A $20 co-pay and the value of an office visit

‘Tis the season for upper respiratory infections, and since I couldn’t tell if what I had was garden-variety crud or crud that needed antibiotics, I went to the doctor. I handed over my $20 co-pay at the reception desk, where they have an electric candle burning, a tradition when a soldier is off to war. Their soldier is my family doctor, who’s in Afghanistan as a colonel with the Army Reserve. They’ll keep the flame burning until his safe return.

My doctor is in his early 60s; the one I saw in his absence must be in his 30s but it’s hard to tell. From my mid-50s vantage point, people in their 30s look like they’re in their 20s, and people in their 20s look like they’re 12. He noticed my Kindle and wanted to know if I got it for Christmas. I said yes and he told me he got an iPad although he had been looking at Kindles. He downloaded Treasure Island, which I had thought about downloading. We compared notes on what you can get on each platform, and then it was time to get down to business.

I dutifully reported how my week-old crud had escalated from clear runny stuff to green globs and wondered if that change in volume and color meant I was working on a secondary bacterial infection. He said studies have shown that color or lack thereof isn’t really helpful in determining whether it’s bacterial. He said they watch for other symptoms.

He asked about presence or absence and timing of coughing, headache, fever, chills, nausea, looked in my nose and throat and listened to my lungs. He said my symptoms indicated drainage issues and proceeded to draw a nose and sinuses from the front and side. (I love it when doctors draw. My oncologist has drawn breast ducts, and my surgeon has illustrated breast surgery. It always reminds me of when my family doctor told me the word “doctor” comes from the Greek for “teacher” and that there’s a lot of teaching involved.)

He said I didn’t need antibiotics, which was fine with me although I know some people feel like it’s wasted money and time if they don’t get a prescription. One friend said it was too bad they couldn’t just call something in, and another asked if he gave me anything.

To answer that question, what did I get for my $20? I got knowledge. Next time I’ll have a much better idea of what to do, when to call and what to take because let’s face it, even over the counter choices can be confusing. He gave me a care list that had some things I was doing already and a couple that never would have occurred to me.

I also got faith in the next generation of doctors. It won’t be long before every doctor I see will be a lot younger than I am. This doctor, and the young woman MD I saw during my doctor’s last tour of duty in Iraq, made me realize that won’t be a bad thing. I’m impressed by their knowledge and the way they communicate.  Knowing that young people like them are going into primary care gives me hope.

All things considered, my $20 co-pay was a bargain.

Jackie Fox is the author of From Zero to Mastectomy: What I Learned And You Need to Know About Stage 0 Breast Cancer, and blogs at Dispatch From Second Base.

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  • http://www.MDWhistleblower.blogspot.com Michael Kirsch, M.D.

    Great piece, Jackie!

    • http://secondbasedispatch.com Jackie Fox

      Thank you, Michael!

  • Muddy Waters

    Consider it another way – if you need a lawyer (with less years of training than a doctor), you are going to pay $200+ per hour. There are no co-pays. Patients need to keep perspective on what they are paying for.

  • Alex Mari

    As a family physician, I cannot tell you how delighted I am to read your thoughts in this post. Too many people expect their physician to give them something to make them better for self limited conditions and therefore feel that their money is not well spent when they leave the office without their prescription for antibiotics or whatever they expected to receive. Unfortunately, this is partly due to those physicians who do not take the time to educate their patients and freely over-prescribe.

  • pcp

    Thank you. I’m sure your doctors’ eyes light up when they see your name on their schedule.

  • Taylor

    This is how I feel when I see my internist pcp too. She is careful with her prescription pen and I appreciate that. She always explains the possible diagnosis and gives me many recommendations on how to improve my symptoms. I always feel my copay is money well spent when I see her.

  • Max

    Many patients feel like Jackie does. And then, when insurance changes forces them to see another provider, out of network, what happens? I’m sorry, Doctor Friend, you are out of network and my insurance doesn’t cover your visit and to see you now is cash and $75 for a basic visit. You’re not worth that to me, Dr. Friend. I’m amazed at what happens between $20 and $75. It may as well be $100000.

    • pj

      Frustrating but often true!

  • http://www.aneurysmsupport.com/ Mike

    Great article Jackie, that I very much enjoyed reading.

  • http://secondbasedispatch.com Jackie Fox

    Just want to thank everyone for your comments. The insurance comment is interesting. I could and would pay more out of pocket to see someone I like and trust. I know not everyone can afford to do that. (I remember what it’s like to reach the end of the month with $5 in your bank account.) It’s too bad the ones who can afford it but won’t do it don’t value their relationships.

    If you don’t have a relationship, I can see cost being more of a factor. It’s too bad though, I’ve talked about this before on kevinmd (“I”m a patient, not a consumer”, but I hate seeing the doctor-patient relationship reduced to a business transaction.

  • pao

    Thank you Jackie! it’s so refreshing to hear a patient’s perspective on a very difficult issue we all face daily. Just another thought,the caring approaches of evidence -based,sound patient education and empowering also is found in care provided by nurse-practitioners. The next generation of caring,knowledgable primary care providers is often just not Physicians but inclusive of Nurse Practioners and Physician assistants. Excellent points Dr.Mari re: the issue of marketing & overly ,inapproperiate over-prescribing whether it is antibiotics ,aniexty ,ADHD ,weight loss or pain medications. it gradifying that some patients appreciate competence vs.fast food “fries”approaches.

  • Heart Patient

    Thank you Jackie. I’m in agreement with many of your comments. I’m always impressed with the Cardiology fellows in my Cards office, and always try to schedule my appts when I know they will be there, even though they “turn over” each year. I’ve really learned much from them. I am grateful for the great physicians I have (seems to be more health challenges as I get older and the list of physicians gets longer), and always learn from them. I’ve not had to go out of network yet, but would probably do that if necessary.

    I truly appreciate physicians’ worth…I’ve always worked in hospital finance (not the billing piece), and don’t think they are overpaid, as many people do.