Want to fix health care?

You have to start listening to The Happy Hospitalist. Here’s his first suggestion:

1. Remove failure to diagnose as a legal basis for a lawsuit.
To spend billions on testing “just to make sure” when your medical training says you already know the answer. The testing that is the result of that 0.5% chance you are wrong. No matter how much we try, we will never get it right 100% of the time. And that 0.5% unattainable goal is what drives much of the testing. As a society we need accept failure as a part of success. Some people may die, but many more will die as we bankrupt our system of care.
Unmanaged expectations are bankrupting our system.

Now read the rest.

Comments

Anonymous
Agreed with all except #17.
Yes, I imagine phone calls and e-mails could add up. Except that I have NEVER known a physician to do this him/herself. It’s always a resident, a nurse, a staffer of some sort. And the amount of time? Negligible. One minute to ask a routine battery of questions following an outpatient procedure, during which it seems the staffer is barely listening (Asked once if I was experiencing any bleeding at the suture site, I truthfully responded yes, and the voice at the other end absent-mindedly responded, “Uh-uh, good” and breezily moved on to the next question). I’m not paying for THAT.
Longer, truly helpful phone calls or detailed e-mails? OK, sure, bill ‘em. But how about the hours patients lose from their lives sitting in waiting rooms even though they’ve scheduled appts for a specific time weeks or months in advance? Going to reimburse that? Doesn’t matter to me if you suddenly got an emergency. It’s my time, it’s worth something too(although I’ll give in on this if you back off on billing me for the indifferent 30-second phone call).
Like I said, that’s my only point of disagreement. Hope you get most of what you want.
The Happy Hospitalist
The reason you are waiting for hours in waiting rooms is because your doctor is double, triple booking on volume to make up for the poor reimbursement rates and ever rising practice costs. To stay open for business.
They are also spending hours and hours a weeks in uncompensated work to fill out forms, answer phone calls, discuss results, Speaking with insurance companies. Speaking with other doctors about complicated patients. Imagine just 5 minutes a year of uncompensated phone calls.
Extrapolate out your 5 minutes of time to a panel of 6000 patients and you have 500 hours of unbillable time in a year. The equivalent of 10 hours a week.
Your one minute adds up.
And it adds up quickly. If you want service, you have to pay for service.
The Happy Hospitalist
I hope you are never that emergency patient on the other end of the waiting room.
The emergency that backed everyone up. You certainly wouldn’t expect your doctor to come running to your assistance with so many people waiting to be seen.
Would you?
RJS
“30 second” phonecalls add up to be a metric sh*tload of time. It’s not possible to do it for everyone, as much as people would like us to.
I use “us” in the medical and pharmacy fields. “Can you call me when my doctor calls in that prescription?” No, because I have no way of making a note of that, and I have a million other things that are actually important that need my attention.
You can call us if you really want something — it isn’t my responsibility to babysit you. Take some responsibility for your own care. You think you’re a beautiful and unique snowflake, but you’re not. You’re one of hundreds of people that come through the doors.
90 seconds of time x 40 phonecalls per day = 1 hour a day — assuming you could be perfectly efficient with each call, which of course you can’t. But even if you could, That’s 365 hours a year (medicine is a 7×365 job), more than nine, traditional 40 hour work weeks.
Two months of lost productivity, for free. Piss that into the wind every year for free? Give me a break. In my other (non-medical) business, we measure time saved in the minutes per week. Not hours per day.
If you want generous helpings of attention doled out to you without having to fight for it, perhaps you should pay up for a concierge doc. The laws of physics pertain to the medical world, too. We don’t have 25-hour days while everyone else gets 24.
Pepsi Loo
I’ve never been able to reach my MD on the phone. Each time I have a problem like getting an Rx filled or refilled I have to speak to the secretary, who then tells me that the “nurse” handles the Rx requests.
So…I tell the “nurse” what the Rx should be and she then phones the order into Walgreens. Only problem…is that the med is the WRONG one. So…I have to call back to the “nurse” about the WRONG med and why it’s WRONG.
Finally 8 hours later, I pick up my med(antibiotic) at Walgreens.
Then, the next time I needed this specific med, I called after hours to the MD on-call, who
e-mailed the Rx to Walgreens and which I then picked up 30 min later.
Anonymous
“And it adds up quickly. If you want service, you have to pay for service.”
So why don’t you guys give us the opportunity to do so?
Michael Rack, MD
“…if you want service, you have to pay for service.”
So why don’t you guys give us the opportunity to do so?
Because it is against medicare regulations and the regulations of most insurance companies to charge extra for this level of service.
Anonymous
It is illegal to bill for this unless you don’t take insurance or medicare or medicaid.
Toni Brayer MD
A recent study showed that primary care physicians spent an average of 6.5 minutes on non-reimburseable work for EVERY PATIENT after the visit. This did not include coding or charting and the practices studied were academic centers where they had social workers, nurses and assistants..so the MD workload is probably higher in a regular practice. This was physician time…not receptionist time. If you do the math at 15 patients a day that is an extra one and 1/2 hours of uncompensated work. In reality, it is more. Every doctor I know spends hours at the end of the day. It’s just a fact.
Happyman
Pepsi Loo:
your doctor emails or telephones an rx for an antibiotic into the pharmacy upon request?
i’m amazed he/she doesn’t make you come into the office, to make a judgment that actually NEED an antibiotic.
is this something you think the secretary should do?
Anonymous
“Because it is against medicare regulations and the regulations of most insurance companies to charge extra for this level of service.”
So quit signing up with them. Market your services to the public and tell them they can get increased attention and better care out of pocket at a certain rate.
Michael Rack, MD
Anon 8:35:
I’m not complaining. I am able to offer a higher level of service because I subsidize my income from seeing patients with income from reading sleep studies. I was just trying to explain to readers of this blog why they can’t expect a higher level of service from their primary care doc (unless they are willing to be seen in a cash only practice, as you suggest).

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