Be Reasonable – Part 1: Availability

The central relationship of healthcare – the doctor-patient relationship – is in tatters in many ways.  The invasion of the exam room by insurance company rules, malpractice threats, and the media barrage has made things increasingly uncomfortable.  But a good relationship is essential to really get/give good care.  Obviously there are two players in this drama, and both can undermine or help the relationship.
So I am going to do a series on various aspects of the doctor/patient relationship and what each party can do to maximize its effectiveness.  The first area I will cover is availability.

Availability

To have a relationship, there has to be some interaction.  Doctors tend to view their own agendas over those of the patients, while the patients can demand things that are unreasonable.

The doctor has to accommodate patients – The patients want to see their doctor when they need to be seen.

  • Some problems can\’t wait. It is not reasonable to have to wait to be seen for a problem that needs immediate attention.  Most of my patients who need to be seen immediately are willing to wait longer for the ability to be seen.
  • Focus on the not-so-frequent fliers – I was taught very early in practice that the most important marketing I can do is to the patient who doesn\’t come in often.  \”Frequent fliers\” are much more forgiving and fewer in number than the patient who only calls when they need the doctor.  People don\’t schedule getting sick, so fitting into a rigid doctor schedule is not reasonable.
  • Remember whose visit it is – Doctors must understand that their existence is for the sake of patients; patients aren\’t there so doctors have a job.  This mindset will help a lot when it comes to flexibility.
  • Patients have jobs and other things to do – It is hard to take time off.  It is hard to drop everything for a 1PM visit – especially if you end up spending 3 hours in the office waiting to be seen.  Accommodating patients needs to be done wisely, as double and triple booking will penalize people with scheduled appointments.

The patient has to be reasonable – Patients sometimes forget that they are not the only person with needs.

  • \”Urgent\” problems should actually be urgent – It\’s one thing to have immediate access for acute problems like abdominal pain, ear infections, and broken limbs; it\’s another thing to demand immediate access for preventive care, routine follow-up appointments, etc.
  • Patience is important – Good doctors are in demand.  This becomes a bigger problem as a practice matures – the better the doctor, the more patients want to get in, the harder it is to get an appointment.
  • Accept alternatives – Refusing to see a PA or other doctor in the office for acute problems is another demand that makes things difficult.  This certainly can be abused by medical offices – scheduling so many patients that doctors simply aren\’t available.
  • You are not alone – Remember that docs have between 2000 and 5000 patients who have needs as well.  It\’s tricky balancing this – I have only limited slots for new patients because my established patients are my priority.
  • Your doctor has a life too – We get sick, we take vacations, and we have families.  Your life may revolve around your illness, but it is unreasonable to expect that your doctor\’s life does the same.

I have personally found that being available is good business.  We allow walk-in visits every day from 7:30-9 AM and 5:30-7 PM for acute problems only.  The visits must be about problems that can be cared for in 5 minutes.  Longer visits are scheduled later in the day.

I have also found that it is important to stand up to people who are unreasonable.  I need to set the expectation that if I am to respect their needs, then they must be willing to play by our rules.  It is very hard to run an office, but it gets much harder when patients are allowed to dictate what goes on.  There always has to be a balance.

In short, both sides must be reasonable.

12 thoughts on “Be Reasonable – Part 1: Availability”

  1. i so agree with you, this could be posted in every doctor’s office. perhaps some of the patients and bad doctors might take a lesson. having had mostly doctors who were stellar with their patients i ennjoyed the benefit of great health care when it had to be tested. then, when my doctor took leave i had to get another pcp which being in boston was very difficult. when i didn’t suceed on my own i enlisted the help of a well connected friend who got his well known , celebrity type doctor to take me on. i thought i was set for life, a well known pcp at my hospital of world class care.
    to make a along story short, for the last three years under his care has been a living hell with my own health being ignored. cavelier, a bully, unavaliable, turf specialist, down right unfriendly[as in not even a nod of the head when spoken to].
    i have learned a big lesson from this and that is it does not matter who the doctor is or how long they have been in practice, if there is no connection don’t waste time like me trying to make one, get away from that practice. you may do well seeing a resident who may show some attention to you and your problems.
    as for me my case was complex and the file thick due to a complicated spine surgery with serious side effects causing ongoing medical problems none of which i could control. i lost valuable time with a physician who had not bothered to read my file and me who thought that this guy would come to accept me.

  2. i so agree with you, this could be posted in every doctor’s office. perhaps some of the patients and bad doctors might take a lesson. having had mostly doctors who were stellar with their patients i ennjoyed the benefit of great health care when it had to be tested. then, when my doctor took leave i had to get another pcp which being in boston was very difficult. when i didn’t suceed on my own i enlisted the help of a well connected friend who got his well known , celebrity type doctor to take me on. i thought i was set for life, a well known pcp at my hospital of world class care.
    to make a along story short, for the last three years under his care has been a living hell with my own health being ignored. cavelier, a bully, unavaliable, turf specialist, down right unfriendly[as in not even a nod of the head when spoken to].
    i have learned a big lesson from this and that is it does not matter who the doctor is or how long they have been in practice, if there is no connection don’t waste time like me trying to make one, get away from that practice. you may do well seeing a resident who may show some attention to you and your problems.
    as for me my case was complex and the file thick due to a complicated spine surgery with serious side effects causing ongoing medical problems none of which i could control. i lost valuable time with a physician who had not bothered to read my file and me who thought that this guy would come to accept me.

  3. “I have personally found that being available is good business”
    I agree, and think alot of docs today forget this very important business tip. Make it easy for patients to come see you and they will come see you more often. The office makes more money and the patient gets good care….everyone wins. However, i think it is easier to “be available” in a pediatric setting as oppossed to an adult practice?

  4. “I have personally found that being available is good business”
    I agree, and think alot of docs today forget this very important business tip. Make it easy for patients to come see you and they will come see you more often. The office makes more money and the patient gets good care….everyone wins. However, i think it is easier to “be available” in a pediatric setting as oppossed to an adult practice?

  5. I completely agree with your logic and reason, and that is why I’ve always selected large group practices from the “preferred list” of doctors. They will find a spot for me *somewhere* for my travel-induced ear infection, and I’m ok with that since all the records are still in one practice.
    One instance, however, really torqued me off. A newly-minted member of the practice reviewed my chart and noted that (1) I had pneumonia 7 years prior, and (2) I’m a cigarette smoker. AFTER the lecture I’d heard many times about the evils of tobacco, bronchitis was diagnosed as chronic and my insurance company began hounding me. WHAT? Not that the insurance company will pay for smoking cessation treatment, just that they’d deny future asthma claims. I’ve never had an asthma attack in my life, but I used Albuterol for the pneumonia. So bronchitis got me on the “list”.

    I’m a relatively healthy 40 year old woman, sterilized by choice and I travel extensively for my job. My M.O. is getting sick once a year, typically after being exposed to the hip-tall germ factories called nieces and nephews around the holidays, or in airports. I also get flu and pneumonia shots every year. That pneumonia kicked my ass for months and I’m NOT a fan of Prednisone or Z-Pack.

    Did my insurance pay for those innoculations? Nope! Why? Because I got them at O’Hare during a layover instead at my PCP. Eh, $85 sure beat the hell out of being sick and Rx copays. Guess what? No flu or pneumonia last year, just strep from the youngest nephew – my sister needs to read the parenting creed, “Thou Shalt Not Take Your Ill Demon Spawn In a Crowd While Communicable”.

    My sister insisted I got strep not from her son loving on me, but in an airport somewhere.

  6. I completely agree with your logic and reason, and that is why I’ve always selected large group practices from the “preferred list” of doctors. They will find a spot for me *somewhere* for my travel-induced ear infection, and I’m ok with that since all the records are still in one practice.
    One instance, however, really torqued me off. A newly-minted member of the practice reviewed my chart and noted that (1) I had pneumonia 7 years prior, and (2) I’m a cigarette smoker. AFTER the lecture I’d heard many times about the evils of tobacco, bronchitis was diagnosed as chronic and my insurance company began hounding me. WHAT? Not that the insurance company will pay for smoking cessation treatment, just that they’d deny future asthma claims. I’ve never had an asthma attack in my life, but I used Albuterol for the pneumonia. So bronchitis got me on the “list”.

    I’m a relatively healthy 40 year old woman, sterilized by choice and I travel extensively for my job. My M.O. is getting sick once a year, typically after being exposed to the hip-tall germ factories called nieces and nephews around the holidays, or in airports. I also get flu and pneumonia shots every year. That pneumonia kicked my ass for months and I’m NOT a fan of Prednisone or Z-Pack.

    Did my insurance pay for those innoculations? Nope! Why? Because I got them at O’Hare during a layover instead at my PCP. Eh, $85 sure beat the hell out of being sick and Rx copays. Guess what? No flu or pneumonia last year, just strep from the youngest nephew – my sister needs to read the parenting creed, “Thou Shalt Not Take Your Ill Demon Spawn In a Crowd While Communicable”.

    My sister insisted I got strep not from her son loving on me, but in an airport somewhere.

  7. Great stories! Doctors can be turds as good as anyone…except that you have to call them doctor turd.

  8. Great stories! Doctors can be turds as good as anyone…except that you have to call them doctor turd.

  9. I agree totally.
    A few months back I replied to sometine similar in a vein that was sort of “If someone goes on leave for 2 weeks, and comes back to 2 weeks of needed 10 hour work days, asking them to make time for a 30 minute appointment for routine bloods and to see if they’ve started smoking (in their mid 40s) is not going to get a helpful response!” Reschedule, particularly if you know that they will make an appointment once their work schedule allows! Oh and please note guys, I’m not in the USA so arguments about how US PHPs get an income don’t apply!

  10. I agree totally.
    A few months back I replied to sometine similar in a vein that was sort of “If someone goes on leave for 2 weeks, and comes back to 2 weeks of needed 10 hour work days, asking them to make time for a 30 minute appointment for routine bloods and to see if they’ve started smoking (in their mid 40s) is not going to get a helpful response!” Reschedule, particularly if you know that they will make an appointment once their work schedule allows! Oh and please note guys, I’m not in the USA so arguments about how US PHPs get an income don’t apply!

  11. I try and avoid my cousins’ kids because I’m alergic to children. Leave me near them for too long and they start breaking out in bruises! 😉

  12. I try and avoid my cousins’ kids because I’m alergic to children. Leave me near them for too long and they start breaking out in bruises! 😉

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