Doctor No

Scanning the health blog universe I wandered across a post on Kevin MD about a council on aging member urging the elderly to demand more than five minutes of a doctor's time if it was needed. What follows is an anonymous comment that appears to heve been made by one such doctor.

1. You are not paying them. You have shrugged that responsibility and the right to represent you onto the government and whatever secondary insurers you have hired. You are entitled to have what they pay for on your behalf, not whatever you want.

2. If you are the sort of person who wants that extra time you feel entitled to, then don't complain when you get seen later than your appointment time. It may be hard to think of someone besides yourself, but imagine for a moment an entire patient schedule of patients like yourself, all feeling entitled to a little more than what they really have paid for. Bring a book.

3. Enjoy bothering the staff? In my office, you will enjoy that just once. They are hard to replace. I want them to stay and if possible , stay happy. You, the botherer, can be replaced easily. It isn't rocket science to run that algorithm. Learn to be nice, even if it kills you.

4. Medicare is not the same as you paying for something, like a dinner. Electing to bestow your custom on a practice, your Medicare custom that is, is not an example of free give-and-take. Ever wonder why many practices limit the numbers of new Medicare patients? It isn't because they're getting rich seeing them, that is for sure. No Medicare heavy practices are worrying about back injuries while carting all the cash out the back door, that is for sure. No one says you need to grovel, but you should get real about what you are and are not bringing to the table. Oh, and your good word and its value in drawing other seniors to a practice? Everyone likes to be spoken well of, but it isn't the bonanza you might think it is. Every Medicare-aged patient has the potential to displace a better-insured patient, if you want to think of things that way.
# posted by Anonymous : 10:46 PM

There's so much that's wrong with that comment, but I'll address the one thing that stings:

Medicare is not the same as you paying for something, like a dinner. Electing to bestow your custom on a practice, your Medicare custom that is, is not an example of free give-and-take.

Utter nonsense. Keeping consumers tied to this belief is propping up a fetid market. Airlines, restaurants, car rental agencies, IRAs, supermarkets, all compete for dollars that you don't have in your hand. They seem to understand that the decision maker, not the payer, is the customer. That's what we're missing in health care. Consumer empowerment begins with us understanding our purchasing power.

To the doc who wrote the above, I challenge you to send your feelings above to each and every one of your bread-and-butter Medicare patients with a list of other doctors, and willingly lose a large percentage of them. Posting anonymously on the Internet may have made your feelings a little better, but I feel sorry for your patients who are unable to evade the system and remain on Medicare and feel they are being adequately cared for by you.

What happened to the word "care" anyway? This doc obviously doesn't "care", yet we call it health "care", "care" givers, it's baloney. Avis cares. Hilton cares. Jetblue cares. My mechanic cares.

Bring back care to health care, and we'll cut back on the apparently-untenable bothering of you and your staff.
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Note to Pharmacists

Stop pressing my buttons! It's my question, I'll answer it!

The last three prescriptions I filled I encountered the same complete lack of customer service that is really beginning to peeve me off.

During checkout, here in NYC at least, after the money has changed hands the little screen pops up a screen that allows you to respond "No I do not need advice" or "Yes I received advice on my medication" or something to that effect.

Each of the last three times, the person handling the transaction leaned over and clicked the "no I don't need advice" button for me.

Un-flippin'-believable.

The first time was an independent pharmacy where I was getting my son's first ever dose of penicillin and yes, actually, I had some questions. I was worried about an allergic reaction as this would be the first time to find out, and I wanted to know the signs to look for if things were going wrong. "Instructions are in the bag" I was told. This was after the lady had clicked the "no I don't need advice" on the little touchscreen I put my PIN into.

The second time was at a Rite-Aid. I picked up some antibiotics for the boy but in fact had no questions so I was only mildly annoyed when the chap reached over the counter and hit the "no advice needed" button.

An hour later I was back to pick up my Chantix prescription for which I did indeed have questions and was subjected to (a) the checkout process completing before I was told they couldn't fill the whole three month prescription and (b) hitting the "no advice" button for again!

Drives me mad. Is this limited to New York or does anyone else experience this? Maybe it's just my face, maybe I look like someone who doesn't want to be helped.‎ Full story...

Ineffective Efficiency

NYT has a section today on "who pays for efficiency", several articles and a handy flash map from Dartmouth Atlas look at cost of care around the country, disparities in coverage and reimbursement, and the price of efficieny and who ends up paying versus who ends up benefitting.


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