Tuesday, November 07, 2006

Thoughtless treatment--A rant against "industrialized" medicine

Parental guidance warning: This post is rated PG-13. It includes details that you may deem inappropriate for, and/or not wish to have to explain to, a young child. So this would be a good time to tell your 10-year-old to stop reading over your shoulder.






The story from the patient's point of view

(Unspoken thoughts after seeing the doctor exit hurriedly from the examining room and close the door)

Doctor, I appreciate the fact that you used gloves and gloop when you examined me. But you've left me lying here leaking lubricant. Do you seriously expect me to get up, get dressed, and go to work in this dubious condition? Couldn't you have left me something with which to clean myself up? Tissues? Paper towels? Anything??!


Well, there's always this handy-dandy paper gown, the one that ripped clean down the middle when I tried to put it on. For lack of an alternative . . .

The story from the doctor's point of view

(Overheard on the way out of the office)

Doctor to front-desk staff: "This is ridiculous. I can't do this. I don't care what they tell you, I can't see a patient every 10 minutes. I need at least 15 minutes. It's not fair to the patients."

Assembly-line medicine is a lose-lose proposition.

Granted that I've been known to joke with health-care professionals that one of the hazards of the profession is that no one ever wants to see you, but the perception, given by time limits on office visits, that health-care professionals don't want to see me, either, is a bit distressing.

As for doctors, what's the point in spending a decade or more paying back the loans for medical school if you aren't being allowed enough time to help people get and/or stay well?


Blogger PsychoToddler said...

I agree with your doctor. I need at least 15 minutes with a patient. And I leave 30 for pelvics. You need to have time to talk and listen to your patients.

FWIW, there are many forces acting on doctors to compress the time they spend with patients. Economics is a big one--primary care doctors get paid very little for their time, and are often being reimbursed even less than what they charge by insurance and government programs. Medicaid pays 1/3 of what my usual charges are, and commercial insurance now shifts about that much onto the patient in the form of a "co-pay", which many patients balk at and often goes uncollected. So even with commercial insurance, the doctor may only recoup about 1/3 of a $75 visit. In order to make up for this, many doctors try to see more patients.

In addition, employed physicians may be required to see X amount of patients per hour, and they may have little recourse if they wish to remain employed.

Finally, don't forget that fewer and fewer people want to go into a low-paying field like primary care, leaving a relative shortage of PCPs around, and patients frequently need to be seen on a "same-day" basis for acute illnesses, leading to double bookings and squeezed appointments.

Good luck.

Tue Nov 07, 10:13:00 AM 2006  
Blogger Shira Salamone said...

I agree with my doctor, too, which is part of the point of this post. The way that medical care is structured, these days, is a no-win situation for everyone. Patients feel like components on an assembly line, and doctors feel like machines on a timer.

Then, too, from what I can see as a patient, the costs of running a private practice must be astronomical. It's rare to see a doctor with only one administrative-staff person these days--there's so much paperwork to be done, so many phone calls to make to get information, authorization for procedures, etc., that a doctor's office needs a veritable army to administer. I imagine that it's relatively rare, these days, for a primary care physician (unless I'm mistaken, that category includes general practioners, family practitioners, and internists) to practice without at least one partner, just because the cost of running an office is so high and the profit is not.

Medicine is not the easiest way to make a living these days, and both the patients and the doctors pay the price.

Tue Nov 07, 07:51:00 PM 2006  

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