Seniors & Aging

Real Life | Waiting for the doctor

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“The doctor will be with you shortly … ”

Sound familiar?

“The doctor will be with you shortly” … in about four weeks … for the attention that you’re anxious for now.

Then, arriving on time for the long-awaited appointment, you’re parked in the waiting room, along with other detainees, comforted only by a pile pile of ragged old gossip magazines. Docs stopped offering current publications because our fellow patients steal them. Finally, after an hour or more of fuming, you’re chaperoned into the inner sanctum, only to serve another quarter-hour in solitary confinement.

No wonder we fuss about doctors rudely making us wait, threaten to bill them for our wasted time and write indignant letters to the editor.

But, know what? It isn’t their fault, they hate it at least as much as we do, they invent brilliant time-saving innovations, but the growing pressures are just overwhelming.

The long waits come from a bunch of harmful facts of life in the health care delivery system, together assaulting our well-being. Call it “medical economics.”

Here are some:

The demand for medical services keeps growing, fast. Our population is increasing. We’re emerging from recession and underemployment and now can afford the high-hurdle deductibles and co-pays that caused us to defer elective attention. Millions more of us seek service because we now have health insurance.

Many of us clog the system seeking unnecessary attention, just to assuage our anxieties. Our advanced society’s miraculous medical techniques and our relative financial affluence lengthen our lives, so we’re old and geriatrics-impacted much longer.

Miraculous medical advances themselves generate delays. Instead of handling our ailments in-house, our primary care physicians cast us asunder to multiple, sophisticated specialists for long-run better healing, putting us in competition with other patients and requiring wait times there, all over again. Doc’s almost forced to do that, because he/she simply can’t afford to give us all the time, thought, careful analysis and TLC that he/she would like to.

Blame the pervasive “fee for service” system that Medicare, Medicaid and the insurance industry invoke to control claim costs and to avoid having to clobber us with even higher premiums than we already pay. The system pays for visits for specific services, not for giving us the time, attention and treatment that will best help us.

The system’s elected-politicians-imposed “negotiated fees” are brutally low, and Doc is contractually barred from charging us more.

So, Doc has to cut corners and keep the patient traffic churning at maximum pace, sometimes shortening our visits by sending us out unnecessarily to specialists, just to cover the practice’s business expenses and to net a decent take-home pay. You and I would love to have income equal to some specialist practices’ malpractice insurance premiums, alone.

But, there’s good news. Congress and President Obama recently enacted legislation creating many welcome care-delivery innovations. Among them is a new health-care-provider payment concept, the “Merit Based Incentive Payment System” for Medicare, to reward the quality and effectiveness of service, instead of the number of patient contacts that providers generate.

A historic piece of legislation! Slowly we’ll see MBIPS developing and taking effect. And if we can voter-power convince our legislators to impose it on Medicaid and the health insurance industry, we’ll see shorter wait times and better quality of treatment.

Admirably, Doc has been able to keep the squeeze from being a lot worse, by inventing some cost- and time-saving innovations. For example, even though the practice receives no compensation for paperwork or for clinical research, patient records and government and insurance company reporting requirements, they usurp hours of Doc’s time daily. Now computer software provides instant access to far-flung patient histories and to treatment wisdom. Transcriptionists feed Doc’s spoken data into cyber records instantly as Doc works with the patient, confers with other docs and peruses records and resources. Smart computers transmit prescriptions, orders and reports, so Doc and assistants don’t have to stop to write or phone.

Paramedicals, nurse practitioners, physician assistants, nurses and therapists now perform routine patient service under Doc’s supervision, thus freeing Doc for the cases that need the most expertise and experience, and enabling simultaneous multiple patient treatment. Practices are businesses, and like commercial companies, they consolidate and merge, to provide wider and deeper services more efficiently and at lower cost under one “umbrella.”

So, why doesn’t the classic economics “law of supply and demand” produce more doctors yearning to partake of the promising paradise of flood-of-patients opportunities? Because a paradise it isn’t. One must be nearly obsessively dedicated to becoming a healer today, to tolerate the costs, time and sacrifices in medical training, and then to be rewarded with a mediocre income in light of other professionals’ earnings standards.

With a B.A. in business or a B.S. in the sciences, one can walk into six figures before age 25 in finance and industry. Instead, an M.D. aspirant must spend $50,000 per year and earn zero for four years of medical school, then two more years of grueling internship at slave-labor wage, then two or three more of residency at nearly the same wage, then a year or two of specialist fellowship. So, over a decade after college, the doc-to-be finally gets to earn a modest income, limited by “negotiated fees,” and already well over $1 million in earnings behind his/her classmates, plus interest-accruing debt averaging more than $170,000.

No wonder we don’t have enough doctors! Further, among the mere 20,000 annual medical school entrants, the few thousand who survive are divided more and more thinly among the rapidly expanding galaxy of specialties. If it weren’t for the training opportunities of the armed forces, Public Health Service and the VA to staff their needs in return for three- or five-year commitments, it would be a lot worse.

So, what can we do?

▪ Doc is reluctant to slow the schedule down. Too many patients need him/her. Understand and accept the reality that even the most efficiently managed medical office is deluged daily with patient emergencies, alarming lab and diagnostic reports mandating immediate doctor attention and action, tardy patients, new patients lacking vital medical history data, impaired and very sick patients unexpectedly requiring extra procedures and time, and phone conferences with patients’ hard-to-reach other doctors. Schedules often are impossible to keep. It’s the nature of the business. Besides, someday the interruption could be for your case.

▪ Quit procrastinating. Initiate the appointment process early on. If the delay becomes alarming, tell the staff, giving clear reasons. If urgent, ask the primary care doc to call the specialist for you.

▪ Keep yourself healthy to begin with, so you won’t need so many doctors so often. Yes, you didn’t need me to tell you this, or how to do it, right?

▪ Voter-power-urge your congressional and legislative reps to enact fee reform throughout the entire system, and to stop ridiculously over-the-top malpractice jury awards.

▪ When you first see your doc, tell all, including the facts that you’re embarrassed, feel guilty or secretive about, and the ugly ones that you’d rather suppress or deny – objectively, straightforwardly and completely. Doc doesn’t have time to laboriously detective-work them out of you; instead, you’ll be sent on endless rounds of specialist encounters in search of them.

▪ Comb your benefits and charges statements for errors, duplications and fraud. That’s a main reason that they’re sent to you.

▪ Take your own magazines with you to your appointments.

All of this is summarized from recent published literature and conversations with practicing physicians. For references, I’ll welcome your query.

Contact GARY NEWMAN at gary@gnewman.org.

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