yet convinced, but might be if you provided a few more details, like what it is that you do, and how the federal government controls your revenue, and how the government tells you that you have 30 minutes to respond to an emergency under pain of 5 figure fines, and how your hospital requires you to operate on illegal aliens at 2am at zero compensation but definite risk of getting sued if things don't turn out right. By the way, one of the reasons that you might have to wait to see me is that I am operating on one of those emergencies. But it's not your emergency, so you feel abused if you have to wait. I read through my post again to see where I said that I think that the patients are the problem. It's not there. I suspect that you are the one who thinks that the patients are the problem, all those troublesome other patients that take up your doctor's time when he could be more usefully listening to your complaints.

Anon 1:15:You are correct that docs are agitating for tort reform, but the concept that it will only benefit insurers is a Trial Bar Talking Point, totally unrelated to the facts on the ground, and not worthy of discussion. The rest of your post is a nice example of the logical fallacy of "I don't know anything about it, so it does not exist." If you think that "the only organized legislative action you take tort reform," (sic) you are either ignorant of organized medicine's vigorous actions in other spheres, or again are reading from the Trial Bar's Talking Points. Doctors have successfully sued large insurance companies to make them stop interfering in our relationship with our patients. Doctors assist state legislators in every state and in D.C. on all manner of health-related legislation and policy. We are trying to change the projected Medicare payment decrease scheduled for next year. You may think that we are only trying to line our pockets by doing this, but if it costs $70 to see a Medicare patient in the office, and reimbursement goes from $60 to $50, what do you think that will do to a doc's willingness and ability to take care of grandma?

Anon 1:50- I don't make anywhere near a cool half million a year; that's 2-3 times the average doc's income, but why not exaggerate when you are trying to make a point? And why not invent "the docs who bitch-post that all that's needed to fix the system is to cap med mal damages," since you will never find any doc in the real world who has said that. Sure, it's something that a lot of us have said will help, but "all that's needed to fix the system"??? It will take a lot more than that, and inventing straw men to make your argument will not advance the level of discourse.

Mr. Vineyard: Thanks for your post. An even better example is comparing the behavior of Medicaid patients, who pay $3 per visit in my state, to those who have invested in their care by paying premiums and copays for their care. Many of the Medicaid folks show up when they feel like it, and rarely call to cancel their missed appointments. Before the Anons begin bleating about how the poor folks can't afford phones and have transportation problems, I will point out that mine seem to have access to nice rides and all have cell phones. It's all in the attitude.

To those of you who are undecided: Many out there have a great deal of hostility towards their physicians. You are unlikely to get good results if you dislike, distrust, or resent your physician. Please find another. If you run into a series of docs who all seem incapable of meeting your expectations, maybe the problem is you. If you expect your doc to run on schedule all the time, and take as much time with you as you feel necessary, there will not be one available when you have an unexpected urgent problem. Most of the time, we do not have unexpected urgencies, so we complain about waiting, but nobody ever complained about me showing up to take care of their kid's ruptured appendix, no matter how many people I keep waiting in the office. When I explain to the folks I have kept waiting why I'm late, they invariably say they understand and we go on with the visit. So far, no one has accused me of thinking that my time is worth more than theirs, at least not to my face.

By the way, I don't know how much you know about illegal aliens, but they're about the last people who go into court with a claim for ANYTHING. They are far more likely to just disappear back across the border. That's why they're so popular with unscrupulous employers.

Can't you post anything on this subject without the overdone scare tactics? You'd think you worked for an insurer.

Thanks to all the Anons who have posted responses that prove my points. All I have seen is responses to arguments not made, references to some mythical "Dr. Death," and resentment over being told to "shut up," when that phrase was never used. I merely recommended that you find another doc more to your liking. Chenry was more pointed but was referring to the undisputable fact that any care that you receive under BlueCross, Cigna, United, Aetna, or any government plan is heavily discounted from the doctor's standard fee, and that there are practices out there, known somewhat derisively as "concierge practices," that will give you what you say you want- all the time and attention you expect. These are the practices that I referred to in my original post as being referred to as elitist, etc.

Insurance companies really will not benefit much from medmal caps. The most that they can pay out from a lost suit is whatever the policy limit is, generally a million dollars. The doc has to worry about the judgement over his policy limits, as that can lead to loss of his savings and possessions. Most docs spend considerable time and money on otherwise wasteful asset protection plans to protect ourselves from such lawsuits. The benefit from caps is that that they lead to more realistic settlement offers and fewer suits initiated when the prospect of a lottery judgement is off the table.

Regarding the 3.05 post :
I think we did but I am not sure we've walked in each other's shoes. I had three surgeries. As a doctor, I patiently waited one hour to see my obstetrician, for two pregnancies in a row. But I was happy that at 2 a.m. when I needed a C-section, he was there.
I worked for an assembly line type of practice for several years. I was always late because I had to see four patients every hour, most of them were managed care and the amount of papers I had to fill was unbelievable. Later, I quit and opened my own practice with the goal of seeing only 15 patients daily, answering calls directly, making house calls when needed and all the good stuff you were dreaming of. The reality is that I had to give up Medicaid, some of the HMO's and probably soon will have to limit Medicare as well. By the time you retire, you will be able to see me right away and be treated with perfect dignity but your Medicare may not be of much help. My rent is 30.000/year and malpractice 10.000. The part-time help I have costs me 20.000 (after counting Uncle Sam's fees). I am doing everything else by myself (including billing and cleaning the space- do you have to mop your office and clean the toilets ?). I do value my patient's time and most of them are my friends but I know that if I would make a mistake their families would probably have no mercy in suing me. Because people are like that, not just patients but people in general.
The truth is that every human being deserves all those things you were talking about but everybody wants to avoid paying for it.
I remember once we did some physicals at church, for people without insurance. The agreement was that we won't charge but everybody will donate something to the church. they donated between 5 and 10 $ each and then went to Bennigan's for lunch...
I can make a suggestion : if you don't have a walk-in clinic, why doesn't the community rent the space and then hire a doctor to do the type of medicine they want ? It is a free society, or not ?

“A physician is one upon whom we set our hopes when ill and our dogs when well.”

The Devil's Dictionary by Ambrose Bierce (1911)

Ambrose Bierce described people's expectations of physicians quite accurately. Even Marcus Welby got half an hour to solve the world's problems.

As for me, I do take the time with my patients, run on time (usually), and give extra attention when needed. Which is most of the time.

I'm thinking of changing my name to "Dr. Obytheway" because that's what they call me after I've spent 20 minutes with them and I'm trying to see the next patient.

The price for this is, I accept no Medicaid, no Medicare, few private insurances, and expect my patients to pay for services rendered.

Of course, what I get for this is criticism for "rejecting the poor". Actually, I have a lot of people who have no insurance and pay cash. They're my best patients, and I find ways to make their healthcare affordable. Those with the entitled mentality well.......there are clinics directed toward that population in my area.

They get the "assembly line" treatment.

Running a "pay as you go" acute care practice and a chronic care "appointment" practice is not possible from the billing standpoint. You are either in Medicare or you're not. You either accept Medicaid or you don't. You are not allowed to see some Medicare recipients in the Medicare system and others on a "cash" basis.

The walk-in clinics that provide ongoing primary care are doing all of it on a "pay as you go" basis.

In a way, they do something like that with "critical access" clinics in rural areas, and similar setups in urban areas.

In reality, all they manage to do is find ways to extract more payment from the government for the same service a private doctor does for less payment.

As such, since they're being paid more than I to see the same patients, I say, more power to ya.

When they call my office I send the Medicaid recipients to those clinics nearby.

This is frequently followed by abuse directed at me for not offering them the personalized attention and forcing them to go to the "factory".

Ambrose Bierce lives.

I have read these postings with some interest and not a little amusement. Most physicians are also patients but obviously most patients are not physicians and therefore don't see the issues from both sides. Admittedly the physician patient often gets priority treatment, but this is not universal. Anonymous #1 is correct in his complaint that it is often difficult to navigate the front office - it is true that in many offices the receptionists and even the triage nurses see themselves as protectors of their doctors' time. That is unfortunate and those offices need to change. But it is also very true as jb and others stated that unlike an oil change or even a psychologist's visit (the first of which has been worked out to the minute long ago, and the second is strictly time limited- "when gong sounds, your appointment is over"), medical visits cannot be entirely predicted. As a primary care physician, I don't know if "ear ache" is going to be a routine ten minute visit or the beginning of a laundry list of complaints. I don't know if a routine 10-year-old checkup is going to be that or the opening salvo of "I think he has ADHD." Sometimes the extra time is not warranted, but the patient who has paid the co-pay, wants everything included in the visit and does not want to pay another $10 to come back in a week for the longer issues, when they can be appropriately scheduled. And many visits are medically warranted and must run over. From time to time we make up time because some visits are truly very quick. And there are always broken appointments that gain time. And as jb pointed out, there are emergencies. Not only surgeons who are called out for emergencies, but pediatricians called to the delivery room for a sick newborn or a C-section, internists and family practitioners who are called to chest pain patients. If anonymous #1 is complaining about the docs who routinely double and triple book and then run behind, I have no argument there. That is not acceptable. Occasional double booking is necessary, to fit a sick patient into an already full schedule, but these should be rarities. As far as "making our cool half million," well my salary is about a quarter of that, thank you. The problem lies with managed care and the insurance mentality that has driven up usage, driven charges up astronomically (to cover the cost of maintaining a complete billing staff, absorbing the "allowed" payments the insurers make, coping with the delays in payment, the increase in non-payment, and the everpresent government intrusion. Perhaps a medical savings/checking account coupled with hospital ("catastrophic") insurance, where the patient pays at the time of visit (but from a cash fund provided in lieu of enormous premiums, the result of savings due to the catastrophic plan rather than the HMO plan) would dramatically cut the medical office costs and thus the charges, and return medicine to a doctor-patient relationship and not a doctor-patient-insurer triangle.

Sorry back at you, but I’m not “just wrong.” I’m not even wrong.
It’s not my job to tell a patient that he’s playing the lottery by filing a lawsuit. It’s his lawyer’s job to tell him that, depending on where he is in the process, he has somewhere between 1/100 and 1/5 chance of recovering any money at all, and less than 1/1000 of recovering big money. I’m sure that any similarity between this situation and your state lottery are entirely coincidental.
I have done several thousand surgical operations in my career, and not one of my patients has asked a priori for details of potential recovery in the event of malpractice litigation. If any one had, I would tell him that his maximal recovery would be gross $1million (my policy limit), less his attorney’s expenses (probably considerable), less his attorney’s fee (typically 30-40% of the total), less his own federal and state tax levy (another 30-40%). If he asked further, I would tell him that I had gone to considerable trouble to protect my family’s assets from his attorney, so he could forget about any additional recovery. I would then tell him that if he preferred that I not proceed further with my plan of care under those circumstances, it would not hurt my feelings one bit, and I would gladly provide him with a list of other physicians in our region that he could consult. I would then, absent anything emergent about his condition, ask him to leave my office and not return, as I do not provide non-emergent care to people who are thinking along those lines from the start. To simplify it further, I would have no trouble telling any patient that it is possible that he, or his child, will suffer an injury as a result of my care that he will value at millions or even billions of dollars, but that all he will be able to recover is the million, gross. It’s his choice to proceed or not.
Your statement that incorporating will protect my assets is the one that is “just wrong.” A physician (or other professional) cannot protect his assets by incorporating the way a hardware store owner can. Incorporating my practice protects me against slip-and-fall litigation, but not malpractice. Ask any competent attorney. BTW, I do work for myself, and the tax benefits are nice but not as great as you might think, after subtracting the extra costs involved.
The urban legend relating malpractice premiums to economic conditions refuses to die, but doesn’t stand up to examination. How does that explain the discrepancy between neighboring states, such as Illinois and Indiana, or California and Nevada, for the same specialties for the same year? Are their economies that much different, or is it the different legal climates that exist in these states?

It's simple to pierce the corporate veil? Tell me, how many times have you done it?

It's only easier (it's never simple) if you violate the corporate form and don't treat the corporation as a separate entity - paying your home mortgage out of corporate funds, buying family Christmas presents out of the corporate account, etc. Other than that, it's very difficult.

If you have that much of a misconception about corporations, what makes you think your assessment of the insurance and legal industry are correct anywhere else?

By the way, jb, I like your full disclosure of your coverage. Would you also give full disclosure of adverse results in your practice? References of satisfied customers?

I've seen the proposal of waivers of liability bandied about the blogosphere, to go to more of a contract basis for malpractice. Would you also advocate more information about you and how you rate as a physician being made available to the public so they can make a more informed decision?

Considering that you would reject a patient who dared ask about malpractice coverage, I suspect that you would not. Interesting how physicians expect patients to fully understand that "you're not God" and "bad things happen" but if a patient dare ask a question about your ability to compensate for your own negligence you fire them.

Perhaps the only contractual arrangement physicians want to enter into is one where they hold all the cards and can't be held accountable for anything. Nice work if you can get it.

Amen jb.

Find a COMPETENT lawyer, tell him/her you want to incorporate your practice to protect your assets in a malpractice suit, judge the answer for yourself.

I'm sure it varies from state to state. What they tell me in my state is it protects from some smaller "slip and fall" kinds of claims, but is of no use whatsoever in a malpractice suit. I did incorporate, but with the knowledge that the advantage for me was small.

I think my state's homestead laws protect the family Bible, 40 acres and a mule, too.

Gee, it's so easy to protect assets. Why bother with insurance? I think I got one of your mass mailings last week. Is there a seminar coming soon?

The cap in Missouri wasn't enough, not because of the dollar value, but because the cap could be lifted in so many exceptions that it was useless.

This time round, they got a hard cap, which was what they wanted in the first place.

http://msma.org/cgi-bin/cgiwrap/msmaorg/htmlos.cgi/003169.5.2288874789915668050

I'm going to take that half million a year that people think I make as a primary care doc and retire to Tahiti

sheesh

I'd sue my lawyer for not getting my economic damages addressed.

glory be, I finally got you to admit your lie that noneconomic damages are all the injured party gets.

We're getting somewhere.

You can't eat money. My "mama" gave me twenty bucks, I got food.

The person didn't "get" the money in that it went to the caretakers.

The person "got" care. To say the person got nothing is just another lie.

The person with "no income" either magically found a way to live on nothing, or had some source of income to pay the rent and put food on the table before the accident. He continues to have that. If the income had come from savings and was exhausted, that's economic damage.

You're good at twisting words, the fact remains that economic damages should be paid. To the extent that they're not paid, it's a failure of the plaintiff lawyer.

Now throw out your bag of quotes. It's time to change the subject again.

Is this conversation still going on, being April, 11, 2007 or is this old and has stopped?
TY,
PD