A Letter to Patients

Dear patient:
I am sorry you are so frustrated with me.  I\’m frustrated too.

People used to look on me as a good thing, but now everyone makes me out to be public enemy #1.  It\’s not my fault.  I was made to give you what you need: medical care; but then they kept changing me and making things harder.  One side doesn\’t seem to know what the other is doing.  Changes are made without realizing the consequences.  Now instead of giving care, I just make it harder.  Now instead of making people get better, I actually harm some people.

It makes me sick to think about it.

I don\’t want that to happen to you.  I don\’t want you to get lost in the paperwork, rules, authorizations, and red tape that seem to define me these days.  So instead of being lost in the system, take my advice to live by as you go through me.  I mean that literally: these rules may just be the difference between living and dying, so listen closely.

1.  Find a home base.

There has to be someone you can go to for trustworty advice.  The rest of care is confusing, and you probably won\’t know who to trust.  Some people will lie to you and others will just confuse you.  You need a translator.  You need a mooring in the turbulent waters.  You need somewhere you can go to orient yourself and know which way is up.

That person may be your PCP – that is the best-case scenario – but it may be someone else.  Find someone who doesn\’t intimidate you who can answer any question you have.  Ask them lots of questions.

2.  Don\’t fragment your care.

Some people think that healthcare is like going to the supermarket.  The shelves may be in different places and the prices may vary some, but the basic stuff they sell is the same anywhere you go.  This is a dangerous way to get care.  The more places you go, the less each place will know about you.  Doctors who are seeing you for the first time can\’t do as good of a job as those who know you well.  Plus, the more places you go, the better chance that you will get bad care.  Not all doctors are created equal.

So if something isn\’t an emergency, don\’t go to the ER.  What constitutes an emergency?  Not a baby crying during the night.  Yeah, it may be more convenient to go to the ER or urgent care center (as you don\’t miss as much work) but you may pay a big price for it.  If you can wait to see your doctor, do it.  If you can\’t get in to see your doctor when you are sick, then maybe you should find another.

3.  You are your own keeper.

One of the biggest mistakes people make is to assume someone is watching out for them.  They get tests done and assume no news is good news.  They go to specialists and assume their PCP knows about it.  They spend weeks in the hospital and have all of their medications changed, and think that this information is passed on.  It may be, but often it is not.  The only one who knows about all of your care is you.  The only one who can reliably watch out for you is you.

I know you like your doctor and think she is on top of everything.  Unfortunately, good people are stuck in a horrible system.  A ton of care is done blindly – without any inkling of what is going on at other locations.  You must make sure these parties communicate.  You must make sure news gets back to your PCP.

Does this suck?  Yeah, it does.  Big time.  Why should you have to be the record keeper?  Why should you be the watch-dog?  It\’s my fault.  I give no reason at all for doctors to communicate, but instead discorage them from doing so.  Everyone is working hard to do the job in front of them, and once you are gone from the hospital, specialist, or ER, they have no motivation to communicate.  In fact, doing so loses them money.

Some are great at communicating, but many are not.  Don\’t gamble with your life in this area.  Make sure that communication happens.

4.  Don\’t BS

If you can\’t afford a drug, don\’t act like you are going to take it.  If you are scared about a brain tumor, don\’t assume the doctor knows your fear.  For some reason, some people feel the need to do PR work when seeing the doctor.  They want to look smart and strong even when they are confused and weak.  This is pure stupidity.

Tell the truth.  Say what you are feeling.  Express your fears, and ask as many questions as you need to ask.  This also holds true if the patient is your elderly parent or your child.  If you wonder about the advice you are getting, get a second opinion.

5.  Famous people can be idiots

Oprah is fun to watch and she is a genuinely smart lady, but she isn\’t a healthcare expert.  I can\’t be so gracious with other celebrities.  Famous people like attention, and so they will usually get it any way they can.  Many of them think that their soap-box makes them smart.  None of them are likely to show ignorance – they are good at faking it.

The fact is, they are probably famous only because they are good looking.  You don\’t see many ugly famous people.  This is a bad way to seek medical advice.  Would you choose a surgeon based on their sex-appeal?  Would you trust the life of your child to someone who got famous because they looked good naked?  Don\’t be a fool.  Trust people who are trustworthy; not people who look good in front of a camera.

6.  Don\’t overdo it

I can only do so much for you.  Everyone dies and most people suffer in life.  Some people have bought into the American mindset that says all pain should be avoided.  This is a bunch of crap.  Don\’t medicate every struggle or seek solution for all suffering.  Some people seem surprised that life has these things in it.  Don\’t be; it\’s normal.

I don\’t say this because I like to see people suffering.  I say it because people are putting unfair expectations on me.  I can\’t beat death.  I can\’t do the \”happily ever after\” thing, and I only have so much money.  Plus, sometimes people hurt themselves by seeking too much treatment.  There are docs out there who will give antibiotics for every runny nose and others who dispense narcotics like candy.  Don\’t go there.  The price you pay is far more than monetary.

That\’s just scratching the surface.  There is so much more I could say, but the politicians are beating at my door and I have to go.  Just remember that nobody else lives in your body.  You are the bottom line when it comes to your care.  Yeah, I may make it tough sometimes (sorry about that), but that should only make you fight harder to make sure you get the care you need.  You can get good care, but it doesn\’t happen if you are passive.

I am about to get a big make-over soon, so the walls of my maze will change.  Chances are, however, the advice I just gave will still apply no matter what I end up looking like.

Stay strong,

Healthcare.

42 thoughts on “A Letter to Patients”

  1. You rock. Thanks for this. My grandparents have been going through many hospital visits of late, often with specialists and other assorted institutions. They are then surprised when their PCPs and ‘home hospital’ staff don’t know what’s up. This is important advice and something I’ve been trying to get them to understand- for their own health, as well as to give doctors the sympathy they deserve.

  2. You rock. Thanks for this. My grandparents have been going through many hospital visits of late, often with specialists and other assorted institutions. They are then surprised when their PCPs and ‘home hospital’ staff don’t know what’s up. This is important advice and something I’ve been trying to get them to understand- for their own health, as well as to give doctors the sympathy they deserve.

  3. Wow! I dreamed I wrote this from a patient’s perspective.
    I have a rare disease (that took many years to diagnose), I know my body and my motivation, and whenever I felt I was being patronized or getting the brushoff, I requested my records and went elsewhere where I would be heard and my time (just as valuable) would not be wasted.

    Many years after the onset of my systemic disease, I am medically retired and “fragile”, but “salvageable” because I’m a member of a wonderful team – each of whom smiles when he steps into the exam room and laughs as I roll out in the Love Buggy (mechanized wheelchair) after having delivered notes from the other physicians I see, asked questions, confirmed the plan, and delivered both a thank you and a punch line.

    I survive – and thrive – despite the Healthcare System, not because of it. I dream of a day when physicians are free to practice medicine in a way that their patients can receive maximum benefit from their education, training and dedication.

    I encourage all patients to register to vote (politicians take registered voters more seriously), and contact your elected representatives to support your physicians. Only by working together will we ever minimize “system” and maximize “healthcare” in the Healthcare System.

  4. Wow! I dreamed I wrote this from a patient’s perspective.
    I have a rare disease (that took many years to diagnose), I know my body and my motivation, and whenever I felt I was being patronized or getting the brushoff, I requested my records and went elsewhere where I would be heard and my time (just as valuable) would not be wasted.

    Many years after the onset of my systemic disease, I am medically retired and “fragile”, but “salvageable” because I’m a member of a wonderful team – each of whom smiles when he steps into the exam room and laughs as I roll out in the Love Buggy (mechanized wheelchair) after having delivered notes from the other physicians I see, asked questions, confirmed the plan, and delivered both a thank you and a punch line.

    I survive – and thrive – despite the Healthcare System, not because of it. I dream of a day when physicians are free to practice medicine in a way that their patients can receive maximum benefit from their education, training and dedication.

    I encourage all patients to register to vote (politicians take registered voters more seriously), and contact your elected representatives to support your physicians. Only by working together will we ever minimize “system” and maximize “healthcare” in the Healthcare System.

  5. Following on from this, if the US system is the same as the UK’s, if you want to get a politician to take your issue seriously, write him rather than just sign a petition. In the UK, they have to send a personal reply to every addressed and signed letter they receive, which isn’t the case with a petition.

  6. Following on from this, if the US system is the same as the UK’s, if you want to get a politician to take your issue seriously, write him rather than just sign a petition. In the UK, they have to send a personal reply to every addressed and signed letter they receive, which isn’t the case with a petition.

  7. Well said. I agree with Ken Ol. You can access your political leaders via the web, and send letters to them either electronically or hand written. It’s best to flood them with individual letters instead of one mailing with a lot of signatures.

  8. Well said. I agree with Ken Ol. You can access your political leaders via the web, and send letters to them either electronically or hand written. It’s best to flood them with individual letters instead of one mailing with a lot of signatures.

  9. I am currently experiencing this frustration trying to be my frail, elderly mom’s watch-dog 750 miles away. Despite traveling there every 10-12 weeks, meeting with one of the docs in her PCM’s office, being her HCPOA, and leaving my name and numbers on the front of her chart, i NEVER get called or consulted, even when i beg. Different docs do not talk to each other, and it seems the plan of care changes by whatever doc does happen to see her. When i act as her advocate and ask questions, (i am not being rude to them or a pest), i feel they punish her by seeking to discharge her before she is ready, etc. I am so frustrated.
    i fought with my 97 y/o grandma’s doc a few months ago. (She also lived 750 miles away, in a nursing home, with end-stage cancer.) He would not listen to me when i believed her pain medicine was not the right one for her, despite my experience as a hospice nurse. We argued for 3 days. When he finally changed the med, she “woke up” and started eating again. We were able to have some significant conversations about end-of-life care. She finally died in mid-April; but despite my order for no more pills (again, as her HCPOA), the hospice nurses found pills in her mouth the last 2 days of her life, when she had not been awake for a week!

    I am angry at docs who don’t seem to care and don’t listen to the family. I know they are busy! I am a nurse! But i asked mom’s PCM, “When did communicating with the family become un-important?” He replied, “When i spend more time talking to them than with the patient.” Humph! … As my mom said, He hadn’t talked to her, either!

    i just don’t know what to do anymore.

  10. I am currently experiencing this frustration trying to be my frail, elderly mom’s watch-dog 750 miles away. Despite traveling there every 10-12 weeks, meeting with one of the docs in her PCM’s office, being her HCPOA, and leaving my name and numbers on the front of her chart, i NEVER get called or consulted, even when i beg. Different docs do not talk to each other, and it seems the plan of care changes by whatever doc does happen to see her. When i act as her advocate and ask questions, (i am not being rude to them or a pest), i feel they punish her by seeking to discharge her before she is ready, etc. I am so frustrated.
    i fought with my 97 y/o grandma’s doc a few months ago. (She also lived 750 miles away, in a nursing home, with end-stage cancer.) He would not listen to me when i believed her pain medicine was not the right one for her, despite my experience as a hospice nurse. We argued for 3 days. When he finally changed the med, she “woke up” and started eating again. We were able to have some significant conversations about end-of-life care. She finally died in mid-April; but despite my order for no more pills (again, as her HCPOA), the hospice nurses found pills in her mouth the last 2 days of her life, when she had not been awake for a week!

    I am angry at docs who don’t seem to care and don’t listen to the family. I know they are busy! I am a nurse! But i asked mom’s PCM, “When did communicating with the family become un-important?” He replied, “When i spend more time talking to them than with the patient.” Humph! … As my mom said, He hadn’t talked to her, either!

    i just don’t know what to do anymore.

  11. This is the type of thing that drives me nuts. I am sorry you are experiencing this. I am sorry anyone has to experience this.
    The problem is that docs are now in the mode of seeing as many patients as possible and are otherwise awash in paperwork. Calling families is an “add on” that comes last in line – especially when the family member may keep them on the phone for 20 minutes.

    This is a reason, not an excuse. It is a very good argument to pay PCP’s more so they have time to offer better service. I do dread making phone calls. I do them, but I worry about getting caught in a long talk. Perhaps e-mail will help. I think it might, because it is done when the time is right for the doc and is more efficient.

    We shall see.

  12. This is the type of thing that drives me nuts. I am sorry you are experiencing this. I am sorry anyone has to experience this.
    The problem is that docs are now in the mode of seeing as many patients as possible and are otherwise awash in paperwork. Calling families is an “add on” that comes last in line – especially when the family member may keep them on the phone for 20 minutes.

    This is a reason, not an excuse. It is a very good argument to pay PCP’s more so they have time to offer better service. I do dread making phone calls. I do them, but I worry about getting caught in a long talk. Perhaps e-mail will help. I think it might, because it is done when the time is right for the doc and is more efficient.

    We shall see.

  13. My “primary specialist” otherwise known as the team captain is some distance away. In order to spare patients like me difficult journeys for office visits, he gives us his email address to check in with problems, questions, exacerbations or a quick, “so far so good” email. It’s an iffy thing to do, but I don’t believe any of his patients abuse it. We’ve worked out refills, tweaked “the plan”, and by the time I return he can see if the adjustment has worked.
    Email also provides a record that can be saved into electronic medical records, and assures that the patient and the physician are on the same page. “The shortest pencil is better than the longest memory.”

    It is a luxury of course for salaried physicians I suppose because to my knowledge physicians are not yet compensated for email interactions with patients?

    With the primary care physician shortage, particularly in rural and outlying areas, email could be a tremendous tool for managing increasing patient loads. Families and caregivers are also more able to follow written instructions than verbal ones, particularly if there are several caregivers involved.

    Perhaps character-restricted secure webmail will be the best tool, and physicians can respond during time they set aside for updating charts.

  14. My “primary specialist” otherwise known as the team captain is some distance away. In order to spare patients like me difficult journeys for office visits, he gives us his email address to check in with problems, questions, exacerbations or a quick, “so far so good” email. It’s an iffy thing to do, but I don’t believe any of his patients abuse it. We’ve worked out refills, tweaked “the plan”, and by the time I return he can see if the adjustment has worked.
    Email also provides a record that can be saved into electronic medical records, and assures that the patient and the physician are on the same page. “The shortest pencil is better than the longest memory.”

    It is a luxury of course for salaried physicians I suppose because to my knowledge physicians are not yet compensated for email interactions with patients?

    With the primary care physician shortage, particularly in rural and outlying areas, email could be a tremendous tool for managing increasing patient loads. Families and caregivers are also more able to follow written instructions than verbal ones, particularly if there are several caregivers involved.

    Perhaps character-restricted secure webmail will be the best tool, and physicians can respond during time they set aside for updating charts.

  15. Agree with this. Docs will resist it as long as they see it as a way to get more free care out of them. The bad side to capturing the information is that it raises the legal liability for the doc. Need to compensate somehow (not even that much). $10 per email encounter would probably do.

  16. Agree with this. Docs will resist it as long as they see it as a way to get more free care out of them. The bad side to capturing the information is that it raises the legal liability for the doc. Need to compensate somehow (not even that much). $10 per email encounter would probably do.

  17. i really DO understand. I truly do know the doc has to have a life, too. But I wanted to ask him, “How would YOU like it if your loved one needed intervention, and the doc didn’t call YOU back for 28 hrs, despite 3 calls?” (1000 and 1600 on Sat., 1200 on Sunday — hardly excessive.) But HIS family would never be treated like this by a fellow doc, because he IS a doctor.
    I believe that for me, anyway, he’d have to spend less time with me if he kept up on a regular basis, rather than my having to throw at him a number of concerns all at once. (And of course there’s always that last significant point you think of after he hangs up.)

    However, i can well understand that there are many who would go on and on during a conversation. I’ve had many pts. like that, and it’s hard to get them to focus.

    There was a study, many decades ago, that demonstrated that families were LESS likely to sue a doc for negative outcomes if they PERCEIVED he cared about the pt. , and vice versa.

    i am not at all even thinking of suing the doc, obviously — there is nothing to sue him for. But that study showed how important feelings are to the pt.

    Even if he just said, “I’m so sorry for not calling you back sooner,” i’d feel better, because he would be acknowledging that his actions impact me (i put all my plans for that day on hold, waiting for callbacks from the doc and the discharge planner, neither of whom called), and that MY time is not less important than his.

    Sigh.

    Since i rely on the internet alot, i’d be very willing to pay for email services. Dr. Rob, you are right, that we need to find some way to cover compensation for this extra time spent. (i know how much time i spent emailing my students while teaching at university.)

    it makes you want to subscribe to concierge medical service, but i cannot afford that! 🙂

  18. i really DO understand. I truly do know the doc has to have a life, too. But I wanted to ask him, “How would YOU like it if your loved one needed intervention, and the doc didn’t call YOU back for 28 hrs, despite 3 calls?” (1000 and 1600 on Sat., 1200 on Sunday — hardly excessive.) But HIS family would never be treated like this by a fellow doc, because he IS a doctor.
    I believe that for me, anyway, he’d have to spend less time with me if he kept up on a regular basis, rather than my having to throw at him a number of concerns all at once. (And of course there’s always that last significant point you think of after he hangs up.)

    However, i can well understand that there are many who would go on and on during a conversation. I’ve had many pts. like that, and it’s hard to get them to focus.

    There was a study, many decades ago, that demonstrated that families were LESS likely to sue a doc for negative outcomes if they PERCEIVED he cared about the pt. , and vice versa.

    i am not at all even thinking of suing the doc, obviously — there is nothing to sue him for. But that study showed how important feelings are to the pt.

    Even if he just said, “I’m so sorry for not calling you back sooner,” i’d feel better, because he would be acknowledging that his actions impact me (i put all my plans for that day on hold, waiting for callbacks from the doc and the discharge planner, neither of whom called), and that MY time is not less important than his.

    Sigh.

    Since i rely on the internet alot, i’d be very willing to pay for email services. Dr. Rob, you are right, that we need to find some way to cover compensation for this extra time spent. (i know how much time i spent emailing my students while teaching at university.)

    it makes you want to subscribe to concierge medical service, but i cannot afford that! 🙂

  19. You are 100% right. I am explaining why it happens, not excusing it. You get the shaft in this way.
    Really, that is the gist of this post. The healthcare system is sick as it encourages this kind of stuff. Why put providers in a dilemma where they have to choose between quality and income? Why make good medicine bad business?

    As docs we need to be willing to swallow the bitter pill of working for free (sometimes a lot). It is galling that PCP’s are expected to do this kind of thing and they are the lowest paid.

    Be angry. You are right. Make noise until you get what you want. I don’t blame patients for that. I shake my fist at the system.

  20. You are 100% right. I am explaining why it happens, not excusing it. You get the shaft in this way.
    Really, that is the gist of this post. The healthcare system is sick as it encourages this kind of stuff. Why put providers in a dilemma where they have to choose between quality and income? Why make good medicine bad business?

    As docs we need to be willing to swallow the bitter pill of working for free (sometimes a lot). It is galling that PCP’s are expected to do this kind of thing and they are the lowest paid.

    Be angry. You are right. Make noise until you get what you want. I don’t blame patients for that. I shake my fist at the system.

  21. How many of you charge $25 for a missed appointment? Do insurance, Medicare or Medicaid rules prevent that? Then I wonder if there is any legal reason that you could not implement a small direct email charge to the patient.
    1. I would certainly pay $10 per email (or say $10 for a specific event). I think many folks would prefer the more convenient $10 email interaction than the $25 or more ER copay, the only same-day interaction many patients can access.

    2. It would limit the nuisance interactions.

    3. No offense intended, I’m sure you all have the most wonderful office staff … but some of us have had some unsatisfactory experiences with the person in between us and our physicians. Remember the party game “Telephone”? This would fix that problem too.

    4. From a liability standpoint, it gives you a paper trail and evidence of who said what.

    This is a really good string. Does anyone see any reasons a physican’s practice couldn’t just implement a modest email fee? If not, why not “just do it1”

  22. How many of you charge $25 for a missed appointment? Do insurance, Medicare or Medicaid rules prevent that? Then I wonder if there is any legal reason that you could not implement a small direct email charge to the patient.
    1. I would certainly pay $10 per email (or say $10 for a specific event). I think many folks would prefer the more convenient $10 email interaction than the $25 or more ER copay, the only same-day interaction many patients can access.

    2. It would limit the nuisance interactions.

    3. No offense intended, I’m sure you all have the most wonderful office staff … but some of us have had some unsatisfactory experiences with the person in between us and our physicians. Remember the party game “Telephone”? This would fix that problem too.

    4. From a liability standpoint, it gives you a paper trail and evidence of who said what.

    This is a really good string. Does anyone see any reasons a physican’s practice couldn’t just implement a modest email fee? If not, why not “just do it1”

  23. A small fee for email access to the doctor’s office is a great idea.
    I’ve seen it work – sort of. One time I took photographs and emailed them to our vet. He was able to make a diagnosis based on the pix and history. The vet didn’t have to make a farm call, and we didn’t have to load a cow and haul it down the road.

    There’s no reason this can’t work for people-doctors as well as animal-doctors in some situations. When I phoned my PCP’s office with a question, it was not a matter of wanting free care. I had just had an appointment and cortisone shots, was sent elsewhere for x-rays, then returned a few weeks later for a follow-up appointment where I learned the diagnosis. Once I had a name for the problem, I started doing research and found a website with exercises that can help. However, the article explaining the exercises clearly stated (quite a few times) that one should “check with your healthcare provider before attempting these exercises.”

    I phoned to ask, “I found these shoulder exercises. Is it okay to do them?” I did not make another appointment to ask this question. I like my doctor, but his office is really not my favorite place to hang out. E-mailing my question would have been even easier than phoning: here’s a link – is it okay if I try this? I would gladly have paid a fee to be able to email the question and get a reliable answer, knowing that the nurse knew exactly which exercises I wanted to try. (Try explaining exercises over the phone. A link would have been much better)

    People will phone/email more frequently when it’s free. They will think twice about emailing their doctor’s office if they know it will generate a charge. That could be a good thing. Maybe waive the fee when the answer is, “This question doesn’t fall within the criteria of things that can be dealt with via internet. Please schedule an appointment.”

  24. A small fee for email access to the doctor’s office is a great idea.
    I’ve seen it work – sort of. One time I took photographs and emailed them to our vet. He was able to make a diagnosis based on the pix and history. The vet didn’t have to make a farm call, and we didn’t have to load a cow and haul it down the road.

    There’s no reason this can’t work for people-doctors as well as animal-doctors in some situations. When I phoned my PCP’s office with a question, it was not a matter of wanting free care. I had just had an appointment and cortisone shots, was sent elsewhere for x-rays, then returned a few weeks later for a follow-up appointment where I learned the diagnosis. Once I had a name for the problem, I started doing research and found a website with exercises that can help. However, the article explaining the exercises clearly stated (quite a few times) that one should “check with your healthcare provider before attempting these exercises.”

    I phoned to ask, “I found these shoulder exercises. Is it okay to do them?” I did not make another appointment to ask this question. I like my doctor, but his office is really not my favorite place to hang out. E-mailing my question would have been even easier than phoning: here’s a link – is it okay if I try this? I would gladly have paid a fee to be able to email the question and get a reliable answer, knowing that the nurse knew exactly which exercises I wanted to try. (Try explaining exercises over the phone. A link would have been much better)

    People will phone/email more frequently when it’s free. They will think twice about emailing their doctor’s office if they know it will generate a charge. That could be a good thing. Maybe waive the fee when the answer is, “This question doesn’t fall within the criteria of things that can be dealt with via internet. Please schedule an appointment.”

  25. Only slightly off topic but I can’t let an opportunity for humor pass by. Warm Socks and I share a farm background, and I’ve just chuckled at the parallel picture of load my oversized “Love Buggy” motorized wheelchair up a folding portable ramp into my minivan to schlep to the far away physician’s office. Thanks for the mooving memories!
    It does appear that a small consensus is forming, Doc Rob. You may have started a nationwide moovement.

  26. Only slightly off topic but I can’t let an opportunity for humor pass by. Warm Socks and I share a farm background, and I’ve just chuckled at the parallel picture of load my oversized “Love Buggy” motorized wheelchair up a folding portable ramp into my minivan to schlep to the far away physician’s office. Thanks for the mooving memories!
    It does appear that a small consensus is forming, Doc Rob. You may have started a nationwide moovement.

  27. Moving, raw, and right-on, my friend.
    I fear that the changes being considered will only exacerbate the red-tape, denials, and paperwork. I am terrified that if they base the new system on Medicare, I will be forced to hang up the stethoscope for good. The whole 20% reimbursement cut and all…

    Sadly, people will never regain control of their own health care until they stop expecting someone else to make it happen for them. Whether the middle-man is an insurance company doctor or an election-obsessed Washington bureaucrat, the disconnect between us PCPs and our patients will remain until the middle-men are eliminated.

    I sincerely hope that I can continue to serve the needs of my patients. I like them very much, and giving their care over to someone else who can afford to see them for free makes me shudder. Oh well. It seems to be what the mob wants.

    See you in the funny papers, Rob. Hang in there.

  28. Moving, raw, and right-on, my friend.
    I fear that the changes being considered will only exacerbate the red-tape, denials, and paperwork. I am terrified that if they base the new system on Medicare, I will be forced to hang up the stethoscope for good. The whole 20% reimbursement cut and all…

    Sadly, people will never regain control of their own health care until they stop expecting someone else to make it happen for them. Whether the middle-man is an insurance company doctor or an election-obsessed Washington bureaucrat, the disconnect between us PCPs and our patients will remain until the middle-men are eliminated.

    I sincerely hope that I can continue to serve the needs of my patients. I like them very much, and giving their care over to someone else who can afford to see them for free makes me shudder. Oh well. It seems to be what the mob wants.

    See you in the funny papers, Rob. Hang in there.

  29. M y husband and I are a decade apart in age. That makes a surprising difference in what we expect from care.
    I grew up with patient responsibility, doctors are not Gods, Doctors ARE human and it is up to the patient to make sure the doc has followed through. Sometimes, I may need to hand deliver xrays or other such reports because it needs to get there faster than the medical system can do so …or the doc won’t recieve information on a new patient who has no chart.

    He grew up with doctor responsibility. The doc will call if I need to be seen on a given schedule and appt is not made. (doc says I want to see you in 6 months, but they can only book out 4 months … so it’s up to him to call at that 6 months …if the doc doesn’t call to remind him to come in, he doesn’t go ……. …. then gets VERY upset that the ball has been dropped. I’ve tried to tell him his chart is in a file with no one looking at it unless it’s being USED)
    The doc will always call with results that are bad, no news is good news. The doc will know everything from every specialist therefore he has no need to update doc on changes made by other docs. If results (xrays etc) need to get from one doc to another, they’ll send them. I have no need to act as currier)

    This, drives both myself and our PCP insane. My PCP is infinately more patient with him over these issues than I am. He’s lucky for that!

  30. M y husband and I are a decade apart in age. That makes a surprising difference in what we expect from care.
    I grew up with patient responsibility, doctors are not Gods, Doctors ARE human and it is up to the patient to make sure the doc has followed through. Sometimes, I may need to hand deliver xrays or other such reports because it needs to get there faster than the medical system can do so …or the doc won’t recieve information on a new patient who has no chart.

    He grew up with doctor responsibility. The doc will call if I need to be seen on a given schedule and appt is not made. (doc says I want to see you in 6 months, but they can only book out 4 months … so it’s up to him to call at that 6 months …if the doc doesn’t call to remind him to come in, he doesn’t go ……. …. then gets VERY upset that the ball has been dropped. I’ve tried to tell him his chart is in a file with no one looking at it unless it’s being USED)
    The doc will always call with results that are bad, no news is good news. The doc will know everything from every specialist therefore he has no need to update doc on changes made by other docs. If results (xrays etc) need to get from one doc to another, they’ll send them. I have no need to act as currier)

    This, drives both myself and our PCP insane. My PCP is infinately more patient with him over these issues than I am. He’s lucky for that!

  31. Following on from Peggikaye’s #17, I have no issue with being asked to handball my medical records from A to B, and A and B can be several hundred miles (2 or 3 days by post) apart, but the doctor at A has to actually ask me to deliver the letter, X-rays or whatever to B! I’m not psychic, so I don’t know that he wants to communicate data about me to B!

  32. Following on from Peggikaye’s #17, I have no issue with being asked to handball my medical records from A to B, and A and B can be several hundred miles (2 or 3 days by post) apart, but the doctor at A has to actually ask me to deliver the letter, X-rays or whatever to B! I’m not psychic, so I don’t know that he wants to communicate data about me to B!

  33. This is a great post – I just tweeted it because I thought it was so timely and relevant. I’m not a doc but have worked with healthcare professionals for my entire career. I think you echo so many of their frustrations. I worked with a slew of 20 somethings and it seems like none of them has a PCP – urgent care is their answer to all that ails them. And few, if any, get routine preventive care. Frustrating.

  34. This is a great post – I just tweeted it because I thought it was so timely and relevant. I’m not a doc but have worked with healthcare professionals for my entire career. I think you echo so many of their frustrations. I worked with a slew of 20 somethings and it seems like none of them has a PCP – urgent care is their answer to all that ails them. And few, if any, get routine preventive care. Frustrating.

  35. Rob, this is very well stated. We PCPs are at once perpetrators and victims, unwitting accomplices to a dysfunctional system. It puts us in a terribly uncomfortable position, which is one reason (of many) that many are fleeing primary care.
    Keep up the good work!

    – Danny

  36. Rob, this is very well stated. We PCPs are at once perpetrators and victims, unwitting accomplices to a dysfunctional system. It puts us in a terribly uncomfortable position, which is one reason (of many) that many are fleeing primary care.
    Keep up the good work!

    – Danny

  37. I’ve seen people give out their doctor or in some cases not even theirs(!) on message boards telling everyone they could write to them for advice.
    when i spoke out about that to those who did that, their answer was ‘well, why would they give out their email if they didn’t want people to write to them? *face palm* Sigh. It’s funny, people wouldn’t call up random doctors but have no qualms about hitting that send button. Ease I guess, and no office staff ‘in the way’.

    People DO expect email to be a quick free access to doctors, so it’s a legitimate reasoning on any docs part to think such.

    I wouldn’t mind paying a fee, though maybe not $10 each since some of my email exchanges are really short. I’d imagine it’d be difficult to set up any sort complexity-based fee schedule.

    Maybe based on how many bytes the emails are :p.

  38. I’ve seen people give out their doctor or in some cases not even theirs(!) on message boards telling everyone they could write to them for advice.
    when i spoke out about that to those who did that, their answer was ‘well, why would they give out their email if they didn’t want people to write to them? *face palm* Sigh. It’s funny, people wouldn’t call up random doctors but have no qualms about hitting that send button. Ease I guess, and no office staff ‘in the way’.

    People DO expect email to be a quick free access to doctors, so it’s a legitimate reasoning on any docs part to think such.

    I wouldn’t mind paying a fee, though maybe not $10 each since some of my email exchanges are really short. I’d imagine it’d be difficult to set up any sort complexity-based fee schedule.

    Maybe based on how many bytes the emails are :p.

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