Why I had to fire my primary care doctor

I like my PCP. She is knowledgeable, kind, efficient, and trusts that I know my body best. All great qualities in a doctor.

But I need to fire her and find someone new. Why? Her support staff and their administrative systems don’t work for me. They make it difficult for me to access timely care and I dislike that very much.

Some background: I rarely visit the doctor. Overall, I’m healthy and very thankful for that. But this week I have a sinus infection and I know that it needs to be treated before I get desperately ill and miserable. So I call my doctor.

The woman who answers the phone sounds annoyed from the first syllable out of her mouth. I asked for Dr. Smith’s office and the response I get is: “Immediate appointments or annual physical appointment?”

Me: “Um, I have a sinus infection, so immediate appointment please.”

Woman: No response…immediate ‘click’ to the lovely music that lets me know I’m on hold.

Hold. Hold. Hold. Recording telling me to see web site for H1N1 vaccine information. Hold. Hold. Hold. Recording on H1N1. Hold. Hold Hold.Recording. Hold. Hold. Hold.

20 minutes on hold.

I hang up.

Call back later. Same rude woman.

Hold. But only for 10 minues this time.

Spoke to nurse. Nicer. Get appointment. Nurse sighs when I ask her for later appointment in the day so I can get my son to a friend’s so I don’t have to drag him to doctor’s office and expose him to more sick people.

Go to appointment. Receptionist never looks me in the eye, even as he is confirming my birth date, address, insurance, takes my copay and gives me a receipt.Someone’s phone rings in the waiting area and he says loud enough for all to hear, “Turn off your phone,” in annoyed tone.

I see the doctor. Nice, helpful, antibiotics. Yay.

These physicians do good work. Their support staff is poorly trained and rude, for lack of a better word. I actually spend more time interacting with the support staff than the doctor, so I would like to be treated like a human being by the people who are the gatekeepers to my care.

And that “on hold” business? What’s up with that? In contrast, my son’s pediatrician’s office asks you to leave a name and number and they call you back when they are available (usually within 30 minutes). How user friendly and respectful! I won’t fire his pediatrician.

If you have trouble with patients not returning for ongoing care, make sure to take a hard look at your administrative staff and procedures. While YOU may be a fabulous practitioner, your staff may be undermining your good work and reputation without your knowledge.

This can be remedied with good staff training, a clear customer service culture and policy, and possibly replacing staff that do not treat patients with respect.

Remember, every “touch” a patient has with your practice reflects on you fairly or not. Make sure you know how your staff represents you and your good work.

Susan Giurleo is a psychologist who blogs at the BizSaavy Therapist.

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Comments

JenJen
People tend to pass pain down – do unto others and all that. Teaching front desk staff to be good to customers isn’t going to work unless their bosses are good to them too. I go to a medical practice that sounds similar to yours, and I don’t see the doctors addressing the desk staff by name or even making eye contact. They come out, they pick up folders and drop off folders and never really acknowledge them except if it’s to brusquely instruct one of them about a special order or appointment. The dental practice I go to is the polar opposite – everyone talks to everyone, and they turn that around to the customers. What’s the difference? Just speculating, but there is competition in dentistry, since so much of the money is in elective procedures that don’t get mixed up in insurance. But where I live there are very few PCPs in my plan that are accepting new patients, so there really aren’t many choices. It’s like the DMV.
docguy
welcome to obamacare, what’s probably happening there is the doctor is too busy and his staff is picking that up.
stargirl65
I understand your frustration with the office procedures at that office. This happens more often in larger practices in my experience. Also it happens more often as primary care doctors are saddled with increasingly more noncompensated administrative tasks with decreasing reimbursements. In other words, you get what you pay for. Of course, your insurance company is most likely the payer and doesn’t care. They just want to hold onto their money anyway.
Nonetheless, you most likely did not need antibiotics or even to be seen. Most upper respiratory infections resolve on their own in 10-14 days with or without antibiotics. Most patients that say they have “sinus infections” either have a cold or a VIRAL infection. So unless you had been sick for 10-14 days without improvement, then your appointment was most likely not needed. This is assuming that you do not have other medical conditions/history that change your risk.
So why did you get antibiotics? Maybe you needed them. (I wasn’t there.) Or maybe it is easier for the doctor to give antibiotics (what you clearly wanted) than to take the time to explain to you why you didn’t need them.
ninguem
Individual /small group practice, or a big box multispecialty clinic?
bladedoc
You are not the customer. The insurance company is the customer. As long as the service is just barely good enough that the pool of insured patients supplied by the contracts the doctor has signed with the insurance companies is big enough to replace those lost in this manner this will continue.
If you do not pay for a service, you’re not the customer, you are the PRODUCT.
family practitioner
So silly to blame this on Obama.
None of his reforms are even close to being implemented.
My primary care office is clogged up with administrative tasks and I cannot afford to higher more staff. This is not Obama’s fault; this is the fault of insurance companies and medicare/medicaid squeezing primary care for years.
Now whether or not it gets better with Obama’s reforms is a different discussion, but comments like “Welcome to Obmacare” are neither accurate nor helpful.
sinyet
I sympathise, but I wonder that you waited 20 on hold. After 7 minutes on hold, I hang up and call again. And repeat as necessary. (And yes, when I do get an answer, I say, disingenuously, “I was disconnected.”)
Patient
“welcome to obamacare”
It seems odd to say this when health care reform has not passed. This is the care we have now…perhaps we should call it “bushcare.” I spent most of the Bush administration being treated poorly by the medical system.
MG
On another note, this illustrates another problem with medicine. “I have a sinus infection and I know that it needs to be treated”. How do you know? Could it just be a viral URI? If the doctor told you didn’t need antibiotics or if he would not prescribe them, would you complain? Would you allow for a wait-and-see approach? What happens when most bacteria are resistant because everyone gets antibiotics for “sinus infections”? Antibiotic seekers, along with drug seekers, are some of the hardest patients to take care of.
David Allen, MD
I think the person who said “welcome to Obamacare’ is saying that issues like this (poor competition, poor reimbursement, poor staff) will only get worse if/when Obamacare is implemented. I agree with that.
This is a case of the customer not seeing the full picture. Does she actually believe doctors lack patients? I don’t know any physician (who accepts insurance) who has a shortage of patients. My problem is the opposite. I see many patients in the hospital and then must still see more scheduled and ‘fit in’ (meaning overbooked) patients in the office. As a specialist, I schedule 20 minutes for patients and sometimes dread seeing people on the schedule with their 20 min appointment who I know I will either have to make happy (by taking a longer time with them and short-changing another), make unhappy (by keeping to the appointment time, thereby feeling I’m not doing a good job), or, more likely, by doing something in between.
If you are a psychologist in private practice (presumably not getting insurance ofrgovernment money, then all of your advice is perfectly appropriate for physicians. If you want better service for yourself, you may consider enrolling in MDVIP, MD squared, or another concierge-type practice where you do get excellent service, at some increased cost. In our current messed up system, you still have this freedom (until the liberals attempt to outlaw such practices!)
Classof65
Luckily I was able to change from a PCP who was as bad as his staff and to find a wonderful PCP who is bright, friendly, sympathetic and actually listens to the patient and whose staff is cheerful, helpful and efficient. Yes, I do have to drive 40 miles each way to get to my new doctor, but it’s totally worth it.
AnnR
Hey – somebody saw you within a fairly short period.
It’s January. Everybody is sick.
My many years of HMO coverage have left me with low expectations. If somebody who knows how to look at body cavities sees you before you’re dead you have to count it as a positive experience.
http://www.drjshousecalls.blogspot.com Dr. Mary Johnson
bladedoc is spot-on.
The government will be the (much bigger/ruder) customer soon enough (that would be the “Obamacare” looming on the horizon). And when that happens, I’d get a phone with a speaker, or your neck is going to crick.
Greg
Did you go to the office to see the doctor or the staff? It sounds like you have a good relationship with this particular doctor and feel your needs are met to your satisfaction. Sure, clerical people can be brusque, but you’re not there for a consultation from the receptionist. Why waste a good doctor patient relationship, which is not something all that common, because of what someone else did?
One could make the argument that the doctor choose poor staff, and thus they are at fault. However, in most busy practices (including where I work), doctors have no say who gets hired or fired – that’s the responsibility of the clinic manager or hospital or other administrative entity. The doctor most likely has no choice who answers the phones.
http://dandavie@gmail.com Dan
Right. As a PHD you might appreciate the reasearch into which sinus infectios actually ate helped by antibiotics.
Nevertheless, you have excellent points. My office staff has great days and bad days. I commonly wish they would treat patients with More respect.
Thanks for your comments.
Albert
Funny how everyone is OK with waiting as long as it takes at the PCP office… in the community pharmacy world, patients think it’s a fast food chain.
PCP
Sorry the staff is rude. However, I have a big problem when people use the “I know my body best” line, b/c that is usually followed by requests for unnecessary antibiotic prescription.s.
gerridoc
When I started out in private practice in the mid 80s, I was the #2 doctor in a small suburban practice. My office manager and staff knew the patients on a personal basis. Unfortunately, that is no longer the case, but don’t blame Obama. The current state of affairs was underway well before he showed up!
R Watkins
The administrative burden imposed on primary care docs by private insurance and for-profit Medicare Advantage plans is much, much greater (and much more capricious and arbitratry) than anything we get from straight Medicare. I agree calling this incident a preview of “Obamacare” is a red herring.
docguy
my point was with declining reimbursements with obamacare which is pretty much a guarantee with a 20% + medicare cut docs are going to have to work faster and faster and this is what you are going to get unless you go to someone right out of school, which will last for about a year or so until they get busy or go to a concierge practice..
I currently see medicaid in order to pay my bills i need to see 6 per hour just to break even. it’s 28 dollars per office visit, i wish more people would just pay cash it would help me out immensely.
ninguem
Why on earth are you accepting Medicaid if it’s paying $28 a visit?
http://www.fortepartnersllc.com Suzanne Dewey
Your post and the comments point to several issues. 1) Customer service in a medical practice is often more about the staff than the doctor, and we all have at least one grumpy experience to recount just in the past year, so clearly, with patients/customers becoming more demanding, some changes (training?) need to be considered in most practice settings. 2) The primary care physician shortage only makes these issues harder for currently practicing physicians and patients — I just was given the earliest appointment for my primary care doctor for a healthy check-up — seven months from now — that was the earliest opening that he had! 3) Having our country’s uninsured covered by health insurance will increase the demand in appropriate places (the practice vs. the ED) and put greater pressure on those tread-milled primary care providers. We are all likely to see more harried staff and providers and more physicians will opt-out of the tread-mill type practice and convert to concierge practices or exit the field entirely. We need to be thinking about efficient delivery, prevention and incentives. Getting uninsured to the table is just step one!
ninguem
The reason I ask about the practice setting – solo/small group versus big box – is it is quite possible the very nice doctor has absolutely no control over the office staff.
Step one would be to bring up concern with doctor. The doc may not have any idea what’s going on up front. Of course, the doctor may well not have any say in how the front, or the back, is run.
I had to bring up concerns with an incredibly good surgeon. I had to transfer three patients in a couple weeks. Each one was outraged by activities of the surgeon’s front desk people.
jsmith
Funny comment, Ann R, with quite a bit of truth to it.
My take on this is that it’s a seller’s market and that the staff are overwhelmed. As a family doc, if I’m nice and my staff are nice, I get more pts than I can handle and have income x. If I’m rude or my staff are rude, I get more pts than I can handle and get income x. Sad, but that’s how it is these days.
Plus, we and the staff are really overworked, especially during cold and flu season. Not an excuse because there is no excuse, just an explanation.
That said, Susan’s service was abyssmal and she is perfectly justified in changing docs. I just hope it never gets to that point in my office.
Susannah
@Suzanne: Are patients/customers becoming more demanding? Or, are they asking for a minimum of courtesy and respect that is, increasingly, not offered (for all the many legit reasons outlined here and in other posts)?
http://www.fortepartnersllc.com Suzanne Dewey
@Susannah I completely agree with you that patients need and should have courtesy and respect. My point was that as demand increases (more patients), the simple courtesies might be harder for harried staff members. And as patients continue to become more knowledgeable (via the web, etc.), they will likely be more articulate about their needs.
docguy
i have medicaid visits fill in the office, after the doc left i want to keep the staff and make sure they all have jobs so i try to make sure that we are busy and i had to fill in appts so i take medicaid. I would love to not take them but i would have to fire staff and I like these guys they work hard and they do a good job.
R Watkins
Docguy:
If primary care docs are unhappy with what they are paid for their services, they need to correctly identify the source of the problem: the AMA and its specialist-dominated RUV system, and the primary care professional associations that continue to support it. I don’t see how we can blame “Obamacare” for the SGR or any other part of the mess we’re in.
David Huss
Can’t really treat a “sinus infection” until you’ve had it for a couple of weeks. Sure a doc “might” give you an antibiotic, but they really shouldn’t before the two week mark is up. It sucks, but up until that point one should just use a home regimen of painkillers, decongestants, and possibly an antihistamine. I’d also recommend a nice soak in the tub/some steam.
Still let the doc know her customer service sucks. She’ll never know unless someone tells her as it’s unlikely she’ll ever run out of people needing appointments.
Fray
I have misdiagnosed 5 times because the doctor I was seeing didn’t think I knew my body. I also had two doctors tell me my bacterial pneumonia was just a cold. I suffered for 3 feverish months. If either doctor had bothered to read my chart, they would have seen that this was not the first time I had problems with lower respiratory infection. Good old guidelines trump critical thinking. I finally went to a specialist…who got it right and whose staff was nice and treated me with respect.
I solved this problem by seeing a naturpath for simple issues. I see specialists for complicated issues. I have to pay for the naturpath out of pocket, but it’s worth it. Family practice is a waste of time. Rude staff, rude doctors, drive-by medicine, misdiagnosis…nobody cares about you in family practice, they just want to get you through the system.
Diora
I don’t think the issue is sinus infection and antibiotics or even primary care. If the office stuff behaves the way it described when the appointment is for sinus infection who is to say this wouldn’t be the case with more serious problems or in an office of a specialist? Nor is “my client is insurance company” justifies rudeness. I am polite to my employer’s cleaning stuff and the cashier in a cafeteria not because they are my clients but simply smiling to people makes both them and you feel better – politeness costs nothing but its value is high. And I’ve been busy too – I had years when I had stayed in office till midnight on some days and had no holidays or weekends. Also, in a doctor’s office there a poorly trained stuff can do a lot more damage then simply get a patient angry.
In general, my mother has had pretty good experience with office stuff and the doctors – in her PCP office as well as other doctors she went to. The only exception was her (former) oncologist. Over there, it wasn’t an issue of simple rudeness – yes, one person in the office was rude once, but more often it was them not doing their job. Calls to the office went unreturned, and if my (very sick) mother didn’t call nothing ever got done.
A couple of examples:
The doctor told they would schedule the first chemo in a couple of weeks and call my mother to tell her when. A couple of weeks go by, nobody calls, my mother calls, the lady in the office said that they are waiting for the approval from insurance, as soon as they get it, they’ll call. Another week goes by. My mother calls again – no response from insurer yet. So my mother calls the insurer – “why aren’t you approving the chemo?” The insurer rep “Nobody sent us any requests”. My mother calls the office again, they send the request, the insurer approves within a day. I guess the request was never sent. No apology, no explanations, everyone behaves as this is normal.
OK, now you are all thinking that it was the insurer who lost the request and not the office. Except for this type of incident was repeated in situations when the insurer wasn’t even involved.
Another time: my mother developed pleural effusion, they drained it, found cancer cells, doctor said they would schedule pleurodesis for the following week and call my mom to tell her went. Mom is on coumadin, the interventional radiologist requires a week off it, so the oncologist tells her to stop. Monday next week comes and goes, Tuesday comes, mother calls – “we sent email (or maybe called) to the radiologist, he didn’t get back to us yet”. “-When would he get back? can I call his office directly?” “No you cannot call him, but don’t worry, we’ll schedule it within next couple of weeks”. “what about coumadin?”. “Take it for now”. OK. A week ends, nobody calls, the following week nobody calls Monday or Tuesday or Wednesday”. In the meantime, it becomes increasingly difficult for my mother to breathe. On Thursday she goes to her PCP office for an unrelated reason, the PCP looks at her chart – “oh, you have pleurodesis scheduled for next Monday”. Of course, nobody bothered to call my mother and tell her about it, and as she is on coumadin, they cannot do it on Monday so it gets rescheduled for the following week. By that time my mother feels so miserable she isn’t sure she’d live that long.
After pleurodesis my mother briefly feels better but soon starts feeling worse; at follow up visit the oncologist sends her for an X-ray and told he’d call the following week when he gets the results. Nobody calls, my mother calls the office said X-ray shows a little fluid but much less than before, they sent my mother a letter which she didn’t get. My mother asks when she goes on chemo again as she felt better while on it, they say to hold off on it. OK. The letter never arrives, my mother calls, turns out they meant they were planning to send it. The letter arrives says that there is fluid but less than before, but mother still feels worse. Now I call telling that my mother has real difficulty breathing, they said that maybe she caught a cold or something and should see a PCP which my mother knew would be useless (she knew how she felt), but she scheduled it. As she isn’t optimistic, she calls oncologist’s office again, the lady in the office answers and immediately said “oh, by the way, the doctor wanted you to see a pulmonologist”. Except for nobody bothered to tell that to my mother or call…
It turns out far from being better, my mother’s effusion was now loculated. Pulmonologist orders oxygen so that my mother could at least feel better, and tells she really needs to be on the chemo again. With all of those delays and waiting it has been 3 months since the doctor stopped the first chemo. In the meantime cancer progressed.
Now, my mother has advanced lung cancer (before anybody starts to blame her – no, she is a never-smoker from a never-smoking family), so I realize that the prognosis is pretty poor with the chemo and maybe all these experiences haven’t made much of a difference in the general scheme of things. But they certainly had an effect on mom’s quality of life. It seems like not only office peple were rude, they lacked basic human compassion.
After that my mother decided to switch oncologists…
DMAC
Let’s knock off the Obama bashing, because the man had nothing to do with the current state of the medical system. Get behind your leader, people. Try being part of the solution and not the problem.
As for being unhappy about a service you are consuming, SPEAK UP.
Fray
“As for being unhappy about a service you are consuming, SPEAK UP.”
I once “complained” about the care I received, wanting to resolve the issues I was having with my doctor so our relationship could move forward. My concerns were ignored. I would guess a note was put in my chart that I was “difficult.”
I have never seen one post from an MD that said that a patient complained and on reflection, that MD changed how they practice medicine. It’s always the patient’s fault, the system’s fault, not enough money, not enough time.
LynnB
I don’t condone rudeness , and I am glad this lady got what she and her doctor think is appropriate . Lets get a grip on “desperately ill”. I apologize for the medical jargon below .
Desperately ill, the first 5 from last week is different than a productive cough in a healthy adult.
1. Cirrhosis of liver, lots of edema with skin breakdown , ascites , blood pressure 83 systolic by home health. Its usually low but this is lower .
2. Stage 4 lung cancer still getting chemo, creatinine rises from 1.5 to 4.0 in the last weeks, electrolytes OK so far . Diarrhea , unknown cause .
3. Infected total joint, surgeons calls -which surgery can she tolerate? What about that organ transplant that she is being evaluated for ,the surgeon who she has waited 2 months to see, wants me to tell him about that . .
4. Can’t breathe, oxygen saturation 87%, 60 pack year smoking, just finishing prednisone and antibiotics, now coughing up a little blood. Already on Coumadin , so probably not a clot.
5. Alzheimers, hallucinating and trying to escape form the temporary facility. Has also tried to escape from hospital in the past and no acute illness. Frightened since his stepdaughter is recovering from her recent hospitalization and not only is he not at home, she can’t visit , she is too sick.
Sinus infections are unpleasant, the lady needs to be seen fairly soon. Most of the patients above are not eligible for hospitalization since they are chronically ill, they have limited benefit, and the ER doc who has not been on an inpatient service since residency may not realize that little can be done in house. The patients spend enough time there , they don’t want to return .
Sending them to ER or hospitalizing when ill so we can see more profitable privately insured sinus infections goes against the grain. One of these 5 did go to ER, one was told “see your doc tomorrow”, so we have the calls from patient and ER and now the problem is shifted to tomorrow ….Hope it doesn’t interfere with my conference with my stockbroker, golf game. massage , whatever it is the patients think we are doing.
. There are lots of ways to handle a practice. We can all write and tell each other how to fit a greater portion of the 10 pounds of flour into a 5 pound sack. I am no martyr , but I didn’t take 14 years of post-high school training (alas I had a well paid IS career before general internal medicine) just for money. I made more money in today’s dollars at my old job, but it was “ego-dystonic”
In my mind, you can pick someone who identifies and refers (where????) serious illness if you like. Most patients who are actually seriously ill understand that we are doing the best we can. I hope we are not putting anyone on hold for 20 minutes , there really is no excuse , but I am amazed they were able to get and then shift a same day appointment . Maybe if most of the patients are basically healthy PhD’s that works better than it does for me. In spite of this experience , it looks like this practice is well run and she got over-the-top service .
Caroline Andrews
My doctor is in a large medical group, and almost everyone is friendly and helpful. The nearby hospital is the same. In recent years, there has been a huge push to make sure every employee is patient-friendly, and I think it has made a huge difference in the level of patient care.

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