A visit to the doctor’s office
Or
Why I’m firing my doctor
Or
How one primary physician can contribute to escalating health care costs
I have a nine o’clock appointment. I arrive about 20 minutes early because I have a new insurance card and figure the office would need time to change their records. At 9:00 they call my name – not to go into the exam room – to fill out brand new information forms, including info about the new insurance. I don’t get into an exam room until 9:30. No surprise. At past office visits I have been Doc X’s very first patient and had to wait 45 minutes. So I was expecting a wait.
I kill time in the exam room another 10 minutes or so before a tech person comes in to take my vitals. As she leaves she explains that Doctor X is working with a Physician’s Assistant so I may be talking to her. After another fifteen minutes the PA comes in. A perky 20-something blonde shakes my hand (I vaguely wonder where she’s had it last), introducing herself as Linda. With my hefty file in hand – I’ve been a patient at this office for about four years – she perches on a swivel stool and begins to ask me about the reason for my visit. “It’s twofold,” I say, explaining that it has been a year since my last visit but I also had made a recent visit to the Emergency Room and the ER doc told me to follow up with my primary physician.
“Uh huh,” says Linda. “And when you were in the ER was it all very confusing?”
“What do you mean?”, I say.
“Well, it must been a very upsetting experience,” she says.
Thinking she has a negative opinion of the hospital, I say, “Not really. They were pretty professional. Is that what you mean?”
“No, I mean how did you feel about going to the ER?”
“Oh. Are you asking why I went to the ER?”
“Okay,” she says. “Why don’t we begin there?”
I hand her copies of all the test results, instructions and medications they gave me when I left the hospital, explaining the reason I went. I had woken up one morning with crazy, wicked dizziness and called Doctor X’s office thinking I could speak to him for guidance. The woman who answered the phone asked about my complaint and suggested I could either seek emergency treatment or, if I felt I could wait, come in to the office. She never let me close to the doctor. I opted for ER.
Linda leafs through the ER info and glances through the top few pages of my medical file. We engage in a bit of back and forth about my general health and recovery from the dizziness. She asks about side effects from meds I am currently taking. I report that it is nothing worse than the conditions they are treating. There is an awkward silence while I hesitate because I have a list of questions I want to ask Doctor X. She says Doctor X will most likely not be in to see me since she, Linda, is handling my visit. I get out my list. The questions cover a lot of ground but she fields each one and I reply candidly to her queries. She laughs and calls me a “stinker” because I ask so many questions. Do I detect a patronizing tone?
She begins to wrap up the meeting by telling me about the routine blood and urine work they will be doing this morning and that the office will call me when the results are in so I can make an appointment to come back. At this point I ask her why I would have to come back in. You see, going to this disorganized office is a major pain and if I am basically going to listen to test results – they won’t fax them to me – why can’t they simply phone them to me? She says it is “office policy” and if I want I can talk to Doctor X about it.
Then, because by nature I am a nosy person, I ask her about this new (to me) procedure of me seeing a PA rather than my doctor. Linda is remarkably game when I say, “So is my office visit cheaper because I am not actually seeing Doctor X?” No, she says, but there are a lot of other good reasons for doing it this way.
“So,” I say, “what’s in it for me to see you rather than the doc?”
“For starters, I can spend more time with you so I can offer greater support and instruction and help you with questions about your health. It saves the doctor time so he can see more patients.”
I mean no disrespect and I can tell Linda understands this. She asks me if I would like to talk to the doctor. Yes, I would.
Following a mix-up of confusing instructions – that clearly irritated an already grumpy tech person and further extends my time in the doctor’s office — regarding just what tests I am there for I am ushered into another room to wait for Doc X. He breezes in, quickly countermands Linda’s recommendations for meds refills and tells me that there are good reasons for having me return to the office to get me lab results. He insists it is important to make sure I understand the results and that he (even it is his office assistant who does this) take my vitals again. I inquire whether he expects my vitals to change that much in a week’s time. By now I am getting a bit irritated. The answers he’s providing are lame at best. Additionally I ask whether the former can just as easily be accomplished with a phone call from him.
Indeed I know plenty of physicians who do just that. My husband’s cardiologist follows every office visit/lab test with a phone call explaining the results. When my husband was taking Warfarin (a blood thinner whose dosage has to be closely monitored) after a monthly blood test the cardio’s nurse called my husband to tell him how to adjust the medication dose. But…
“I am here to serve you,” Doctor X says, “If I don’t take your vitals I am remiss in my duty to you. And I won’t compromise that principle because it inconveniences you.”
My frown exposes my skepticism here and he continues, “I am not an attorney,” he confesses, “I can’t bill for a phone conversation. If I am on the phone talking to patients I am not making any money.” Wow.
I can recognize that he must have enormous expenses what with the office, staff and malpractice insurance, to name a few. But come on. Now I know how he affords that mountain cabin he’s boasted to me about on a previous office visit. Now I know what his bottom line is. It is not my health or even my well-being. It is billable hours. I don’t come first with him. My office visits and I are commodities. My time and priorities are inconsequential next to his economic health. Maybe not entirely. But his priorities don’t impress me.
My face must reveal my distaste because Doc X suggests that, even though he would hate to lose me as a patient (yeah. right.), maybe I should look for another physician.
Thanks, doc. I will. But where is one who will not be putting his mountain cabin ahead of me?