Comments on: I Work for a Living

By: Genevieve Fire

Genevieve Fire — Thu, 11 Jun 2009 22:59:37 +0000

I think I’m at the opposite end of the spectrum as far as protocols for follow-up care are concerned. After having a pulmonary vein isolation ablation last August for long-term A-Fib and A-Flutter, I still do not know when or if I need to see the diagnosing cardiologist on any regular basis. I’ve only seen him 3 times since the original diagnosis and not once has he indicated a follow-up plan (including after being put on arrhythmia medication and warfarin). The last time I saw this doctor was 7 months after the procedure, at my initiation, due to shortness of breath and persistent chest pain. At the end of that appointment, as usual, there was no discussion of follow-up. I guess by that time I should have known to be pro-active about this, but hope springs eternal… As an engineering consultant and very adherent patient, I wonder if this the way a HMO/clinic doctor saves time and money. Your thoughts?

By: Rob

Rob — Mon, 08 Jun 2009 19:19:01 +0000

You should be cynical about this. I am not sure why she would refill your medication for five years without caring if it was a. doing good, and b. doing harm. At the very least, I check a lipid profile and liver tests once a year – most of the time I do it every 6 months. Why? Because it is what is best for the patient.

By: melissa

melissa — Mon, 08 Jun 2009 18:51:32 +0000

I read your blog all the time. First time I’m leaving a comment.

Just so you know, my doctor prescribed me Lipitor at least 5 years ago. She insists I come in to have my liver checked. She says she actually needs to see me and touch my body in order to check it efficiently.

She has only checked it twice, one of those times being because I asked her, “Didn’t you say I needed to come it so you could check my liver?” This makes me think she only wants to drum up some money.

By: Aaron B. Hicks

Aaron B. Hicks — Thu, 04 Jun 2009 18:42:20 +0000

Aha, it does seem that I missed the point. Thanks for clearing that up.

And I agree. It takes two to tango and physicians need to be mindful of the fact that patients have schedules, lives, and commitments too. In many cases, the “do this now” / “my way or the highway” mentality isn’t conducive to high quality patient care.

By: Ken O

Ken O — Thu, 04 Jun 2009 12:10:43 +0000

That’s a fair point, but doesn’t actually address mine even if I lived in the USA. I live in Scotland, where the basis of PHP remuneration is a capitation fee (or fixed salary for small rural practices like the one I’m in).

My point was that sometimes patients have to do stuff at times which don’t fit a schedule which is drawn up on the basis of “we need you to do this now”. I wasn’t complaining that I had to travel to the surgery; I was complaining that I was told “you need to do this now” at a time of year when I honestly couldn’t spare the time I needed to do it for the next month.

By: Aaron B. Hicks

Aaron B. Hicks — Wed, 03 Jun 2009 18:11:52 +0000

In order for primary care physicians to make a living, they have to see their patients during occasional office visits. Doctors aren’t payed by insurance companies to talk on the phone, consult via email, or to write refills for prescriptions.

The problem lies in the reimbursement system. Only paying physicians for office visits blocks innovation in patient-physician communication. Why did you have to travel to see your physician? Because, in the interest of delivering excellent patient-centered care, doctors have no other viable financial alternative to conducting office visits.

By: Ken O

Ken O — Wed, 03 Jun 2009 10:31:35 +0000

Can I just put the other point that most of you PHP types seem to be ignoring. “I work for a living” can mean that, whether because you won’t get paid for medical visits, or just because of the nature of your job, you can’t always afford (time, never mind money) to attend a doctor’s appointment. As a case in point, I was recently asked to make an 30min appointment, being asked at close of play Thursday, I was on vacation away from home for 2 weeks, then when I got back I had to be in the office all day the next 2 because my boss was on vacation! To be at the doctor’s for a 30 min appointment (assumes surgery is on time) means taking about 90 minutes out of my day including travel!

By: Victoria Powell

Victoria Powell — Wed, 03 Jun 2009 03:39:30 +0000

As a nurse I am guilty of trying to get refills for maintenance medication without a visit. I am really busy and feel that as a nurse I know what I need. Thank you for reminding me that it is more than just the obvious. You are taking a risk too and you also need to feed your family. Thank you for helping me see outside of my own needs, wants, desires. Great post.

By: MOCKBADOC

MOCKBADOC — Wed, 03 Jun 2009 02:08:59 +0000

I feel you, man. I run into this all the time. It’s a catch-22. I can do the wrong thing for the patient and get on their good side, or I can do the right thing and be accused of being a money-grubbing creep.

And how, exactly, did we allow ourselves to be made to feel guilty for plying our trade? I guess we’re supposed to give our services away for free. People need groceries, too, and I don’t hear anybody clamoring for the government to “negotiate” their fees for lettuce and tomatoes at the point of a gun like they do with us. Well. At least not yet.

Once our profession is decimated in the interest of ensuring health care as a “right”, somebody else is bound to be next.

Sorry. I guess I’m just a bit bitter. Still $200K in debt and Ted Kennedy is promising to destroy my family’s future by the end of July. May the mob get what they want…and may they get what they are willing to pay for.

Demoralized,
MOCKBADOC.

By: Rob

Rob — Wed, 03 Jun 2009 01:45:17 +0000

Isn’t that what both you and I are trying to do? I try to do it in my blogging and in the exam room. You certainly advocate educated and empowered patients. This guy is in the minority (thankfully), but is representative to me of a mindset that thinks medicine is simple and straightforward. I really believe he thinks he understands is blood pressure better than he really does.