Politics shouldn’t be discussed in the exam room

Jack Cassell is either Florida’s most hated, or loved, urologist, depending on your point of view.

He famously taped a sign outside his office, advising President Obama supporters to seek care elsewhere.

Politics shouldnt be discussed in the exam room

Slate wrote a piece saying, from a civil rights perspective, Dr. Cassell is probably in the clear: “While the law bars physicians from excluding patients on the basis of traditionally protected classes like race, religion, national origin, and disability, most jurisdictions permit political discrimination.”

The stunt happened at a doctor’s office, not the emergency department, where doctors are compelled by law to treat everyone that comes in.

But should politics ever be introduced in the exam room?

The answer, of course, is no. Health care and reform is already a contentious issue, not only among the America public, but between doctors as well. As you can see from a recent post by the American Medical Association, there is a lot of physician anger stemming from the new law.

I’d like to think that most doctors will give patients the best care possible, despite their political persuasion.

But, as you can see from this case, that may not always happen. And I’m afraid it may get worse, when you consider how contentious health reform is, and how politically divided our country has become.

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  • http://medicalpastiche.blogspot.com Peter

    When physicians are supposed to serve as the patient’s advocate in a government-controlled system where a central budget is more important than an individual’s access to medical resources, discussion about insurance and government involvement will inevitably arise. $500 billion are being cut from Medicare; is it completely unexpected that a physician would want to discuss this impact on a patient on Medicare?

  • NewYorker MD

    “The answer, of course, is no.”

    Why not? This is part of the reason why the government has been able to insert itself further and further between doctors and patients. Doctors should be more willing to take a stand to defend their right to practice on their own terms, and limit government intervention in medicine. I applaud Dr. Cassell, and I wish there were more brave physicians to follow his lead.

  • stargirl65

    I have had some great discussions with many patients about politics and the health care reform bill. Both of us seem to enjoy the discussions. One recently told me he consults with several large corporations and they are considering paying the fines instead paying for health insurance for their employees. The fines may end up costing them less money due to the ridiculous increases in health insurance over the last few years. My office’s policy for health insurance went up 20% this year. I can see their point.

  • NoVA doc

    Jon Stewart had a segment on this physician a couple weeks back.

  • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

    Hummmmmmm . . . I was under the (apparently misguided) impression that, in this country (and excepting in the emergency department setting), physicians still had the right to accept or discharge patients at their discretion . . . and patients could “doctor-shop” (i.e. vote with their feet and their insurance card).

    I think it’s called free enterprise.

    Moreover, doctors have just as much right as anyone else to have an opinion – and express it.

    That’s called free speech.

    There are, in my humble opinion, very serious Constitutional issues with the healthcare bill. And not all of us are going to placidly don a white coat and stand behind Obama & the AMA.

    There seems to be a lot of confusion in our national dialogue about “access” and “care” when the REAL issue is payment for services rendered – and who does the paying/absorbing of the fiscal blows.

    I don’t have to “think”. I KNOW that the massive majority physicians in this country take their Oath very seriously, and are doing the best they can by their patients NOW (oftentimes to their own personal detriment) – regardless of their political/moral/religious beliefs. But a lot of us in the trenches are sick and tired of busting our tails to serve – only to be horribly treated, ignored, demonized and vilified.

    I will point out (again) that this President, husband to a former hopsital administrator, thinks that Pediatricians perform tonsillectomies for the money. This is the man who brought us healthcare “reform”.

    The sign on the office door (as opposed to the exam room) was not about “care”. And Dr. Cassell made it clear that he would not turn away or abandon patients based on their support for Obama.

    So it’s not discrimination of ANY kind.

    On the other hand, Cassell’s patients now know where he stands. And they have some CHOICES (another thoroughly American buzzword) based on the knowing.

    Politics is ALREADY in the exam room. And free speech is not a bad thing. Patients are talking and asking questions of their doctors & nurses. And doctors and nurses are finally talking back.

    It’s about time – although probably too little too late.

    And you’re right. It’s probably going to get much worse – because no one really wanted to hear what doctors had to say – or our stories of woe – before this bill was passed.

    We can do a census that quizes everyone in this country about their ethnic background and socio-economic status. But before drafting a bill that affects every aspect of the way healthcare is provided, the Congress could not concoct a way to poll physicians – all physicians (as opposed to the dues-paying members of the AMA/other special-interest groups) – to find out what we really think and need.

  • k

    While I do not feel that Jack Casssel is the most articulate under pressure (see his CNN interviews), he needs support from like-minded physicians. They need to go on TV because that is how Obama has managed to captivate American people (remember his appearance on Jay Leno?). Your average, non-critical-thinking American with a valuable vote in their hand will listen then.

    As an aspiring medical student keen on family practice, Jack Cassel is my hero. I think more physicians should stand up for their rights before I, too, leave the country or specialize.

    Teachers are fighting to stop their pay freeze in New Jersey. As another ethics-based career of great importance to our society, it follows that physicians should fight against pay cuts. Social and political consequences be damned, because ultimately this will save the American people when they lie on what shouldn’t be their deathbed.

  • Smar Doc

    So….

    Doctors are supposed to the happy slaves of our new socialist quasi-totalitarian usurper overlords?

    We cannot authentically advocate for our practices and our patients?

  • BD

    Physicians already express their political views when they refuse to honor valid DNR/DNI statements (regardless of family members’ wishes), won’t refer patients for abortions, fail to recommend Plan B for rape victims, or even refuse to prescribe birth control pills, for any reason (as I recently read on the blog Medicine and Other Stuff – the blogger, an OB/GYN herself, was also disgusted).

    A sign on the door is mildly provocative but harms no one. Furthermore, those patients whose political opinions differ from Cassell’s may prefer not to pay him another dime. Just a thought.

  • http://nostrums.blogspot.com Doc D

    Although a doctor myself, my spouse and I have been told by three of our doctors in the last month that they will no longer be able to follow us in the future. Two comments: first, we talk about the doctor-patient contract–that means it’s a two-way street. Except for ERs, doctors get to choose patients, and patients get to choose doctors, It’s uncommon, but over the last three decades I’ve arranged for some patients to see someone else because we just couldn’t form a good working relationship. I think it’s important to preserve that choice on both sides. Second, I’m hearing a lot of anger over the new law and inaction on tkhe Medicare fix, and expect the number of physicians accepting Medicare/Medicaid/TRICARE to continue to decline.

  • jsmith

    I generally avoid these discussions. I have had some uninsured pts who have brought up universal care, usually because they find themselves facing tests or treatments that they can’t afford, and I expressed my belief that everyone should have basic insurance in this country.

  • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

    BD, ain’t “choice” grand?

    The thing about choice (that a lot of people seem to forget) is that it’s a double-edged sword. Yes, some physicians (on moral or religious grounds) do not provide the “services” patients want (like abortion, like Plan B). Those patients are, in fact, free to seek out physicians who’ll give them what they want (like the “disgusted” OB-GYN). It might not be convenient or easy to find that “service”, but that’s the way things work in a free society.

    Last night, I watched a PBS show about “assisted” suicide in another country – where physicians “evaluate” those who wish to die, and “prescibe” the drugs, and mix the death-juice (basically a massive dose of sedative) and assist in giving it. I was horrified. A patient literally died on-camera at the hands of a physician.

    Some would argure that’s all about “choice” too. The patient wanted to die and the physician obviously thought he was acting compassionately – and not at all in conflict with his Oath. I’m thinking that it was, at the very least, manslaughter.

    Not paying your bills (for services already rendered) because you disagree with your physician about his/her politics is grounds for discharge – and being reported to the credit bureau.

    Just a thought.

  • garanimal

    I’m on the opposite side of the aisle politically from this doctor, but I find his honesty refreshing…no need to guess about his motivation for getting into medi$ine…

  • Ed

    This presence a of insurance, FDA, CMS, OHSA etc. already presumes that politics is in the exam room dictating what is happening. It therefore becomes the duty of the physician to discuss politics to those with political power -the voting agents themselves-the patient.

  • rezmed09

    This is more a sign of the helplessness that some docs feel at the hands of a broken health care system. The fact that this doc lashes out at one group is immaterial in my mind. Of course he hates the HCR and the politics behind it. But this doc has probably been poked and prodded for the last 15 years by an increasingly complicated and less lucrative compensation system. To look at this doc as an outlier would be to miss the bigger picture. Docs most everywhere are getting angrier with the “system”, and patient care will be affected adversely.

    Yes, docs should be above this all, and we probably should work for next to nothing too – but this is a capitalistic society and most of us shop at Walmart.

  • anonymous

    Sorry to be the voice of dissent here, but individual political views should not be intruding in the doctor-patient relationship. The last time I checked, American citizens still had the right to vote for whom they choose and their ballots were still confidential. I’d be an idiot not to recognize that politics do indeed intrude into the exam room, but at the end of the day it’s none of this guy’s business whom his individual patients voted for.

    There’s a big difference between voicing your opinions on health care reform and pushing them, unsolicited, onto your patients, who are coming to your office to seek care and instead get a political diatribe at the front door.

  • BD

    >>some physicians (on moral or religious grounds) do not provide the “services” patients want (like abortion, like Plan B).>>

    Re-read what I wrote. I didn’t say “provide” abortions or Plan B. I said “refer” (for an abortion; not readily available in all parts of the country to those who do not have a private physician willing to perform this service though many do, quietly, even in Catholic hospitals) and “recommmend” (not all patients know Plan B is available OTC). Some “principled” physicians outright refuse to provide information when asked direct questions.

    I’m not Jewish, but if one of my houseguests wants to attend services, I know where the nearest synagogue is located.

    >>Those patients are, in fact, free to seek out physicians who’ll give them what they want>>

    Probably reasonable in the case of abortion, but not in the case of a rape victim seeking treatment from an ED physician. I don’t think it’s reasonable to expect a rape victim to be thinking entirely clearly, and Plan B is of course most effective when used quickly following unprotected intercourse.

    >>…It might not be convenient or easy to find that “service”, but that’s the way things work in a free society.>>

    Considering that I’m well-educated and have an above-average income, I don’t need convenience. Not everyone has those advantages.

    >> A patient literally died on-camera at the hands of a physician…Some would argure that’s all about “choice” too. The patient wanted to die and the physician obviously thought he was acting compassionately – and not at all in conflict with his Oath. I’m thinking that it was, at the very least, manslaughter.>>

    That’s your opinion, and it’s also against the law in the U.S. If one of your patients wants a referral for doctor-assisted suicide, I see no ethical or legal problem with your refusing to do so.

    Abortion and Plan B, however, are both legal in the U.S. Quite a different kettle of fish.

    Last time I checked, birth control is also legal in this country. The disgusted OB/GYN blogger offers birth control as part of her regular practice. I have no idea what her policy is re: performing abortions, but I’m almost positive she recommends Plan B when appropriate.

    >>Not paying your bills (for services already rendered) because you disagree with your physician about his/her politics is grounds for discharge – and being reported to the credit bureau.>>

    Where did I say anything about not paying bills for services rendered?

    To be more direct, one of my friends who supports healthcare reform is considering a vasectomy. He has an excellent insurance policy. He would not choose Cassell as his urologist. His choice. It’s grand.

  • Vox Rusticus

    No, the answer is not “obviously, no.” Patients ask me about what I think about the Obama administration’s actions, and many of them are far more upset about the plans of this president than I have been.

    This November will be interesting. President Obama will likely finish his first term with a Congress less cooperative than the one he started with. Repeal and amendment will be the watchwords.

  • Rat

    Clearly, patient health isn’t really that important. If a doctor refuses to provide care because I voted for Obama, then is it ok for him to refuse care because I am gay, or because I am pro-choice. Where does the line stop. Maybe I dye my hair dark purple and wear it in spikes on top of my head and the doctor doesn’t agree with my choice of hairstyle and refuses to see me.

    • Vox Rusticus

      “Maybe I dye my hair dark purple and wear it in spikes on top of my head and the doctor doesn’t agree with my choice of hairstyle and refuses to see me.”

      He would be within his rights. Persons with bad taste are not a protected class.

  • ninguem

    If you voted for Obama, go somewhere else. I won’t stick that screwdriver down your urethra and I won’t stick that baseball bat up your a$$.

    But if you did not vote for Obama, you’re my kind of guy.

    Come on in. Bend over.

    I saw the story, but I still can’t wrap my mind around it.

  • family practitioner

    Hanging the sign on the front door had nothing to do with a rational discussion between patients and doctors regarding healthcare issues.

    It was a provocative, grand-standing gesture and for that reason was inappropriate. Dr. Cassell is also rather poorly informed of the issues. Perhaps he never should have been accepting medicare at all. Too many doctors in their fifties and older have gotten drunk and fat at the medicare trough; now that it is drying up, they are whining, for themselves, not for younger doctors like myself that are left with their crumbs.

  • Anne Marie

    If a patient that voted for Obama walked in the door, disregarding Dr. Cassell’s sign, he could still be treated if he keeps his mouth shut. I doubt the office staff would grill him about his politics or ask that he sign some sort of declaration that he didn’t agree with the healthcare reform bill.

    One of my doctors said he was contemplating early retirement, clearly angry at the bill. Maybe he was just vetting, but I took it as a veiled warning that I might have to look for another doctor. I did vote for Obama, but said nothing. I just nodded and listened. If he does retire, it will be my loss too.

  • Rat

    “What if your lawyer does that?”

    So you equate your services to that of a lawyer-or someone else.

    You would deny someone care because of hairstyle. So you think only certain people are entitled to medical care?

    “I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.”

    Perhaps this should be taken out of the hippocratic oath. This doesn’t seem to apply to today’s doctors.

  • alex

    “Where does the line stop. Maybe I dye my hair dark purple and wear it in spikes on top of my head and the doctor doesn’t agree with my choice of hairstyle and refuses to see me.”

    Uh, so? What if your lawyer does that? Or someone else who provides you services? Then you find someone else. Doctors are not slaves and have the same rights to free association as anyone else.

  • Michael Rack, MD

    “I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.”

    “Perhaps this should be taken out of the hippocratic oath. This doesn’t seem to apply to today’s doctors”.

    ————————————————————
    There is no need to take it out of the Hippocratic oath, since it is not in the Hippocratic oath. There is nothing in the original Hippocratic oath about who a doctor accepts as a patient.

  • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

    Rat, for twelve years, I’ve been beaten bloody over the head with my “special obligations to patients” – having gone above and beyond to meet them.

    No one who was supposed to has given a rat’s tail about me . . . my life . . . my needs . . . my well-being . . . my dreams. I’ve been on my own and pretty much SOL. As a primary care physician on the front lines, I’m not alone.

    And THAT is what is WRONG with healthcare reform. And THAT is why you have so many physicians who are angry, frustrated, disgusted and talking back.

  • http://paynehertz.blogspot.com Payne Hertz

    The simple answer to this question is this: would you, as a doctor, mind if a patient with socialist political views came into your office and proceeded to discuss his opinion that the country needs a fully nationalized health system? If no, then you shouldn’t try imposing your views on your patient. It is rather ironic that some doctors complain they don’t get to spend enough time with their patients because of the way they’re reimbursed, and then demand the right to waste what time they do have on proselytizing.

    The patient is paying you for medical care, not your political opinions. Every minute you spend proselytizing your political views is time the patient is not getting what they paid for. This is irresponsible. You have a right to free speech, but on your own time and your own dime, not mine.

    Refusing to treat someone because of their political views should be regarded as unethical. It can take months to get into see a doctor and I doubt most people will appreciate having their time wasted like this.

    I would see a sign like this in my doctor’s door as a pretty good indicator that this is a doctor who doesn’t respect my time or right to have an opinion that is different than his, and I would expect this mindset to carry through to the therapeutic relationship and not just limit itself to politics.

  • Dan Hendersob

    Was it Virchow who said “Politics, which I view as medicine on a grand scale by the way, are just plain too icky to mention with patients!”

    Since Rudy’s triple threat of practice, politics, and pathology, the narrowing of our definition of “doctoring” has shifted the profession from one of community involvement, advocacy, values-driven work, to one restricted to the immediately proximate causes of illness and, primarily, the billable moment.

    Patients look to me for counsel about health policy issues. Who am I to assume that they are too politcally polarized to process and decide on my honest opinion?

    Political rancor should be kept out of the doctor-patient relationship, and, Dr. Cassel’s approach is a non-starter, to be sure. Nonetheless, not telling patients about health policy issues that can help or harm them is hardly different from avoiding smoking cessation counseling because it can get “awkward.”.

    In Virchow’s day, “therapeutic privilege,” the practice of depriving patients unpleasant information, was commonplace. Today, it is anachronism and anathema. No doubt, Virchow would extend his view to point out that sheepishness about questions of critical health policy concerns is simply bad medicine, on a grand scale.

    Dan H, typed by iPhone (pardon any typos)

  • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

    Payne, you’re back to “the patient is paying” nonsense, when the FACT is that a good portions of the time, it’s NOT the patient who is paying. Over the last 20 years, patients have been insulated and/or completely divorced from how much medical care really costs.

    Moreover, the ones coming into the office or ED and “proselytizing” the most about their “right” to “universal (translation: FREE)” are the ones who already don’t pay a cent for it – and suffer no limitations on their behavior in the getting of it.

    There a whole LOT of things going on in medicine these days (on ALL sides of the equation/relationship – particularly the business side) that should be considered unethical but are somehow not . . . not to mention brazenly illegal things going on NOW (or in my case, in the 1998-2001 time frame) that are ignored because they’re not considered “important” . . . because doctors are considered to be “a dime a dozen” . . . cogs on somebody else’s “pursuit of happiness” wheel.

    The high-minded notion that doctors are supposed to keep mum or march like good soldiers while the government tramples all over them is simply un-American and bad medicine for what ails us.

  • luke54

    Since healthcare reform will affect access to care, which will undoubtedly worsen, physicians absolutely have the right to discuss the law and politics in the exam room. The far reaching effects of this ill advised misadventure will affect us all for years to come, and patients need to understand how this will affect their relationship with their physician, and how care will be impacted in the future.

  • http://paynehertz.blogspot.com Payne Hertz

    Payne, you’re back to “the patient is paying” nonsense, when the FACT is that a good portions of the time, it’s NOT the patient who is paying.  Over the last 20 years, patients have been insulated and/or completely divorced from how much medical care really costs.

    Medical care is the number one cause of bankruptcy in the US, most insurance plans have high deductibles and co-pays and often refuse to pay for procedures and drugs, people are forced to stay in dead-end jobs just to keep their insurance, Medicare only pays 80 percent, decent health insurance is a benefit that people have to negotiate and WORK to receive, Obama now has the most desperate people in our society being forced to give money to the insurance industry for substandard “coverage,” 15 percent of the nation’s GDP goes to medical care….I could go on and on…

    But you think patients are insulated from the cost of medical care? Might I suggest you reevaluate your opinion in the light of this evidence, as any true scientist would do?

    Moreover, the ones coming into the office or ED and “proselytizing” the most about their “right” to “universal (translation: FREE)” are the ones who already don’t pay a cent for it – and suffer no limitations on their behavior in the getting of it.

    This sounds suspiciously like a stereotype, and proof of nothing but your contempt for indigent patients. I doubt people go to the ER and pay $2,000 for the purpose of delivering a lecture on universal coverage. Universal coverage is a right when the people of a country decide it is and vote it into law, same as any other right.

    The high-minded notion that doctors are supposed to keep mum or march like good soldiers while the government tramples all over them is simply un-American and bad medicine for what ails us.

    I don’t see where anybody suggested such a thing. You are free to discuss the health system all you like on your blog, among your colleagues, in the media, and to anyone who is willing to listen. But it is unprofessional to do so when someone is paying for your time, whether that is a patient or a health insurance company. You are being paid to deliver medical care, not a lecture on politics. Your focus should be on that.

    • luke54

      Since healthcare reform will limit access to seeing me in my office as the floodgates open and more patients try to get appointments and wait times increase, and as I damn well will be told by government beareaucrats how to practice my profession and care for my patients (yeah, I know what the insurance companies are doing), I have EVERY right to discuss politics with my patients in the office. This is not unprofessional by any means, not when reform can affect the care they receive.

  • Yious

    Worst of all, he admitted later that he DID NOT KNOW EXACTLY what was in the bill….yet he was hardcore against it strictly because a Democrat proposed it

    Moron

  • ninguem

    Rat – “I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.”

    “Perhaps this should be taken out of the hippocratic oath. This doesn’t seem to apply to today’s doctors.”

    The phrase you quoted is not in the Hippocratic Oath.

  • http://paynehertz.blogspot.com Payne Hertz

    I have EVERY right to discuss politics with my patients in the office. This is not unprofessional by any means, not when reform can affect the care they receive.

    While you’re busy explaining your opinion of how government policies you don’t approve of effect the patient’s medical care, you might also want to explain how wasting the patient’s time proselytizing rather focusing on their medical problems effects the “care” they receive.

    If you have a “right” to waste my time proselytizing, I hope you will support a similar right of me not to pay you for wasting my time.

  • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

    Payne, if you feel your time is being “wasted” in any way by your doctor, you are free to find another one. And, as I said before, if you don’t pay your bill, your doctor is free to report you to the credit bureau.

    I’ve spent my entire career working for non-profits – mostly in rural areas. The healthcare reform bill did not, in ANY way, address the underlying reasons why medicine in this society is in the fix it’s in – why the poor remain poor and the medically desperate remain desperate – despite fifty years of social “safety nets” and the welfare state. It’s just a great big BandAid, and a poor one at that.

    It’s not showing “contempt” to discuss these things – in any venue where the discussion might prove productive.

    Robbing Peter to pay for Paul has not worked and there is no reason to believe that it will work in a pretty, newer, much more expensive package. And I would submit that Paul’s “rights” STOP where Peter’s begin. Turning medicine into a “dead-end” job for its practitioners under a government umbrella (which is where we are headed) is NOT a solution.

    And/so if, in the privacy of the exam room, a patient asks me what I think, I’m going to tell him/her, and at this stage of the game (especially after what I was put through IN GOVERNMENT SERVICE) I’m not inclined to pull punches.

    Anything less would be showing true contempt to the patient.

  • http://paynehertz.blogspot.com Payne Hertz

    Payne, if you feel your time is being “wasted” in any way by your doctor, you are free to find another one.  And, as I said before, if you don’t pay your bill, your doctor is free to report you to the credit bureau.

    I would expect the sort of doctor who demands to be paid for proselytizing to do no less.

    I’ve spent my entire career working for non-profits – mostly in rural areas.  The healthcare reform bill did not, in ANY way, address the underlying reasons why medicine in this society is in the fix it’s in – why the poor remain poor and the medically desperate remain desperate – despite fifty years of social “safety nets” and the welfare state.  It’s just a great big BandAid, and a poor one at that.

    And your “solution” is what?

    It’s not showing “contempt” to discuss these things – in any venue where the discussion might prove productive.

    When you cannot refer to patients without stereotyping them as freeloaders that is contempt. It shows just how shallow your alleged concern for patients really is.

    The only people being robbed here are patients, who are forced to pay monopoly rents to a government-enforced medical monopoly which is bleeding the country dry, yet complains endlessly that it is not making enough money.

    Just doing away with the prescription pad alone would save hundreds of billions a year but I’m afraid that will be coming out of your pocket.

    So be careful what you wish for, you might get what you deserve.

    There is a difference between a patient asking for your opinion and you shoving your unwanted opinion down the patient’s throat unsolicited. Most people with any degree of manners and couth learn not to talk about religion or politics with others unless they are sure the conversation is welcome.

  • BD

    >>if you don’t pay your bill, your doctor is free to report you to the credit bureau.>>

    With the exception of the co-payment I pay prior to visits, my insurance company pays physicians, regardless of whether the physician addresses my problem or wastes limited appointment time ranting about Obama and Nancy Pelosi. So don’t worry… you’d be paid… for one visit.

    Of course, in addition to immediately discontinuing care with a physician unable to keep her mind on practicing medicine, I’d complain to the insurance company and pressure to have her removed from the list of “preferred providers”. Because unlike a harmless sign on the door, patients expecting a competent consultation and instead receiving a political diatribe are being harmed by delays in care. Similarly, if I were a woman seeing an OB/GYN for birth control advice and received a lecture on the evils of contraception, I’d complain to the insurance company about that, too.

  • stargirl65

    “regardless of whether the physician addresses my problem or wastes limited appointment time ranting about Obama and Nancy Pelosi”

    Physicians for the most part are not paid by the minute by insurance companies. They are paid by the medical complexity of the visit which is calculated by a complex set of rules. So whether or not they spend 3 minutes or 30 minutes completing the required number of elements for the visit, they get paid the same. So you are NOT charged for the time they spend talking politics. This is on their dime.

  • BD

    >>Physicians for the most part are not paid by the minute by insurance companies.>>

    Didn’t say they were. I’m well aware how they’re paid.

    >>They are paid by the medical complexity of the visit which is calculated by a complex set of rules.>>

    IOW, they’re paid based on how well they or the staff member responsible for coding can maximize payment by the insurance company.

    >>So whether or not they spend 3 minutes or 30 minutes completing the required number of elements for the visit, they get paid the same.>>

    In the opinion of most physicians, who determines the “required elements” for a visit: the insurance company, or the patient?

    >>So you are NOT charged for the time they spend talking politics. This is on their dime.>>

    It’s a waste of my time. As I doubt I can bill a physician at my hourly rate, I’d still lobby the insurance company for the physician’s removal from their preferred provider list.

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