It’s an age-old problem, made more complicated by our new era of electronic medical records: optimizing collections in a time of unprecedented price pressures on our health care complex. With the economic downturn and declining government payments for services, everyone in health care is feeling the pinch.
It is no secret that work not billed will ultimately be work not paid. Hospitals and practice managers, adept at business principles, know this. Deep down inside, doctors know this, too. Historically, doctors dictated when they billed their patients, even if it meant waiting over a week to do so. If a doctor was to take a vacation, some of those billings could wait until his return.
I used to get lots of gifts from patients during the holidays. Not so much anymore.
I’m more patient-centered than ever. And the older I get the more relaxed I get with my patients. I’d like to think
that I’m more likeable. But still fewer gifts than ten or fifteen years ago.
So what gives?
Times have changed.
Doctors nowadays are dispensable. If a patient doesn’t like what they’ve got they can move on. But this is probably a good thing. Read more »
*This blog post was originally published at 33 Charts*
Being with the wrong doctor can have grave consequences – literally. As a practicing physician, I’m the first to admit that no doctor is perfect, especially me. I’m in a field that is eternally humbling, with my next mistake potentially hiding just around the corner. The stakes are enormous and the number of tasks I must juggle often daunting. From my point of view, I’m trying my best. But from the patient’s point of view, that may not be enough. So how do you know when it’s time to call it quits with your doctor? Here are ten reasons to make you think twice about continuing with the status quo:
1) You feel your doctor isn’t listening to you.
Listening isn’t waiting to speak. One of my favorite and most beloved teachers, Dr. Alfred Markowitz, once told me, “If you let patients talk long enough, they’ll actually tell you what’s the matter.” Studies show that, on average, doctors let patients talk for 18-23 seconds before interrupting. Patients are allowed to finish their opening statement of concerns about 25 percent of the time.
You want a physician who not only is willing to hear what you’re saying but who’s intrigued by interpreting nuances of words and body language, who notices when you hesitate a millisecond before answering a question that’s hit a hidden sore spot. Don’t be shy about confronting a doctor who isn’t listening. And leave if your concerns aren’t addressed.
2) Your doctor can’t communicate effectively with you.
Your doctor not only needs to be a great listener but has to be able to explain things to you in a way that you can understand. You’ll know it when you don’t hear it.
3) The doctor isn’t taking you seriously.
This is a deal breaker. It may happen if your doctor jumps to a conclusion about the cause of your symptoms before considering other possibilities. Even if you’re a hypochondriac, your hypochondria needs to be seriously addressed. And even hypochondriacs get real illnesses.
4) You have a problem with the office staff.
Office personnel represent the doctor. If they’re unfriendly or unkind then you’re starting off on the wrong foot. And it gets worse if they’re inefficient. Messages must be given to the doctor, insurance forms filed, tests properly scheduled and results reported. Last week, a survey of primary care practices found that patients were not told of abnormal results an average of 7 percent of the time.
5) You’re kept waiting too long.
Doctors can be delayed by unpredictable medical emergencies. But if it happens consistently then the doctor is probably scheduling inefficiently. A clue you’ve been in the waiting room too long: if you pass completely through menopause while waiting to discuss your hot flashes.
6) It takes too long to get an appointment.
Routine annual visits can be scheduled months in advance but new problems and ongoing medical complaints need to be addressed in a timely fashion.
7) The doctor’s too busy.
This may develop over time, as the practice grows. If messages are going unreturned, insist on talking to the doctor. If the problem continues or the doctor always seems to be in a hurry then you may need to find somebody else.
8) Your doctor gets annoyed by questions.
This may be a reflection of other problems listed above such as the doctor being too busy or not taking you seriously. Whatever the cause, it’s unacceptable. Not only are patients entitled to careful consideration of questions, those questions may provide doctors with important clues. “Why do I get a stomach ache every time I eat a slice of toast?” may lead to the diagnosis of celiac disease, a condition in which gluten – a component of wheat, rye, and barley – is toxic to the body. If a doctor doesn’t immediately know the answer, a perfectly good response is, “I don’t know but I’ll research it and get back to you.”
9) Your doctor is too arrogant.
God save us from the brilliant doctors. You probably need to be a B+ student to be smart enough to learn everything you need to be a great doctor. But you also need to be A+ in empathy, listening, carefulness, keeping an open mind, logic, and common sense. Doctors who think they are brilliant scare the heck out of me. I’ve seen them make huge mistakes as they take short cuts or rely on their instincts without seeking help from others or adequately listening to their patients.
10) It just doesn’t feel right.
As with any relationship, sometimes you can’t put it into words but you just know it’s wrong. Don’t fight your instincts.
For this week’s episode of CBS Doc Dot Com, I visit the Mount Sinai School of Medicine in New York City and speak to Erica Friedman, the director of the Morchand Center, where budding doctors are schooled on bedside manner by treating actors pretending to be patients.
My friend and fellow blogger David Kroll just wrote an interesting post about the use of “doctor” as a title for a wide range of expertise, including medical. The discussion reminded me of the usual misunderstandings associated with my title…
Typical Val conversation with lay strangers:
Dr. Val: “Hello, I’m Dr. Jones…”
Person: “Oh, hi Dr. Jones. What kind of doctor are you?”
Dr. Val: “A medical doctor.”
Person: “Oh, so you’re like, a pediatrician?”
Dr. Val: “No, my specialty is rehabilitation medicine.”
Person: “Oh, my uncle has a drug problem. He’s been in and out of rehab for years. I’m so glad that there are people like you willing to help addicts.”
Dr. Val: “Uh… Well, actually my specialty is focused on physical rehabilitation – like patients with spinal cord injuries, amputations, strokes, car accidents, etc…”
Person: “Oh, so you’re a physical therapist?”
Dr. Val: “No, I’m a physician. But I work closely with physical therapists.”
Person: “So you’re a REAL doctor?”
Dr. Val: “Yes, I went to Columbia Medical School…”
Person: “Well, you don’t LOOK like a doctor.” [See example here]
Dr. Val: “Uh… thanks?”
***
Dr. Val: “Mom, why don’t people believe I’m a medical doctor?”
Dr. Val: “What’s oddball about helping the disabled population?”
Dr. Val’s Mother: “Well, you know ‘rehabilitation’ usually conjures up ideas of drug rehab.”
Dr. Val: “Yeah, my specialty has the weakest PR in all of medicine. Nobody knows what we do.”
Dr. Val’s Mother: “At least people don’t think you’re a hypnotist.”
Dr. Val: “What?”
Dr. Val’s Mother: “Did I ever tell you about the time I was on an elevator with someone at a Spanish literature convention?”
Dr. Val: “Uh…”
Dr. Val’s Mother: “My tag said ‘Dr. Sonia Jones, member of the American Association of Hispanists.’ A woman in the elevator with me was staring at my name tag and finally blurted: ‘Are you here with the convention?’ And I said, ‘yes.’ And then she responded: ‘Could you hypnotize me too?!'”
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It’s an age-old problem, made more complicated by our new era of electronic medical records: optimizing collections in a time of unprecedented price pressures on our health care complex. With the economic downturn and declining government payments for services, everyone in health care is feeling the pinch.
