Comments on: What do patients want from their doctors?

By: Encouraging Signs on Health Care « The Bag of Health and Politics

Encouraging Signs on Health Care « The Bag of Health and Politics — Mon, 19 Oct 2009 04:38:12 +0000

[...] Bill he voted for and helped write–allowing insurance companies to set rates and obtain even greater control over a doctor’s day–doesn’t make too much sense. Neither does forgoing the opportunity to use collective [...]

By: David

David — Mon, 29 Jun 2009 21:08:53 +0000

I’m going to keep on whining! Whining is the first step in identifying a problem. You then search for solutions, which can be at the macro level (fix ‘the system’) or at a micro-level (quit your job, modify your job, don’t accept insurances). Again, such ‘whining’ does serve a purpose and should help people to understand why physicians are making the choices they are making.

Doctors can decide not to accept insurances, although this is not exactly easy, and depends on the overall wealth of the region in which you live. I wonder if the same people who tell physicians not to whine would then whine themselves about doctors who choose the concierge or no insurance model.

By: Anon

Anon — Mon, 22 Jun 2009 13:51:20 +0000

” Doctors are frustrated because they are having a hard time HELPING THEIR PATIENTS get better care while in the constraints of the system. ”

Doctors helped create the system. They sign up with these third party payment contracts, which to be honest have paid them exceedingly well over the last few decades. If they feel squeezed now then they only have themselves to blame. If you don’t want to be paid in 15 minute increments, then don’t sign the contracts that pays you like that. The choice is yours.

And Monica is right – stop whining. A lot of people who don’t make near as much as you work just as hard. And they don’t have the lobbying power you do.

By: Hospitalist

Hospitalist — Fri, 19 Jun 2009 19:20:14 +0000

Monica -
Many doctors are doing just what you suggest – packing it up and leaving medicine. It is easier to get a breast augmentation than to get an appointment for health care maintenance. That is the American way. But when we all pack up and leave medicine, who will help you when you scald yourself with coffee (I did it as a waitress) or slip on the floor and break your wrist? Doctors are frustrated because they are having a hard time HELPING THEIR PATIENTS get better care while in the constraints of the system. Not only are there constraints of the system, but this mentality of “fix me after I destroy myself” is incredibly pervasive and has penetrated awfully deep into our society. So far, 6/6 patients today are in the hospital due to alcohol related illnesses and smoking. I still have 9 more to go, all of whom want an hour of my time, right now. I have been a waitress, you have not been a doctor. With all due respect, please do not try to tell me how to do my job unless you have walked in my shoes. That seems to be a favorite pasttime of Americans.

By: Roy M. Poses MD

Roy M. Poses MD — Thu, 18 Jun 2009 20:48:39 +0000

It is very hard to do adequate medical care when it is broken up into visits of 15 minutes or less, especially when a patient has problems that are even slightly complex. There are some tricks that make it easier to do barely adequate care under these circumstances, but the tyranny of the 15 minute visit is bad for patients, and for doctors.
What I don’t understand is why so many of us physicians act like the 15 minute visit resulted from an act of God, and must be accepted as inevitable.
In fact, the 15 minute visit is a product of the current system for paying physicians. And this system has largely been driven by how Medicare pays physicians, which in turn has been controlled by the opaque RBRVS Update Committee (RUC).
On Health Care Renewal, we most recently summarized the pernicious role of the RUC here:
http://hcrenewal.blogspot.com/2009/6/letter-from-RUC-and-my-reply.html

By: amar

amar — Thu, 18 Jun 2009 07:01:21 +0000

Mainly what I want from my doctor is respect. A show of respect by my doctor puts me at ease and allows me to better communicate with her. The other important quality I look for in a doctor is communication. My doctor is open and explains what her course of action will be and helps me to understand the tests and the treatment plans. She always follows up and will send me a letter if she cannot reach me by phone.

By: David

David — Wed, 17 Jun 2009 22:43:30 +0000

Monica said “…I gotta say, I’m tired of the whining of physicians.” That’s funny, I didn’t really hear much whining in the comments above.
She also states: “If you don’t like it, you can go do something else.” This is true, and clearly many physicians are doing just that – or retiring early – or finding alternative career paths. But why would you want to state the obvious? Perhaps you feel there is no value in analyzing our health care system, including the many players (hospital administrators, taxpayers, physicians, nurses, patients , etc.) and their concerns. Well then, perhaps you should go read something else. For anyone who is trying to find solutions, though, it should be interesting to hear from providers of health care to see their concerns.

By: Monica

Monica — Wed, 17 Jun 2009 20:36:17 +0000

While I certainly understand the frustration on both sides, I gotta say, I’m tired of the whining of physicians. Yes, your work is hard, boo hoo. We’re all overworked, overstressed and undervalued, and guess what most of us aren’t lucky enough to be doctors. So suck it up, MD. If you don’t like it, you can go do something else. At least that’s what people tell me when I complain about the stresses of my job as a waitress.

By: K

Wed, 17 Jun 2009 05:11:45 +0000

“I’ve always been able to see the ARNP on the same day I phone.”

Seeing the ARNP or the PA does nothing for the doctor-patient relationship. Most of the time I have to repeat everything again with the doctor wasting valuable time.

The last urgent issue I had I was shuffled off to the PA. When I had complications with my condition, my PCP was not up to speed and was unable to direct my care (and unavailable for an appointment.) Some relationship.

I have two clinics to chose from…they both operate under the same model of care.

By: David

David — Wed, 17 Jun 2009 02:12:07 +0000

I think patients need to realize that most physicians WANT to offer the best of care to everyone and make everyone happy – appointments lasting 30 minute to an hour – or whatever it takes. We want to be compassionate and sensitive and competent and thorough. But to run a business in the current climate (or to be an employee physician with others running the business) requires a high ‘throughput’ – the industry name for rate of product or service provision. Keep in mind, this is simply, in many cases, to keep the doors of their practices open.

Concierge physicians offer all of the time patients want – but at a premium price. Some physicians simply don’t accept insurances – which is their way of escaping the system. They provide a better service, but patients pay more and may have to file their own reimbursement request with the health insurer.

As a neurologist I often am asked to provide my patients with medications (blood pressure meds, antidepressants) which I did not originally prescribe or I am asked about basic medical problems which I am less qualified to answer. They are asking me because I listen to them more, am more attentive, and they can book appointments with me more easily. But fundamentally they are asking me because I am paid more by the insurers – thus giving me the TIME to address their concerns. Their primary care physicians are harried, have a difficult time keeping up with their schedules, and are booked out for a considerable amount of time. Primary care physicians are reimbursed less and undervalued by insurers. The result is the poor service that patients get, unless they are willing to pay more.