Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

On-demand doctors: Are we becoming medical waiters?

Annie Moore, MD, MBA
Physician
March 10, 2020
56 Shares
Share
Tweet
Share

Seven years ago, I vividly recalled a patient saying, “It needs to be as easy to schedule with you as OpenTable.” For most health care systems, this request is now a reality. Yet, how far has the restaurant metaphor moved into patient expectations?

Recently on a closed Facebook physician group, a post discussed how to convince patients they do not benefit from antibiotics when they have a respiratory virus. One theme of many comments prompted this article:

“We need to prescribe antibiotics to not receive poor customer service star ratings.”

In the age of online star ratings and system incentives aligned with those ratings, are physicians to become the new “medical waiter” for our patients, even when the “order” is not in the patients’ best health interest? Or, are physicians, especially those in ambulatory primary care, to remain as we are trained, as health care advisors, coaches, consultants, and coordinators for our patients’ medical concerns?

Recently, several days after a patient was seen by one of our NPs for her viral bronchitis, I received a portal message insisting on opioid cough syrup. I prescribed benzonatate capsules. She responded with both an angry phone call and portal message to the office. I reminded her how I had helped guide her through her recent breast cancer care, for which she is very pleased, and that I always have her best health in mind. The next day, after the benzonatate had worked well, she had slept and was rested, she sent an apology portal message.

Another newer patient requested to have her labs drawn for a repeat thyroid level due to a recent decrease in her thyroid dosage based on very low TSH. I placed the TSH order. She then insisted that I order an extensive panel of free T4, free T3, total T3, etc. After observing that she would not be dissuaded and hoping to avoid an unpleasant confrontation, I placed her “order” for the more extensive thyroid panel. Results were all normal, except her TSH remained very low. I recommended we continue to lower her thyroid dose.

Again, she sent several negative portal messages, stating I was out of date, she knows her body, she is hypothyroid and needs a thyroid medication increase, rather than a decrease. I volunteered to speak with her by phone to deescalate the situation. I used my integrative medicine reflective listening skills for 15 minutes, then advised her that I would not be able to increase her thyroid dosage due to her very low TSH and offered to refer her to a holistic endocrinologist. She hung up on me. Filling her first “order” did not alter the outcome of dissatisfaction.

We have all experienced the demanding patients, whether looking for opioids, antibiotics, sleep medications, hormone therapy, imaging, or referrals. The patient is convinced that they are more informed in what they need for their health than what our training, experience, and evidence-based medicine would recommend. With the advent of EHR patient messaging, we now receive online portal “orders” from patients for these services without a medical assessment other than the patients’ self-diagnosis. What has changed since most of us were trained, is that now, not promptly filling the “patients’ order” can result in negative online reviews. As an internist, I find myself debating the values of patient satisfaction and shared decision making versus values of evidence-based medicine and our duty to reduce unnecessary health care costs.

For our annual reviews, in my large academic health care system, we can receive up to 12 points for meeting benchmarks in health care quality indicators of hypertension, diabetes, and preventive screening. We receive two points if we are in the top 5 percent of patient ratings for the general internal medicine division and one point for the top 20 percent. There are no points allotted for cost containment, such as limiting unnecessary referrals or imaging, antibiotic, opioid, or other controlled substance prescribing stewardship or evidence-based care in managing common conditions other than hypertension and diabetes.

In this final decade of my now 35-year career as an internist, I am grateful that I experience a “good tired” after the 12-14 hour day required to see patients and complete the electronic in-basket.

Part of my “good tired” comes from the satisfaction that I feel content with my work that day; I have lived my values of helping patients, caring for them and confident the patients are receiving excellent medical care from our clinic, whether online portal messaging, telemedicine visits, phone calls or face-to-face visits.

I am pleased I have been able to adapt to all of the changes in health care over my career and can still work hard.

My “good tired” would be lost if I became a “waiter,” spending my day filling “orders” from patients that may not help and potentially harm them. My 4.75/5.0 rating did not qualify for any “points” for my annual review, and yet I find the patient comments to be supportive and meaningful. I will remain a health care investment advisor for my patients, in a shared decision-making model, with the hope that, over time, they will find the increasing trust that this is for their best health.

Annie Moore is an internal medicine physician.

Image credit: Shutterstock.com

Prev

Love in the time of coronavirus

March 10, 2020 Kevin 0
…
Next

What prevents coronavirus? A pathologist grades COVID-19 precautions.

March 10, 2020 Kevin 1
…

Tagged as: Primary Care

Post navigation

< Previous Post
Love in the time of coronavirus
Next Post >
What prevents coronavirus? A pathologist grades COVID-19 precautions.

More by Annie Moore, MD, MBA

  • A physician leaves concierge medicine after 13 years

    Annie Moore, MD, MBA

Related Posts

  • America trains enough doctors: Redefining medical supply and demand

    Rushi Nagalla
  • Digital advances in the medical aid in dying movement

    Jennifer Lynn
  • We need more doctors. International medical schools can provide them.

    Richard Liebowitz, MD
  • More physician responsibility for patient care

    Michael R. McGuire
  • The health care system will cause its own physician shortage

    Advait Suvarnakar and Aashka Suvarnakar
  • Why do doctors who hate being doctors still practice?

    Kristin Puhl, MD

More in Physician

  • The heart of a Desi doctor: Balancing emotions and resources in oncology

    Dr. Damane Zehra
  • The Iranian diaspora’s fight for liberty: Overcoming challenges in the largest women’s rights movement of our century

    Montreh Tavakkoli, MD
  • The harmful effects of shaming patients for self-education

    Maryanna Barrett, MD
  • The power of self-appreciation: Why physicians need to start acknowledging their own contributions

    Wendy Schofer, MD
  • Skydiving and surgery: How one doctor translates high-stress training to saving lives

    Alexandra Kharazi, MD
  • Don’t be caught off guard: Read your malpractice policy today

    Aaron Morgenstein, MD & Laura Fortner, MD
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
    • The psychoanalytic hammer: lessons in listening and patient-centered care

      Greg Smith, MD | Conditions
    • The heart of a Desi doctor: Balancing emotions and resources in oncology

      Dr. Damane Zehra | Physician
  • Past 6 Months

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • The heart of a Desi doctor: Balancing emotions and resources in oncology

      Dr. Damane Zehra | Physician
    • Safe sex for seniors: Dispelling myths and embracing safe practices [PODCAST]

      The Podcast by KevinMD | Podcast
    • Overcoming Parkinson’s: a journey of laughter and resilience

      Cynthia Poire Mathews, FNP | Conditions
    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
    • Maximize sleep efficiency with stimulus control

      Pedram Navab, DO | Conditions
    • The Iranian diaspora’s fight for liberty: Overcoming challenges in the largest women’s rights movement of our century

      Montreh Tavakkoli, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 4 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • How This Doctor Found Purpose After a Devastating Injury
  • House Lawmakers Squabble Over HHS Budget
  • Infant Formula Crisis Exposed FDA and Industry Failings, Lawmakers Say
  • Building Vaccine Trust Among the General Public
  • Is It Business as Usual for the Drug Industry?

Meeting Coverage

  • Phase III Trials 'Hit a Home Run' in Advanced Endometrial Cancer
  • Cannabis Use Common in Post-Surgery Patients on Opioid Tapering
  • Less Abuse With Extended-Release Oxycodone, Poison Center Data Suggest
  • Novel Strategies Show Winning Potential in Ovarian Cancer
  • Children Do Well With Fewer Opiates After Surgery
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
    • The psychoanalytic hammer: lessons in listening and patient-centered care

      Greg Smith, MD | Conditions
    • The heart of a Desi doctor: Balancing emotions and resources in oncology

      Dr. Damane Zehra | Physician
  • Past 6 Months

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • The heart of a Desi doctor: Balancing emotions and resources in oncology

      Dr. Damane Zehra | Physician
    • Safe sex for seniors: Dispelling myths and embracing safe practices [PODCAST]

      The Podcast by KevinMD | Podcast
    • Overcoming Parkinson’s: a journey of laughter and resilience

      Cynthia Poire Mathews, FNP | Conditions
    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
    • Maximize sleep efficiency with stimulus control

      Pedram Navab, DO | Conditions
    • The Iranian diaspora’s fight for liberty: Overcoming challenges in the largest women’s rights movement of our century

      Montreh Tavakkoli, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

On-demand doctors: Are we becoming medical waiters?
4 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...