Comments on: Medicine fantasy versus reality

By: Anonymous

Anonymous — Sat, 19 May 2007 20:58:00 +0000

Ideal is fantasy isn’t it? Assuming everyone everywhere will act accordingly and fall into neat packages that are never out of order or place? Applying idealism to the complexity of caring for individuals, as individuals, is, (to me), a fantasy. Patients come to see a Dr. with varying degrees of expectation, life circumstance, and preconceived notions, on top of their symptoms. How can any one man or woman provide an ideal situation for, (as is already posted by Rich)the countless levels of expectancy that patients have? Where is the line between what is an acceptable level of care… like say.. successfully treating gout, and what is, (and has become), what I can only describe as abusing the Dr’s and staff with problems that go beyond say… a sinus infection and are rooted in years upon years of emotional, physical, circumstantial..(on and on…) issues ? There is alot of talk about ways to achieve the ideal, but none that just say that it doesn’t exist. Yes, you can treat patients in an affluent area, have alot of very pleased people and some more money in pocket,(temporarily), but sooner or later, that patient population would also become accustomed to demanding the Dr’s and their staff’s time and efforts that go beyond what is personally acceptable to the caregiver. It is a vicious cycle. Ask all day, the real issue is, and is not asked of patients, is some level of exactly what the Dr’s and their staff’s responsibility to the patient is and where it ends. Patient’s have choices, (as mentioned), as anywhere else in life and they should make them if their emergency hangnail was not attended to quickly enough. Save your compassion and use your time as Dr’s to care for the patient population that adheres, as closely as possible, to the ideal that YOU set, the rest will find someone else who suits their ideal. As patients are different, Dr’s are also different. What an incredible waste of time to even attempt to please everyone. Private practice utopia, as in any business, does not exist. Just try and give the best level of care you can to people without compromising the boundaries you have set in your mind or the ethics you are professionally and personally bound to. Most will be happy and money will be made.. closest thing to ideal I can think of!

*I am not a Dr. but work for Dr’s. It is clear to me that for every patient’s disillusionment, there are more who are happy with their care… unless of course the Dr is a real @&)(*…. then… it costs another service Dr’s provide that is overlooked here. Jobs.

By: Rich, MD

Rich, MD — Wed, 02 May 2007 02:16:00 +0000

The fact of the matter is that physicians and patients alike have choices. We (physicians) can choose to spend more time, perhaps for slightly (or more than slightly) less income. It depends on patient mix and other factors.

It remains axiomatic that you can't please all people all of the time. In my practice, I choose to keep a fairly rigid schedule. I book in 15 minute blocks, and I rarely overbook. It has to be exceptional. Yesterday, a patient berated a staff member because we had no availability to have him come in for his gout episode. He had been seen in the ER the day before, and his symptoms were improving. In any case, we had a cancellation, and brought him in. His wife asked why it was so difficult to get in -today- when it was so "urgent." I explained as follows:

In my practice, I have made a choice. I have chosen not to practice emergency medicine nor run an urgent care center. (I am an internist). As a result, I keep fairly on schedule. I rarely keep patients waiting. I could make the choice, as some physicians do, to see everyone who wants to be seen. The result of this is that you may end up waiting 2 or three hours in the waiting room for your appointment which was made 3 months ago. I would probably make more money, but this is not the kind of practice that I want to have.

You have a choice. You can choose to see a physician who respects your time and honors your appointments, and spends adequate time with you when you have one because he is not pressured with everyone who wants to be seen today (and everyone believes that their case is at least as urgent as yours). Or you can choose a physician who will see you right away, and perhaps spend a lot of time in the waiting room.

The husband explained: "That's why I left my last doctor!"

By: Anonymous

Anonymous — Wed, 02 May 2007 01:24:00 +0000

Even in academic medicine this model can't work. At my fine institution, faculty billing, grants, endoments and all other sources of income are reviewed monthly by the non-MD administration.

Those of us who don't "justify ourselves" are reprimanded; if we don't shapre up our salary and benefits are decreased.

I guess one option would be to take very good care of a few rich people and be very pleasant about it, but that's usually not what we do.

If society views the time that doctors spend with their patients are valuable, then doctors shoudl be able to bill based on time - just like other professionals do.

Otherwise it will be more like a factory with emphasis on "throughput" and efficiency.

By: The Independent Urologist

The Independent Urologist — Tue, 01 May 2007 18:07:00 +0000

Works in my office.