Comments on: The Medically Homeless

By: Ben

Ben — Fri, 02 Oct 2009 12:43:53 +0000

Being a medical receptionist, we do see it alot. Many people come into our office once and are never seen again. It's stinks to not have a medical home.

By: Donna B.

Donna B. — Wed, 30 Sep 2009 22:06:11 +0000

Medical Home. How I would love to have one!!!

My husband is lucky in that he started going to a certain Family Practice doc (at my recommendation) about 15 years ago. He and this doc have a great relationship and the doc keeps up with all my husband’s extensive and complicated medical problems.

I had to stop seeing the doctor because of my age. My husband is on Medicare and Tricare For Life, which is about the best possible ever insurance coverage. I’m not old enough to qualify for Medicare.

So, to insure an affordable out-of-pocket expense since we’re on a fixed income, I enrolled in Tricare Prime and am assigned to a PA at a MTF as my primary care physician.

The problem is that MTF’s have this horrible thing called “same day appointing” which means if you are not one of the first callers and do not have the ability to show up at the clinic within 20 minutes, you can’t get an appointment. Now, I’ve learned a few “work-arounds” but they amount to me being my own PCP.

I have “complex” medical issues that include side effects from bariatric surgery, meningioma, arthritis, osteoporosis, fibromyalgia (dating from my teen years!), hypothyroidism… and the problem of deciphering which symptom is due to which problem is overwhelming for me. I have received little help from any doctor I’ve ever seen (other than the PCP my husband now sees, who I no longer see because of insurance).

My PCP is my computer, the internet, and Excel.

By: Grand Rounds Vol. 6 No. 2 « Laika’s MedLibLog

Grand Rounds Vol. 6 No. 2 « Laika’s MedLibLog — Tue, 29 Sep 2009 21:02:06 +0000

[...] Rob Lamberts (alias Dr. Rob) of “Musings of a Distractible Mind” muses about The Medically Homeless. He summarizes his post as follows: There’s much ado about the quality of medical care and the [...]

By: David

David — Mon, 28 Sep 2009 15:15:56 +0000

Great piece. And after reading it my primary thought is….It seems so simple, why can’t we make these little changes for the betterment(sp, never actually written this word before) of our healthcare system? Healthcare rules and regulations are like the US tax code…a giant mess!
Maybe Doctors should recieve some business training during their residency years? Many are small businessmen afterall. I know the docs hire other people to do all this business stuff, but at least provide some classes about CPT coding and documentation, which is so important to the financial well-being of most offices.

By: chris keller

chris keller — Thu, 24 Sep 2009 17:38:12 +0000

Sari, you have expressed the needs, provided examples of how to best address the needs, and discovered good care for your child with special healthcare needs. You are a satisfied customer, and to me that is the best motivation of all: seeing a satisfied customer; seeing a child who can carry on because her needs are being met. Then there is the profit motive . . . and the sad fact of medicine-as-business. It is a complicated game we play in medicine . . . and we may lose sight of keeping the patient #1.

I respect Dr. Rob’s analysis of this “game,” and I applaud his description of medical home and its deep meaning for individual patients and for the community of people with special healthcare needs . . . of which I am one.

Chris and Vic

By: pcb

pcb — Thu, 24 Sep 2009 14:48:34 +0000

any proposals around to fix those rules? No need to keep dumb rules, if they’re truly dumb.

By: Ken O

Ken O — Thu, 24 Sep 2009 07:40:20 +0000

That reminds me of the PCP physician I was with when I was in elementary through high school (he’s retired, and I’ve moved since). He was required to schedule appointments every 6 minutes, so he did. He was also notorious for having late-running surgeries, because if a patient needed more than 6 minutes then they got more than 6 mins!

By: Doctor D

Doctor D — Thu, 24 Sep 2009 04:15:04 +0000

Brilliant post Dr. Rob!

We have a system that is stacked against this kind of care. I was once employed at a federally-funded clinic (which shall remain unnamed) that basically ordered me to stop doing this kind of care because it was a “waste of time” when I could be churning out the numbers. They requested I provide primary care in 7 minute slots. They got Doctor D’s letter of resignation pretty quick.

By: Rob

Rob — Thu, 24 Sep 2009 01:51:17 +0000

Sounds great, but the only way to do this would be to drop Medicare and Medicaid. We can’t charge them anything extra and if we offer things to other patients while we accept M’care and M’caid, we are not offering them a service we are offering other patients. That’s against the rules.

Dumb rules.

By: pcb

pcb — Wed, 23 Sep 2009 23:53:03 +0000

couldn’t you simply charge a yearly “membership fee” to cover coordination for patients in your practice? You may have to decrease your panel a bit as you spend less time with office visits and more time on the phone, doing email, researching topics, etc. (But maybe you wont, because you’ll be able to handle a lot of stuff more efficiently when everything isn’t tied to an office visit.)

If a substantial chunk of your revenue came from your membership fees, a substantial amount of time could then be spent doing things other than jamming patients into an already stuffed schedule.
You and your patients would be happier, right?

The shortage of primary care docs means there should be little problem finding people willing to pay the fee, especially if it’s somewhat reasonable.