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Old 05-03-2013, 09:57 AM
 
487 posts, read 654,710 times
Reputation: 605

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Quote:
Originally Posted by Swack View Post
This is an old thread, but I thought I could throw in my 2 cents..

1) Most doctors are overworked, they can see upwards of 100 patients a week. They may see a patient for 5-15 minutes, but will actually chart for an additional 10-20 minutes per patient.

2) Medical knowledge has advanced quite a bit over the last 50 years, many of the things learned in medical school today were completely unknown 50 years ago

3) Medical school admission has actually (believe it or not) become more competitive

4) Doctors make less now than they did 20-30 years ago.

5) Doctors make money by either fixed salary or production, sometimes a combination of both. They make money by generating RVUs (relative value units). These are generated by seeing more patients or performing more procedures and ordering more lab tests.

6) Money that doctors make from Medicaid/Medicare/Insurance companies is prenegotiated. Fees paid to the doctor are largely controlled by these entities.

7) The current pay system does NOT encourage long visits, or extensive counseling.

8) Most people who come into the emergency room do not have emergencies.

9) This may sound harsh, but for most doctors, if it is not life-threatening, it is not very important.

10) If someone is able to walk into an ER and sit and wait for several hours, they probably do not have something life-threatening. If they have had the problem for several months or even years, they probably do not have something life-threatening. Again, if they have had the problem for years and they are able to visit the ER multiple times, probably not something life-threatening.

11) Missing something life-threatening is probably the biggest fear of most doctors. For example an earlier poster, Charolastra00, had Hodgkin's lymphoma that was missed. This would have been a nightmare for most doctors.

12) Unfortunately, daily diarrhea, daily vomiting, a chronic rash (things I saw pointed out earlier in the thread); these things may not necessarily be life-threatening, so knowing this, some doctors may ignore them.

13) Most people are under the false assumption that good bedside manner = good doctor; interestingly, when doctors rate their peers, they see the best doctors as the ones who not only make the most accurate diagnoses but also make the fewest mistakes. These doctors may not necessarily have the best bedside manner.

14) Studies have shown that doctors who are the most highly rated by their patients also overtreat and over-prescribe. They order more tests and prescribe more medications than necessary.
Dear Rural Lady....I can understand your frustration. The health care system has run amuck and people
have to become better consumers. As a consumer, you are paying your doctors for a service.
The drawback here is that if you are not getting the service or help you need it then requires you to
go elsewhere which then becomes expensive.
I don't expect every doctor to have a sweet bed side manner but I do expect them to treat me with
some respect, really listen and review my chart and medical history and most importantly to be very
knowledgeable. I do not want to be brushed off, spoken to as if I'm a child, get an angry look if
I ask a question or be treated as if I were an ignorant fool. Some doctors have this "god like" attitude.
As for the above quote;
1. Yes, many doctors are overworked as well as other professionals.
4. Since I have never seen a doctors financial records I can't respond however, I do not see most
of them suffering financially either. No tightening of the belts if you know what I mean.
Plus many new doctors are going into specialized fields which has decreased the numbers of GP's
and internists.
5.Since doctors are ordering more RVU's to make up the difference, that drives up premiums, insurance
costs and exposes patients to unnecessary tests and risks.
6.Many doctors are no longer accepting Medicare or Medicaid.
8.People without insurance are being told to go to the ER as well as those who might call a doctor
after hours if they have a problem or important question unless you are fortunate enough to afford
a concierge doctor.
12.Those symptoms listed can be a sign of something very serious and no doctor should ever ignore it.
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Old 05-06-2013, 04:56 PM
 
219 posts, read 250,401 times
Reputation: 220
Quote:
Originally Posted by key4lp View Post
Dear Rural Lady....I can understand your frustration. The health care system has run amuck and people
have to become better consumers. As a consumer, you are paying your doctors for a service.
The drawback here is that if you are not getting the service or help you need it then requires you to
go elsewhere which then becomes expensive.
I don't expect every doctor to have a sweet bed side manner but I do expect them to treat me with
some respect, really listen and review my chart and medical history and most importantly to be very
knowledgeable. I do not want to be brushed off, spoken to as if I'm a child, get an angry look if
I ask a question or be treated as if I were an ignorant fool. Some doctors have this "god like" attitude.
As for the above quote;
1. Yes, many doctors are overworked as well as other professionals.
4. Since I have never seen a doctors financial records I can't respond however, I do not see most
of them suffering financially either. No tightening of the belts if you know what I mean.
Plus many new doctors are going into specialized fields which has decreased the numbers of GP's
and internists.
5.Since doctors are ordering more RVU's to make up the difference, that drives up premiums, insurance
costs and exposes patients to unnecessary tests and risks.
6.Many doctors are no longer accepting Medicare or Medicaid.
8.People without insurance are being told to go to the ER as well as those who might call a doctor
after hours if they have a problem or important question unless you are fortunate enough to afford
a concierge doctor.
12.Those symptoms listed can be a sign of something very serious and no doctor should ever ignore it.
1. Most professions do not work 60-100 hour weeks and take 24 hour calls. Some do, but most do not.

4. You are right, doctors are still compensated very well. Some older docs are angry about declining reimbursement as we are no longer in the "golden age" of medicine (the 80s). It is harder to make money now compared to 20 years ago. Not saying that these complaints are founded, just offering some perspective. Most people will be resentful when things are taken away from them.

5. Unfortunately you are right.

6. I also agree with this.

8. Agreed.

12. I do agree that these symptoms should not be ignored, but when it comes to triaging patients, these symptoms will generally not be "high priority." Symptoms such as "chest pain" or "shortness of breath" will probably take precedence over diarrhea or a rash.


I am not condoning rudeness or disrespect. I was just offering some perspective on how doctors think and why they act the way they do. I have worked in several ERs and actually have very high Press Ganey scores (these are patient satisfaction ratings). So I know what it takes to "satisfy" patients. I do however sympathize with my colleagues who are burnt out and have to deal with demanding patients. I think overall, there is a problem with the system. It is a system that breeds overworked unhappy doctors, places them in an inefficient healthcare delivery system, to see frustrated and demanding patients.
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Old 05-07-2013, 09:03 PM
 
487 posts, read 654,710 times
Reputation: 605
I am very familiar with Press Ganey. Their questions are short and do not allow patients to completely evaluate and explain their experience. There is also Health Grades which is often outdated and really doesn't give accurate reviews.
Regarding number 12. I had an elderly friend who had diarrhea, vomiting and pain and went to her doctors several times.
She had the routine blood tests and was examined each time. Turned out she had cancer and died in 4 months.

I know doctors are overworked and sure some are burnt out but the same can be said about the teaching profession.
So can I assume we agree that there is a burden on both? However, other than the ER, doesn't a doctor have a choice
to reject a patient? This is a sincere question, can a doctor drop a patient?
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Old 05-08-2013, 12:33 AM
 
219 posts, read 250,401 times
Reputation: 220
Quote:
Originally Posted by key4lp View Post
I am very familiar with Press Ganey. Their questions are short and do not allow patients to completely evaluate and explain their experience. There is also Health Grades which is often outdated and really doesn't give accurate reviews.

Regarding number 12. I had an elderly friend who had diarrhea, vomiting and pain and went to her doctors several times. She had the routine blood tests and was examined each time. Turned out she had cancer and died in 4 months.

I know doctors are overworked and sure some are burnt out but the same can be said about the teaching profession. So can I assume we agree that there is a burden on both? However, other than the ER, doesn't a doctor have a choice to reject a patient? This is a sincere question, can a doctor drop a patient?
Yes most doctors will tell you Press Ganey scores are completely bogus. Most of us hate them however this is how we are evaluated. I think outcomes would be a much better way of evaluating healthcare workers.

I am sorry about your friend, I truly am. Medicine is not perfect, but it tries to be as efficient as possible. If you see the diarrhea/vomiting people that come in, aside from appendicitis, 99% of them will not have something life-threatening. Things do get missed unfortunately. If I was the doctor who missed your friend's diagnosis, I would have been deeply distraught. Not to understate the loss of others, but having someone's life in your hands and knowing that someone died because of something you missed is quite devastating. Also, to look at their family members and deliver the news is one of the worst things a person can experience. The first death I had of someone I was actually taking care of completely devastated me. I would say that it was the worst day of my life. I grieved for several weeks. The experience completely changed me and I am now a different person because of it. I still keep notes from her chart on my desk to this very day.

I have a great respect for teachers. My greatest mentors were teachers. I do feel that teachers are overworked and underappreciated. I also "teach" medical students and residents however I would not say that I am in education.

A doctor can "fire" a patient however this can only be done under extraordinary circumstances. A doctor must feel that he/she is not able to provide care to the best of his/her abilities. This is actually very rare and I have never actually seen this but I know it can be done. It is much more common to see a patient fire/sue a doctor.
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Old 05-09-2013, 10:09 AM
 
25,476 posts, read 23,317,854 times
Reputation: 15343
Quote:
Originally Posted by Swack View Post
This is an old thread, but I thought I could throw in my 2 cents..

1) Most doctors are overworked, they can see upwards of 100 patients a week. They may see a patient for 5-15 minutes, but will actually chart for an additional 10-20 minutes per patient.

2) Medical knowledge has advanced quite a bit over the last 50 years, many of the things learned in medical school today were completely unknown 50 years ago

3) Medical school admission has actually (believe it or not) become more competitive

4) Doctors make less now than they did 20-30 years ago.

5) Doctors make money by either fixed salary or production, sometimes a combination of both. They make money by generating RVUs (relative value units). These are generated by seeing more patients or performing more procedures and ordering more lab tests.

6) Money that doctors make from Medicaid/Medicare/Insurance companies is prenegotiated. Fees paid to the doctor are largely controlled by these entities.

7) The current pay system does NOT encourage long visits, or extensive counseling.

8) Most people who come into the emergency room do not have emergencies.

9) This may sound harsh, but for most doctors, if it is not life-threatening, it is not very important.

10) If someone is able to walk into an ER and sit and wait for several hours, they probably do not have something life-threatening. If they have had the problem for several months or even years, they probably do not have something life-threatening. Again, if they have had the problem for years and they are able to visit the ER multiple times, probably not something life-threatening.

11) Missing something life-threatening is probably the biggest fear of most doctors. For example an earlier poster, Charolastra00, had Hodgkin's lymphoma that was missed. This would have been a nightmare for most doctors.

12) Unfortunately, daily diarrhea, daily vomiting, a chronic rash (things I saw pointed out earlier in the thread); these things may not necessarily be life-threatening, so knowing this, some doctors may ignore them.

13) Most people are under the false assumption that good bedside manner = good doctor; interestingly, when doctors rate their peers, they see the best doctors as the ones who not only make the most accurate diagnoses but also make the fewest mistakes. These doctors may not necessarily have the best bedside manner.

14) Studies have shown that doctors who are the most highly rated by their patients also overtreat and over-prescribe. They order more tests and prescribe more medications than necessary.
this is a great post to help view both sides of the story, and there are always two sides.... thank you
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Old 05-09-2013, 10:13 AM
 
25,476 posts, read 23,317,854 times
Reputation: 15343
yanno, after reading your posts, it surely helps give some valuable perspective, it is not the doctors, but the system that is once again, affecting health care.

something to think about....

I am soon to be 65 years old, and I do not know if many of you remember, going to a doctor who were family practitioners and also specialists. And I can remember when they even came to our home....I had the chicken pox and was so sick....

Anyway, long story short, back then those doctors knew EVERYTHING....and could identify what was wrong with you a whole lot quicker then today.
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Old 05-09-2013, 12:09 PM
 
Location: NoVa
18,434 posts, read 28,559,797 times
Reputation: 19578
Quote:
Originally Posted by cremebrulee View Post
yanno, after reading your posts, it surely helps give some valuable perspective, it is not the doctors, but the system that is once again, affecting health care.

something to think about....

I am soon to be 65 years old, and I do not know if many of you remember, going to a doctor who were family practitioners and also specialists. And I can remember when they even came to our home....I had the chicken pox and was so sick....

Anyway, long story short, back then those doctors knew EVERYTHING....and could identify what was wrong with you a whole lot quicker then today.
I have found myself very lucky to find an Internist who is very caring. I am not sure but I think she may be younger than I am, and I will be 40 in December. She did not always know all of the complications or possible complications of my RA but in my most recent visit, I noticed that she had learned about it.

That spoke leaps and bounds to me. My Rheumatologist is three hours away, and I cannot always get to her. My Internist sent me for a stat CT last week because my symptoms met with the possible symptoms I may have for something that someone with RA is much more likely to have than someone without it.

She has taken the time to learn my disease more thoroughly. She also takes the time to give me a hug if I need it.

She is just a tremendous physician.
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Old 05-09-2013, 12:49 PM
 
6,209 posts, read 6,591,183 times
Reputation: 3091
Quote:
Originally Posted by Swack View Post
Yes most doctors will tell you Press Ganey scores are completely bogus. Most of us hate them however this is how we are evaluated. I think outcomes would be a much better way of evaluating healthcare workers.

I am sorry about your friend, I truly am. Medicine is not perfect, but it tries to be as efficient as possible. If you see the diarrhea/vomiting people that come in, aside from appendicitis, 99% of them will not have something life-threatening. Things do get missed unfortunately. If I was the doctor who missed your friend's diagnosis, I would have been deeply distraught. Not to understate the loss of others, but having someone's life in your hands and knowing that someone died because of something you missed is quite devastating. Also, to look at their family members and deliver the news is one of the worst things a person can experience. The first death I had of someone I was actually taking care of completely devastated me. I would say that it was the worst day of my life. I grieved for several weeks. The experience completely changed me and I am now a different person because of it. I still keep notes from her chart on my desk to this very day.

I have a great respect for teachers. My greatest mentors were teachers. I do feel that teachers are overworked and underappreciated. I also "teach" medical students and residents however I would not say that I am in education.

A doctor can "fire" a patient however this can only be done under extraordinary circumstances. A doctor must feel that he/she is not able to provide care to the best of his/her abilities. This is actually very rare and I have never actually seen this but I know it can be done. It is much more common to see a patient fire/sue a doctor.
My wife's doctor dumped her because she was on medicare. She was my wife's doctor before she was deemed totally disabled and put on medicare. It took 4 years to find this doctor who treated her rare neurological disorder, so losing her was not good. I paid out of pocket for her to treat my wife but had to use medicare for her medications because of very high monthly costs. She treated my wife for another 1.5 years before she said she couldn't treat her anymore because we still use medicare for her scripts, she needs to go. I think other issues were at play here because my wife's condition is progressive and chronic with no cure and this doc is a bit unorthodox and was investigated by the DEA and the state of VA. But none-the-less she stated she is dropping my wife because of medicare.
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Old 05-09-2013, 03:52 PM
 
219 posts, read 250,401 times
Reputation: 220
Quote:
Originally Posted by jmking View Post
My wife's doctor dumped her because she was on medicare. She was my wife's doctor before she was deemed totally disabled and put on medicare. It took 4 years to find this doctor who treated her rare neurological disorder, so losing her was not good. I paid out of pocket for her to treat my wife but had to use medicare for her medications because of very high monthly costs. She treated my wife for another 1.5 years before she said she couldn't treat her anymore because we still use medicare for her scripts, she needs to go. I think other issues were at play here because my wife's condition is progressive and chronic with no cure and this doc is a bit unorthodox and was investigated by the DEA and the state of VA. But none-the-less she stated she is dropping my wife because of medicare.
Unfortunately this is very common. When I was discussing doctors "firing" patients, I did not include insurance rejection. At our practice, I would say at least 10% of the patients who walk into the door cannot be seen by us and are turned away at the front desk. Also, patients will sometimes have insurance changes, as did your wife, and this becomes a logistical problem. We are not allowed to see these patients "for free." Some do decide to pay out of pocket, but it is ridiculously expensive with upwards of $150 for a simple visit not taking prescriptions into account. I have even tried to save some of these parents money by down-coding them, but our thorough coding department catches these and up-codes them again. Our practice takes 70% medicaid yet we still end up rejecting people. It is frustrating to want to treat someone and to be told that you can't. It is not good healthcare.

This is why American healthcare access and medicaid/medicare reform are such hot topics right now.
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Old 05-09-2013, 05:29 PM
 
6,209 posts, read 6,591,183 times
Reputation: 3091
Quote:
Originally Posted by Swack View Post
Unfortunately this is very common. When I was discussing doctors "firing" patients, I did not include insurance rejection. At our practice, I would say at least 10% of the patients who walk into the door cannot be seen by us and are turned away at the front desk. Also, patients will sometimes have insurance changes, as did your wife, and this becomes a logistical problem. We are not allowed to see these patients "for free." Some do decide to pay out of pocket, but it is ridiculously expensive with upwards of $150 for a simple visit not taking prescriptions into account. I have even tried to save some of these parents money by down-coding them, but our thorough coding department catches these and up-codes them again. Our practice takes 70% medicaid yet we still end up rejecting people. It is frustrating to want to treat someone and to be told that you can't. It is not good healthcare.

This is why American healthcare access and medicaid/medicare reform are such hot topics right now.
I was paying $300 per visit per month, actually much longer than 1.5 years. More like 3 years. Long story short she was terminated from her employment, lost coverage. I picked her up at my employment at triple the cost. When the economic downturn took place my employer went under merging with another company who does not provide coverage. The only coverage I could get for her was Hipaa at $2600 per month. That was too much to handle so I paid out of pocket for years and just continued when she started on medicare with this particular doctor.
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