Friday, March 7, 2014

Your Doctor And You: Contemporary Changes To The Doctor Patient Relationship

Your doctor and you together form a vital alliance for your health.

This relationship, like any, is going through some changes due to outside pressure from societal changes. Here are two main topics to discuss:

Yelp Reviews
As someone, a drug rep, said in the break room, during our discussion, 'You don't even need to look to ads to find a restaurant. You just say what region you are in, and look at Yelp, and go by the reviews.'

I scanned the room. Not one but TWO caregivers with awful reviews were present. I enjoy working with them both. And I acted dumb. I said, 'Does anyone really look at those reviews on themselves online, anyway? I do, but there is nothing there for me.'

They both had.

One--who is an oral surgeon who has Yelp reviews saying everything from he is too old to practice to he's in it only for the money--mentioned that once those reviews are up there is nothing you can do. There is no defense. He says his office really works on the wait times, because that is important to people. What he didn't know is I changed my plans for my son's oral surgery procedure to another specialist my orthodontist friend referred because of those online reviews--they were scathing, and I didn't want to take a chance with my son, even through I've known and adored working with this dental surgeon for years...and seen his skills in the O.R. as I anesthetize his patients.

The other, an OB-Gyn, was on call and cross covering for her colleague, who warned that a certain patient had drug-seeking behavior. (That's when people will lie and cheat and do anything to get a prescription for more pain meds). Sure enough, the patient called the physician, the physician did exactly what their colleague said to do with these patients, and the result is now online forever--she didn't even see me, I had so much pain, she is the worst doctor, she was rude, etc, etc.

When I was a professor, we were routinely evaluated by our students. The students did not know how critical it was to our advancement that we had 'good evaluations'. However, it was known by the department that some students are rather vindictive--so if there was a 2 or lower with no evidence to support it, the score was dropped from our permanent records. It was policy to counteract vindictiveness on the part of the students in the anesthesia program.

Often, it is because there is request for compensation for services rendered that lead to bad Yelp reviews on physicians, and other health providers. I follow them, but with a grain of salt. For example, in my choice of doctors for my thyroid, the one I wanted had reviews about the wait and the ease of making appointments. I thought against my initial choice because I didn't want to have trouble being seen.

In everything, use your intuition, your inner guidance, and heart.

Remember ridicule is one of the most potent weapons in the arsenal of the dark forces on the planet.

This is based on what I have overheard in the doctor's lounge and the doctor's dining room--
payments are now seventy percent of Medicare.

As you know, in certain parts of the country, the southwest/Arizona areas in particular, where due to the inability to make enough money to support a practice, many primary care doctors are REFUSING to accept Medicare patients. The retirees in those areas must drive three hours to Las Vegas to see a doctor.

And this is at Medicare Rates.

Apparently the Gold, Silver and Bronze 'levels' of Obamacare correspond to 'how much copayment the patient pays you'.

And there is concern about reimbursement due to the nature of the very high deductibles with the plan.

Hospital administration has encouraged participating physicians to 'collect the co-payment before seeing the patient'. This is because many patients do not pay their bills, and it goes to collection, which is expensive and doesn't always produce compensation.

Now there is a 'strategy' of sorts, where the smart doctors don't submit the billing until the patient has met their deductible--which they won't pay. Then they submit it. And all the other doctors who have submitted billing before are on the hook trying to find how to get the deductible actually paid to them.

It is a disaster in the making.

I also know with declining reimbursements, care is getting more limited. The gastroenterologist and I make about the same with, for example, a procedure such as upper GI endoscopy. But over there, a case I was assigned to, I got told to 'go for a coffee break' because the patient's insurance had denied anesthesia in favor of nurse conscious sedation. Either way, I didn't get paid. At least by not doing the case I did not expose myself to risk of something else going on with the patient that could lead to malpractice.

Every doctor taking care of a patient always is making a subtle assessment of benefit versus risk of treatment to the patient; what the patient does not know, is that at the same time, the doctor is weighing the benefit to risk of being sued by that patient at the same time. Every interaction opens up the risk for malpractice, even when the physician does not get paid. When the risk is too great the physician will refer out to another colleague and decline to treat the patient. Some patients are at very high risk for complications, and as the likely outcome is estimated, the physician decides that course to take for both of them.

I call this the 'post-wallet biopsy' era in medicine--those days of 'wallet-biopsy' are long over, and survival of the practice is now the number one factor on the physician's mind; mind you, there are lots of HMO's and big box organizations that are waiting in the wings for the practice to fail, to step in, and buy out the practice, making the physician an employee.

I hope you don't mind seeing it from inside the system.

Now it's time for some breakfast! I'm hungry.

P.S. BTW, there is a psychic who is coming to the area. Her readings are one hundred dollars and hour on the phone and two hundred dollars and hour in person. This is way more than an office visit would be paid in cash--it's about sixty-five dollars to see a physician, of course, it's a different kind of personal, and doesn't take an hour. It's about twenty minutes.

Aloha and Mahalos,

Reiki Doc

You Are My Life by Michael Jackson