The Doctor Will See You for Exactly Seven Minutes

Discussion in 'Fibromyalgia Main Forum' started by ephemera, Mar 22, 2006.

  1. ephemera

    ephemera New Member

    Interesting reading from today's New York Times. Well written & thought provoking lengthy article.

    March 22, 2006
    Op-Ed Contributor
    The Doctor Will See You for Exactly Seven Minutes
    By PETER SALGO

    WHEN politicians speak of America's health care needs, they often miss an important point: the doctor-patient relationship has become frayed. Patients aren't unhappy just because health care costs too much (though they would certainly like it to be more affordable). Rather, people sense a malaise within the system that has eroded the respect they feel patients deserve.

    There has been a shift in attitude within the profession. I see examples of it every day. I was making rounds in my intensive care unit recently when one of the interns presented a case. "This is the first admission for this 55-year-old male," he said.

    "Stop," I said. "He is a man."

    "That's what I said," the intern replied.

    "Not exactly," I answered. Clearly, the intern didn't get it. Neither do a lot of other health care professionals anymore.

    The problem has been sneaking up on us for almost two decades. As health-care dollars became scarce in the 1980's and 90's, hospitals asked their business people to attend clinical meetings. The object was to see what doctors were doing that cost a lot of money, then to try and do things more efficiently. Almost immediately, I noticed that business jargon was becoming commonplace. "Patients" began to disappear. They were replaced by "consumers." They eventually became "customers."

    This may seem a trivial matter, but it is not. You treat "patients" as if they were members of your family. You talk to them. You comfort them. You take time to explain to them what the future may hold in store. Sometimes, that future will be bleak. But you assure them you will be there to help them face it.

    You treat "customers" quite differently. Customers are in your place of business to purchase health care. You complete the transaction such a relationship suggests: health care for money. And then they aren't your customers any more. Taken a step further, you can make the case that the less time you spend with your customers, the better your bottom line will be. This gets everyone's attention.

    "Length of stay" became a buzz phrase in hospitals in the 1990's. So did "throughput," an awful neologism for the number of patients per hospital bed per week. One of my colleagues joked that a hospital stay was a lot like a taxi ride. The institution collected a big fee when a patient got admitted, just as a cab driver saw most of his fare when he first turned the meter on.

    The additional money collected over time wasn't nearly as impressive as that initial charge. The economics of the situation favored short trips, or lengths of stay, and lots of new riders, or throughput. The arithmetic worked, but I didn't notice a lot of people laughing.

    Doctors in hospitals all over the country began hearing the same business language and facing the same pressures to "keep things moving." I used to be asked how well my patients were doing. Suddenly administrators were asking how long I was planning on keeping sick people in the intensive care unit. Each day a patient spent in my unit was a day some other paying patient would have to wait for a bed. Eventually, I was warned, some of those patients "in orbit" would go elsewhere, and we would not only "lose their business," but we risked losing future referrals from other centers.

    It wasn't just hospitalized patients who were taking up space other "customers" could use. Outpatients "consumed" health care "resources," too. Publicly traded H.M.O.'s, for example, began restricting doctors to an average seven-minute "encounter" with each customer. This apparently kept shareholders happy. But it reduced the doctor-patient relationship to a financial concept in a business school term paper.

    Doctors know you cannot provide compassion in seven-minute aliquots. But we have felt powerless to change things. The medical establishment has, many of us feel, simply rolled over and gone along to get along. It has sacrificed patients' best interests on the altar of financial return.

    This leaves the solution to the problem in the hands of our patients. You, the patient, are the system's best hope. In the age of seven-minute health care, you need to realize that you employ doctors. That is, your doctor works for you. Although doctors shouldn't think of patients as customers, you can, and should, adopt a business mind-set when shopping for health care.

    Evaluate what it is you expect from your doctor, then ask for it. If you are unhappy with your doctor, fire him. If you cannot get more than a seven-minute face-to-face encounter with your doctor, he needs fewer patients. The true power in the health care economy rests not with the doctors and certainly not with the backroom business staff. It rests with you. If you insist on being treated with care and respect, you will be. And the system will improve as a result.

    A pediatrician I know put it quite succinctly. "There are a lot of doctors in town," she said. "There's no need to settle for one that doesn't treat you well."

    In one respect the business people are right. Restoring the doctor-patient relationship will not save anyone any money. But I submit that it doesn't have to. There are other ways to curtail health care costs. Some involve high technology; others do not. None of them requires patients to sacrifice their self-respect.

    We can and must reduce health care expenses. But we cannot do it at the expense of patients' well-being. The doctor-patient relationship is critical to the integrity of the health care system. It is not disposable. Turning doctors into shopkeepers who regard patients as customers is unacceptable.

    How will the M.B.A.'s and the politicians respond to what can only be termed a "patient-driven revolution"? They will have to cope. I suspect doctors will be thrilled.

    Peter Salgo, a professor at the Columbia University College of Physicians and Surgeons, is an internist and anesthesiologist, as well as the host of the PBS series "Second Opinion."


  2. kaiasmom

    kaiasmom New Member

    Thanks ephemera, that was interesting. I have to say, I have Kaiser, and despite my pretty good doctor, I feel like one of a herd of cattle being herded around that place when I'm there, weaving through all of the other cattle....I know, it sounds silly. But, that is how it feels.

    Take care,
    Leanne
  3. gypsysoul

    gypsysoul New Member

    great article from a Dr's perspective. Thank you.
  4. ephemera

    ephemera New Member

  5. Shannonsparkles

    Shannonsparkles New Member

    ... that they are running a business. And it's sad, and it shouldn't be that way, and it takes away from what is called a "caring profession", but that's how it is.

    So, I've been looking at it from a business prospective too. I am the customer, and the customer is always right. If one 'business' doesn't treat me well, then I can take my business elsewhere. There are plenty of places to choose from. I'm too old and to ill to settle for a doc who is mediocre or who doesn't seem to care.
  6. gongee

    gongee New Member

    I think that article says it all. I have been with my primary physician for several years. He has been so helpful and I thought he really did care about his patients. Well, now I am beginning to wonder. I received a formal letter from him stating that he was leaving his practice of over 29 years and going with another practice that I was welcomed to follow with him. My first reaction was YES, until I found out that the practice he is going in with charges a $1700 membership fee per year as well as your co-pays or self pay charges. I was so disappointed. No way am I able to do with as I am on disability. After the initial shock, I really thought hard about this and to me no one should have to pay for good healthcare. A doctor that is only in the medical field for money than the compassion of caring for patients isn't for me. My son, who is now a medical resident, made me realize this. In his opinion,
    if a doctor is only in medicine to make a buck, he needs to get out. You take an oath to become a doctor and no where in that oath is money involved. I am now interviewing other physicians to take his place and thank God for my son who has given me the questions to be sure to ask. If I don't receive the answer I'm looking for, I will move on to the next. Thanks for posting this article.
  7. livin4him

    livin4him New Member

    do you mind me asking what questions you ask doctors?
  8. Cromwell

    Cromwell New Member

    WHO WORKED FOR A LARGE OUTFIT. He was so fed up with the number of patients he was supposed to rush through, he and another doctor branched out by themselves this way. They asked us if we wanted to stay with them, would we be willing to pay $45 each amonth for unlimited doctor time and 24/7 cover even home visits? Family membership was $90.

    This way, they would only take on 200 patients and thus be well rested, have a ton of time etc.

    Although we are low low income we decided to do this. Guess what, all the free meds we got added up to more than the $90 in any case, plus we always felt so well treated. Always got same day appointments, great advice, help etc.

    Unfortunately, we moved and I miss that service. The point is that if they could do this for just $108,000 per year guaranteed for the office etc.(we also paid our usual insurance or medicare etc.) why are other doctors so pressed to see so many patients? These two doctors explained that all that was needed was $50,000 per doctor guaranteed, and all doctors could then see just 100 patients on their "roll". All else was greed. Just passing this along, this worked for them and they have now been in business five years.

    Love Anne C
  9. jackiegraye

    jackiegraye New Member

    A very good article!
  10. ephemera

    ephemera New Member

    I think it's time we really ask ourselves & talk about what we as individuals want in a doctor & what we will tolerate or put up with in order to get the kind of caring service & trust we need as patients.

    Like, how many miles will we go via car, public transportation, catch a ride with a friend, etc.; what the office hours are -- such as evening or weekends; how long will we wait in an office to see the doctor & what kind of environment is that waiting area; what time limits does the doctor place on our appointment; how competent, caring & human is the staff (receptionists, nurses, techies, etc.); can the doctor say "I don't know" when it comes to our specific health issues; can they refer us to a specialist without harming themselves through the health care system that rewards doctors who don't refer patients to specialist. ETC.

    I have been with my primary care doctor since 1990. I've had lots of health problems & surgeries & procedures. He's easily able to say that I've often presented symptoms which he isn't familiar with & has actually gotten his Merck Manual & PDR from his office during my visit. Most of the specialists he's referred me to have been helpful. For my major problems like FM/CFS & hypermobility I've been on my own & that's been OK with me.

    The practice is a small group of internists (3 women & 1 man) does not allow any drug reps on the premisis, nor do they take any pharmaceutical freebie gifts; hence, they don't have free samples of drugs that some patients may need desparately due to finances. I've been able to live with that but many cannot.

    I can relate lots of reasons why I like my doctor. Maybe just 2 will suffice. In 2001 I had spinal surgery at a local hospital & had a very difficult experience both during surgery & recovery. My physician was out of town, but at 5:30am when I was still awake in my hospital bed in walks one of the associate doctors to check up on me. I was astounded & shocked to see her. Imagine, coming to see me before going to the office to see her patients starting at 7am! I had no idea they did that & I'm not sure all hospitals would allow that today.

    Another example of what I consider above & beyond level of care is when on a Friday I left a message at the doctor's office concerning an upcoming procedure. It wasn't urgent & I said I'd call back the following week. 9pm that Sunday night the phone rings & it's my physician who is snowed in after attending a medical meeting. He couldn't get back to the office for 2 days & was responding to his patients who'd left messages. I was floored at his level of reaching out & personal concern.

    He doesn't walk on water & he's too conservative in some of his approach to my needs, but I know whenever I move I will be hard put to find another doctor I trust as much.
  11. gongee

    gongee New Member

    Sorry, it has taken me so long to respond to your question.
    Haven't been on the computer much due to this flare I'm in.
    The questions I have been instructed by my son to ask (and these are just a few) He was really busy at the time (delivering babies) but he will be giving me some more within the week. They are as follows:

    1. How much education have you had in Fibromaylia,Chronic
    Fatigue and Chronic Pain and where did you acquire it?
    2. Approximately how many patients do you treat with
    these illneses and how often are they seen on a follow-
    up basis by you?
    3. How much time are you able to invest in these patients
    when they come in for a visit?
    4. Do you treat their symptoms yourself, or do you send
    them out to other specialists?
    5. If you do send them to other specialists, do you
    follow up with that physician in order to set up
    a treatment plan for that patient?
    6. What means of treatment do you use (drugs, physical
    therapy, alternative, combinations etc.)?
    7. What is your success rate in treating these
    patients?
    After he gives me the rest of the questions he wants me to ask, I will post them so you will have them. He did say yesterday, that he may call the physicians that I will be interviewing on my behalf just to make sure they are a good match for me. He said that even though a physician is educated etc. they also need to have a caring, listening attitude. Yes, he says they are busy, but in his opinion what are a couple of extra minutes if it can put a smile on a patient's face, especially when their future is so unknown.
    Hope you don't think I am boasting, but I do think my
    son really knows the true meaning of medicine. Take care and hang in there.

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