A word of warning for those looking for new doctors

Gertrude wasn’t able tell me herself. She was 90-years-old and moderately demented. It was her daughter who called. She pleasantly greeted me as I picked up the phone.

We had a good working relationship, Gertrude’s daughter and I. We navigated a heart attack and stroke, multiple hospitalizations, and many discussions concerning end of life care. Gertrude was well taken care of. She was lucky enough to have a group of helpers who were under the doting, watchful eyes of her daughter.

In fact, the last pneumonia and urinary tract infection were both treated successfully at home without need for hospitalization. I guess I took it for granted that Gertrude would be a part of my new practice. I had no doubt she could afford it. So I assumed that this would be a phone call about some pressing issue or another.

But I was wrong.

Gertrude’s daughter called to thank me for my service, and inform me that her mother was moving to another office. Her voice was smooth and confident with a tinge of pride as she gushed about the first visit that occurred earlier that morning. Although saddened by the realization that I would never see Gertrude’s warm if not vacant smile, I tried my best to be gracious. I offered to have my staff forward the medical records, and wished them well.

A few days later, I received a letter from Gertrude’s new doctor. He thanked me for the referral, and enclosed a copy of his note. My hands started to shake as I read the assessment and plan.

Gertrude, my 90-year-old demented woman, was referred for a screening mammogram and a colonoscopy. To add injury to insult, he ordered full lab work including a cholesterol panel.

No matter how depressed I am at this unbelievably inappropriate care, I can’t complain. It was I who changed things up on Gertrude. I have no right to be indignant. But I would like to offer a word of warning for all those out there looking for new doctors.

Buyer beware!

You can no longer be a passive force in your own medical care. Before you race into the bosom of a new provider, do the research. After each visit, question each new prescription and lab order.

And above all else, verify.

Jordan Grumet is an internal medicine physician and founder, CrisisMD.  He blogs at In My Humble Opinion.

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  • ninguem

    I’m not up to speed, I assume you’ve gone to some type of direct pay practice?

    I assume the patient/family did not want to pay, and so went to a practice that accepts Medicare?

    Perchance, did your patient move to a “big box” hospital-owned practice?

    Meaning, if that’s accurate, that the practice adds on “facility fees” about doubling the Medicare payment, and of course the lucrative revenue stream that comes with the mammograms and colonoscopies.

    • Dr. Drake Ramoray

      I agree with this line of questioning. I am also interested if the new doc ordering the above testing has to do with computer generated algorithms for PQRS purposes. Do the primary care goals take into account age (upper limit) for this testing?

      As an Endo I don’t know for these primary care metrics but I do know that an upper age bracket does not apply for diabetes This is despite the fact that most Endo’s will tell you in older patients we tolerate a higher A1c than the typical patient, usually to avoid hypoglycemia. I would still get dinged for the uncontrolled diabetes.

      The cost and facility fees is an important question, but I’m also curious as to whether or not the the patient is now in a large corp med algorithm driven practice. I suspect that they are, and in that case the author of this post should redirect at least some of his unhappiness to the changes to the medical system driven by bureacrats as opposed to this individual physician (not that the doc in question is without fault).

  • Suzi Q 38

    How sad.
    It is tough when it is all about “the money.”
    My 89 year old mother is on Medicare. We do, though, use her money to pay for whatever healthcare or physician is preferred or needed. We figure that she earned her money, and it should be spent on her for whatever she needs. We are careful with her money, just in case she makes it to her 100th birthday.
    Would you be willing to call her daughter and ask why?
    After all, you did receive the notice about the mammogram and cholesterol panel from her new doctor. What are her thoughts on this new treatment modality?
    I would let her know your treatment style, and how in the long and short run, it will cost the patient and her family less, yet not make her subject to such unnecessary intrusive testing at her age. Isn’t there a copay for Medicare and various tests?

    Tell her that you still value them as your patients and liked the prior teamwork displayed during the patients various health challenges.

    If they go to this new doctor and things aren’t going well as planned, to please return to your practice.

    I would be appreciative of a physician who wanted us to stay. Maybe you can work something out and find out what her objection to you and/or your practice was, if anything. If you uncover what the problem is, you can get some answers to your questions about “why.”

  • LeoHolmMD

    This story should make everyone sick. Medicare will gladly pay for those tests, which should make everyone sicker.

  • rtpinfla

    There is a good chance that the family likes the new doctor because he is “doing stuff”. I’ve had more than one patient walk because I recommended against “doing stuff” that was not appropriate. It’s frustrating but as long as there is a doc down the street that will gladly order tests and procedures it will continue to be an issue.

    • goonerdoc

      Amen to that

  • http://drwhitecoat.com/ White Coat

    Your buyer beware warning will fall upon deaf ears until the system changes.
    Gertrude and your other patients would be a lot more appreciative of your services if Gertrude and the other patients had skin in the game.
    Your post doesn’t specifically state so, but it is likely that Medicare paid for all of the tests that the new doctor ordered. The idea of getting “free” health care appeals to everyone and encourages people to extract as much “free” care as they can. Look at how many patients want to get extra services and testing done at the end of the year after their insurance deductible has been met. And look at how many patients won’t have a test performed if insurance doesn’t agree to pay for the test in advance. No pre-approval = no test.
    The whole “best healthcare that someone else can pay for” mindset is bankrupting our country.
    If patients were held responsible for payment of all or some portion of testing performed, two things would happen. First, there would initially be a lot less testing being done. Then, the cost of the testing would eventually decrease as market forces began to take hold. Look at all of the innovations and downward cost pressure on free market medical areas such as cosmetic surgery and Lasik procedures.
    Our current medical system is heading in the opposite direction. That should be the thing that patients are most concerned with.

  • buzzkillerjsmith

    Good comments all.

    There is no perfect way to solve this problem. WC is right that some skin in the game would help. But that cuts both ways. We all see many patients who don’t receive appropriate care because they can’t afford it.

    Dr. Drake points out the insanity of taking clinical judgement away from physicians. With the best of intentions, the myopic subspecialty societies have let their recommended care guidelines go absolutely ape. Note that I don’t blame individual subspecialists, many of whom are victims of this insanity as well. Yet I do take a dim view of many individual urologists, at least the ones around here. with their disgusting promotion of PSAs. Ka Ching!

    Primary care has its own insanities. Turning small practices into PCMHs anyone?

    As rtp states, doing stuff is often the wrong thing to do and patients, or their families, are can be co-conspirators in this. And the lawyers, with mouths watering, play a huge role.

    Solution, lousy but better than what we have now: Put the business of medicine mainly in the hands of us primary docs who see the whole picture and who will protect people from inappropriate care and who will be tasked to do so. And pay us to do it by putting us on salary mostly, not completely. And have us “owned” by ourselves and supervised by other physicians of our own specialties in doctor-owned groups. You all will sputter with indignation at this, as well you should. It is not a perfect solution. I’m not reinventing the wheel here. See the models other advanced nations use. Try to admit people to medical school who are budding professionals, not budding business greedheads. Easier said than done.

    Group Health and Kaiser are models here, although much smaller versions are preferred.

    I hated working at Kaiser, a cog in a machine that was way, way too big. There is no perfect solution here.

    CorpMed is a medical failure despite this society’s free-market silliness. The free markets works for wheat more of less but not for medical care. Hear me.

    • rbthe4th2

      Great post. Agreed w/parts, disagreed with parts, but think hits a lot of nails on the head. At least it tries to address various options w/a solution.

  • dontdoitagain

    Wow, I want YOU as my doctor! My doctor wanted me to go for the same “colonoscopy” and “mammogram” screening as shown above. I don’t see much use for it as I’m asymptomatic and there is lots of downside with these tests starting with Versed/Midazolam. I did do the cholesterol screening and my doc wanted me to take statins for my not quite high cholesterol. Do I want the side effects of statins for cholesterol that is within limits? Nope. Will I subject myself to surgery? (g/a + Versed + $5,000 deductable and a copay) Not for the doctor… I think of a lot of these tests as a witch hunt. Seek and ye shall find [a billable procedure].

    • ButDoctorIHatePink

      , I have end stage breast cancer, and yet my insurance company insists that I get a screening mammogram yearly, not a simple thing to do without breasts. I continually get the letters and reminders, despite phone calls, etc. Cancer has already spread to my liver. Plus, despite the fact that they pay for PET scans every three months, and I had c-diff colitis, they still want me to have colonoscopies, which will never, ever happen. In my view, they have found a sufficient amount of cancer, I’m forever in treatment for it, so why on earth do we keep looking for more?

      It’s ridiculous and it’s clear that one hand doesn’t know what the other is doing. It’s all just popping up as a check box that my doctor can’t make go away if I don’t have the screenings.

      Which I don’t. Have the screenings, obviously. So the box is his problem. But still, insurance companies play a role in this insanity too. I have no doubt that I have cost them over a million dollars, (and I have gotten fantastic care from all my doctors and from the insurance company which has approved every treatment recommended, including liver resection). Yet they seem to have no idea what goes on with me. It’s crazy.

      I just hope the daughter understands that she can say no to these things. I would not submit my 90 year old mother to any of these screenings either.

  • querywoman

    I’m almost speechless, or “typeless.” What was the deal about your new practice? Did you go to concierge or what? You said you thought she could afford it.
    Why did this doctor even bother to tell you what he was ordering? Hmm, maybe he violated HIPAA for that. You didn’t refer her to him, either, so his letter was a lie. Maybe you could file a complaint against him.
    Does he have any online reviews? Any way to find out more about him, just out of curiosity?
    He sounds like a money-grubbing, arrogant jerk.
    I hope poor Gertrude doesn’t suffer from unnecessary invasive procedures.

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