Under the way this would apply, basically, anything that is diagnosed whilst you’re covered would still have to be covered until cured on the same basic terms. Certainly I think this could be made to stop insurers dropping patients who develop a disease, and over-riding a “this is only coverd until [age]” clause, when treatment normally only commences after that age.

Trisha: You are not the one I am really referring to about negative comments on docs. If you read other comments, they seem to imply pretty bad things about docs as a group.

When I see people who are acting in ways I don’t understand (like someone who does drugs, cuts themself, or is bulimic) I look for the reasons they act that way. Too often people jump at a “moral” answer (they are “bad” people) and not look for reasons (such as a history of trauma or sexual abuse). It is comforting to us to think that we would not do things so bad, so saying the person is “bad” (unlike us) keeps us safe. But to really help, we have to understand that people get the way they are for reasons.

The same thing can be said for all sides of this issue. Doctors behave like they do because of the system they are in. I speak mainly for primary care doctors, but I often have to bite my tongue when I read some stuff about “greedy doctors” and docs who “don’t care about patients” or “never listen.” These are rants to be sure, but they are not constructive toward engaging doctors – which is something the patient community needs to be doing. Don’t ignore our faults, and don’t deny there are bad docs; but if your goal is to fix things, engaging docs is the best route.

If you don’t believe me, read the other comments on this. There are some very harsh things. Certainly equating docs/patients with insurance execs/docs is pretty much like saying patients think docs are evil (because docs HATE insurance execs). The analogy may be appropriate, but it still offends, so your point is lost on the listener.

I REALLY offended a pharmacist with my previous rant on e-prescribing. I don’t think all pharmacists are idiots (only the one pharmacy gets it wrong), but if I want to engage pharmacists, ranting has to go on the back seat.

Yes, social workers don’t understand what it is like to be poor, but they understand the culture of poverty in ways the poor do not, and anyone who wants a good picture on poverty should talk to them as well as talking to the poor. Both would be extremely valuable. That is my whole point.

Thanks for engaging this discussion everyone! It is very valuable and I will probably distill the comments on this and make it into a post of its own.

Excuse me, Rob — but you are putting words in my mouth. You say, My problem with all of this is that patients don’t like being talked down to by doctors, but it seems a lot of comments here and elsewhere are returning the favor.

I have not talked down to anyone! You are the one who used the terms “insensitive doofuses” and “idiots” – not me! And I certainly never said doctors didn’t give a damn.

A doctor can be the most caring and effective practitioner on earth, but that is NOT the same thing as understanding a patient’s point of view.

To use your metaphor, a social worker may do her job extremely well, but that doesn’t mean she truly understands what it’s like to be hungry, or live in a homeless shelter. I also think that to suggest she would understand, would be insulting to those who ARE hungry and who DO live in homeless shelters.

You are an exception to the rule, not because you give a damn, but because you listen and engage. That means you understand a patient’s point of view better than most docs do. Even still — you have never (metaphorically) been hungry or lived in a homeless shelter.

Back to what Mary said — all perspectives are important.

Retain Insurance
I want to be able to keep my insurance at a reasonable price. I don’t want to be forced onto a different plan (or dropped) when the insurance company stops making money off of me.

Real Coverage
For the most part, my insurance is good. However, some things are covered only in theory, not in reality. Example: according to my plan booklet, speech therapy is covered. Since many speech issues are developmental, therapists often recommend waiting until children reach age seven or eight to see if they outgrow the problem. I waited. And waited. Finally, our doctor wrote a referral. And I learned that there’s more to it than the plan book we received, and that the fine print (in a file in some obscure closet) says “only until age six.” This means that speech therapy for children is not really covered. At all. Insurers can write whatever they want in a policy, but they shouldn’t be able to claim they’re offering coverage for something when they really aren’t.

Malpractice Reform
I want my doctor to be free to do what is best without having the threat of a frivolous malpractice suit hanging over his head. If premiums for malpractice insurance weren’t so high, doctors would have more take-home pay without having to generate more income. When there is a physician shortage, obstacles such as this need to be addressed.

Fair Pay
I like my doctor, and I don’t want him to retire early or take a different job because he can’t make ends meet. I’d like my doctor to be fairly compensated for his services so that he stays in practice as long as possible.

Most service providers (the electrician, the plumber, the housekeeper, the babysitter, the tutor) are paid an hourly rate for their labor. It is in their best interests to take the time to do my job right. Whether the job takes thirty minutes or two hours, they take as much time as is needed to get the job done, and bill accordingly. Another example is the legal profession. Attorneys bill by the hour – not just time spent with a client, but also for time spent working on behalf of a client.

Medical services are the exception, and medical services suffer as a result. Doctors do not get paid for their time, but for the number of people they can see. Sometimes a simple medical issue could be thoroughly addressed in twenty minutes instead of fifteen, but doctors only get paid for it if they bring patients back for a second appointment rather than take the extra time to take care of the problem in a single office visit. By paying doctors for their time, they would be freed from the tyranny of running patients through exam rooms as if they were working on an assembly line. Patients would benefit by getting the time they really need, without the inconvenience of a second appointment.

Fair pay would include compensating doctors for time spent on behalf of a patient, for things such as writing referrals, determining a treatment plan for complicated conditions, phone calls/emails, or jumping through insurance hoops for preapproval. If insurance companies knew they’d be billed for the amount of time it took the doctor to deal with them, would they respond differently?

I realize that this topic typically comes from doctors, but it comes from patients, too. “You get what you pay for.” I am accustomed to paying for high quality work, firing people who provide poor service, and giving a bonus for a job well done. Yet when I read the EOB’s from my insurance company, I wonder how doctors can afford to run a practice on the reimbursement they receive.

Confidentiality
I want what transpires between me and my doctor to be confidential. It is not. The solution is not additional regulation, nor is it threat of punishment/fines for violations. The solution is to permit doctors to maintain confidentiality. Doctors are required to provide information to insurers, and insurers have demonstrated an appalling propensity for releasing medical information to employers. The system needs to be fixed so that doctors can be paid without releasing a diagnosis code (or any other information).

A Level Playing Field
I have no confidence that the politicians will do what is best for anyone, unless they have some skin in the game. “Separate but equal” doesn’t exist in civil rights, and it won’t exist in the healthcare world. Our senators, representatives, and president need to have the same plan that the rest of the country gets.

Respect Good Doctors
Give my doctor the freedom to do his job. I want my doctor to use his expertise to diagnose and treat me. My doctor should be able to order tests based on his medical judgment of what is needed, not based on the pre-approval of an outside source. I want a treatment plan based on what is most appropriate for my specific situation, not based on some cookie-cutter recommendations developed for the “average” patient.

Responsible Use of My Tax Dollar
Healthcare reform should include having a team of ER doctors rewrite the emergency access law. Why do I include this in what patients want? Because when my two-year-old falls on a big piece of metal and cuts a three-inch gash across his forehead, I don’t want to wait while the emergency doctor writes a non-emergency prescription for a Medicaid mom to get her kid some children’s Tylenol. The people who are most affected by the problems of the current law would have good ideas on how to fix it.

I am willing to contribute taxes toward the healthcare of people who fall sick due to misfortune. I don’t want tax dollars to pay for treating people if they willfully make lifestyle choices that cause their own poor health. Someone who can find money for cigarettes can find money for their own lung cancer treatments. People who have been able to purchase enough food to weigh 400 pounds (not caused by a medical condition) can come up with their own money for insulin, heart medication, knee replacements, etc. I know doctors aren’t supposed to judge patients, but other patients do it all the time. Tell the politicians that making people live with the consequences of their actions will help keep costs down.

Affordable Meds
I want medication to be affordable. Actually, what I really want is a cure. Until a cure is discovered, I’ll make do with meds. My concern is that healthcare reform, done wrong, can result in companies being unwilling to develop new treatments. Pharmaceutical companies (like all businesses) need to earn a profit. Look at biologic response modifiers. Biosimilars (generic biologics) sound like a great idea to the person paying for these expensive drugs, but if the pharmaceutical companies decide there isn’t enough profit in these, we all lose. Reform needs to encourage research and the development of new treatments.

1) It is not necessary (or cost effective) for every single person in this country to have electronic health care records, but a patient oriented solution (starting with patient access to records) would allow chronically ill patients the ability to at least manage the information, and probably provides the biggest bang for the buck.
2) For the chronically ill, reimbursing physician email and phone calls, in lieu of visits, would certainly reduce costs.
3) For the chronically ill, reimbursement for regular (short) conference calls by consulting specialists and the pcp would undoubtedly reduce costs, especially in situations where the patient ends up using several visits to try to resolve dueling and inconsistent treatment plans. These could also be used to facilitate better diagnostics — having the X specialists in the room who have input into a diagnosis working together would also likely lower the number of round robin office office visits and allow for prioritization of tests, all of which are expensive. Having the patient on the conference call would be really appreciated by the patient.

1) Doctors need to fix their billing systems. I have a chronic illness and I spend at least two hours per medical “event” (visit, test, etc.) straightening out the messed up billing by the medical providers. I am not going to buy that you all are blaming others when back room operations are so poor — this is why you have such horrendous overhead.
2) Communicate. Here’s a story. Had surgery at a “world class” hospital last year. Electronic everything up the whatever. They forgot to tell me about post-operative complications and severe hyperthyroidism. Even though I called the doctor, patient advocacy, and eventually the hospital’s general counsel. Nobody could be bothered to read the records. Several ER visits later and a couple MONTHS, we get most (but not all) of it figured out. But by then I have had severe muscle wasting, probably need shoulder surgery and may not be able to because previously undisclosed heart complications now predominate, must be resolved, were exacerbated by the hyperthyroid and are now much harder to treat. Cost of the refusal of the entry level, $60k per year doctor to pick up the phone — easily $30k and a year on disability at $95k. The $125k and counting phone call that never happened. This includes play nice with others. Don’t be pissy with my other doctors or me expect to resolve disagreements between the two of you and I don’t care to see you fighting in front of me or through me.
3) Doctors need to think more about schedule — not how many patients they think they can cram into their offices per day, but how quickly they can get to diagnosis and effective treatment. Doctors should have something that causes them bodily harm when footdragging. Illness begets illness. The faster you get the right dx and the right treatment, the less things will cost. So, if you have a many month, multi-visit plan to give yourself time to figure things out so that you can be “cautious” and “conservative”, you are probably already harming your patient, and often more than any treatment that you might prescribe. I guarantee you that almost every patient you see is judged in their job based on how well they accomplish a timely and cost-effective solution — and they will judge you the same. Think long and hard before you decide that its ok for them to stay sick for six months between visits and punting. Cycle time matters. If you are over your head, admit it.
4) Patients expect specialists to know their stuff and that knowledge needs to be CURRENT — not what you learned in med school. This is probably one of the biggest gripes and biggest causes of the increasing distrust of the medical profession. It is not that tough to find out the basic side effects of meds online. It is not tough to find out what the basic standard of care is for most illnesses or to see the most recent medical journal articles. If a patient knows more than you about an illness based on ten minutes on the internet, guess what, they are not going to trust you or think well of you. Take the time to look up what you treat on the internet so that you don’t get scooped and consider your degree to be a rapidly depreciating asset, not some permanent seal of approval.
5) Be organized and prepared. If you want a test redone in a month, have the lab slip ready and don’t make patients call you five times for it. Have your records be set up so that you can see the most recent test results. Ask the patient what they want to get accomplished in this visit up front.
6) Treat me they way you would expect to be treated by other professionals who provide a service to you. Return phone calls. Be prompt. If an additional explanation is needed, provide it. If you don’t like to spend the time to fill out my disability paperwork, its fine to ask me to reimburse you for the time, but its not ok to do a crappy job on it or crab about it. If your medical plan doesn’t work for me because of other things that are going on with me, work with me to come up with a compromise — don’t get give a “take it or leave it cause you must have a problem if you are questioning me” attitude. If your lawyer did that to you, you would be unhappy and ignore him/her– so why do you think the attitude works with patients?
7) Learn to apologize and foreswear BS. Doctors do not get sued because they make mistakes. They get sued because they were enough of a jerk that someone is willing to spend alot of time and alot of money (even contingency cases require the plaintiff to cover costs), to make sure that the doctor hears how perturbed they are with him or her. Which means that in general, the doctor had to have stepped on some toes or be perceived to have been pretty disingenuous somewhere along the way so that someone really feels that they have to let loose the big guns to get the doctor to pay attention. If you want to lessen litigation, be nicer, less manipulative, and more honest. Nice guys do win in this.
We don’t want to hear your whining. When I see my accountant, I don’t want to hear him moaning about the pressures of tax season, his student loans, his mortgage, his car payment or his office management problems. While I am happy to hear some humility about what you don’t know about medicine, you do not increase my respect by blathering about your PERSONAL problems — it just makes you look like you can’t manage your life.
9) Understand that at best, you can only have half of the solution to my medical issues. I live in my body and I am the only one who can say if things are right or not, and if not, what is wrong. All of the information that is in your brain that you studied so long for, can never be the whole answer. So you need to work with me if you are going to do a good job.

By the way, I don’t think that this list covers a single thing that is on the “big” political agenda.
9)

You know, people say that I am an exception to the rule, but I would beg to differ. Most of the docs I know do give a damn, and most patients seem to think THEIR doc is OK. I think this broad stroke of docs as insensitive doofuses is not a constructive way to approach them. Yes, I know there are a lot of idiots out there in the doctor population; but I doubt it is more than the general population.

My problem with all of this is that patients don’t like being talked down to by doctors, but it seems a lot of comments here and elsewhere are returning the favor. I know it is hyperbole to some extent, but it really is no way for people who want docs to engage patients to talk.