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Hippa Oath 1How are things working these days with your doctors? I thought we might take a few minutes and compare notes.

I remember the old days. When doctors made house calls. Now, they barely make office calls. Think I’m kidding? When’s the last time you were able to call your doctor and actually speak to him or her—when it was good for you, when you had the need? Not for a long time in terms of my experience.

First of all, it’s rare that a human being even answers the phone. It’s usually a machine that has no interest whatsoever why you’re calling. “If this is a medical emergency, don’t call us. Hang up and go to an urgent care facility. If you’re unable to do that, call 911. Just know that we’re not responsible to anyone other than our malpractice carrier and you can’t count on us for anything.”

An exaggeration? Maybe a little, but not much. Most are not candid enough to include the last sentence, but pretty soon the recording won’t bother with the beginning part, “If this is a medical emergency. . . ” It’ll just begin with “Hang up. . . .” The only time you can get the machine to put a human body on the phone is if you want to make an appointment—in about three or four weeks. God forbid if you need a question answered or a prescription renewed or one of your medical records.

My doctors are fairly competent, professionally speaking. They’re even kind of nice folks on a personal level. Why else would anyone put up with their administrative mediocrity? It’s become universally acceptable to them not to return a call, let alone take one. If that used to bother them, it doesn’t seem to any longer. They rationalize that they’re too busy to do that, to discharge their ethical responsibilities. Too busy doing what? Not taking calls, that’s for sure!

They used to return calls. Why not today? What’s changed?

The superficial answer is that they’re too busy taking on more patients than they can responsibly handle. Why is that? Business that good? Nope. It’s because business is that bad. They’re seeing way too many patients because the government and the insurers have squeezed them so dry they have to do that just to make a fraction of what they were told in medical school they could expect to make.

So, ain’t it just great? Thanks to Obamacare, we all can get insurance today. But Obamacare has so prostituted the medical economic infrastructure that the insurance isn’t really worth having.

Here’s an illustrative real world experience I just had. I needed one of my prescriptions refilled because I was almost on empty and I was about to go out of town for two weeks. Called my pharmacy to get a refill. Was told my prescription had expired, but not to worry, they would contact the doctor for a new prescription. They called me back the next morning. The doctor’s office was not answering the phone—in the middle of the day! They sent a fax request to the doctor. In fact, they sent three faxes. No response to any of them.

I finally got through to the doctor by email. (She must have been worried about her malpractice exposure once there was a record that she was on notice of my need.) Her answer: “We respond only to fax requests from the pharmacy and we need a week to do so. You should have known when the existing prescription would expire. The pharmacy tells you that.”

Nope. I had the pharmacy paperwork in hand. It told me I had nine more refills. It didn’t tell me that those refills authorized by the doctor ran beyond the one-year life of the prescription, that the doctor must have been delusional when she checked off a number of refills that was meaningless. (Nor did she bat an eyelash when that was pointed out to her. I would have felt pretty foolish.) So, I asked her what I was supposed to do since my stash was about to run out and I would be out of town for two weeks. Begrudgingly, like she was outdoing Sister Teresa, she told me she’d take care of it the old fashioned way, she’d call in the new prescription to the pharmacy on the spot. Above and beyond. How sweet of her. I feel like I should send her malpractice carrier a thank you note.

I asked the doctor to please tell me the date she issues a new prescription in the future so I can keep can track of things and assure that she receives fax requests at least a week in advance of the next need for a new prescription. Nope. She won’t do that. I have to get that information from my pharmacy. Silly me, I thought my doctor was . . . my doctor.

My doctor may not be happy with her economics in today’s environment, but she’s darn lucky she’s not a lawyer. My clients would never put up with my telling them they’re there to serve me instead of the other way around.

Think I’m going to check into the local hotel. At least they offer concierge service. So much for the wisdom and value of Obamacare.

How’s it working for you? Let me know. If it’s any better for you, maybe I can sign up where you are. Lord knows it ain’t working where I am.


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  • I feel your pain, Ron. Obamacare has messed with everyone.

    My hubby is a family doc, and he goes in to the office every day at 4am.
    I. Am. Not. Kidding.

    He doesn’t see patients until 8:00. All that extra time is for PAPERWORK (some of which is because of Obamacare).
    I’ve seen him when he’s on call; he always calls the patients back. And I know how hard he’s working…trying to make the same amount of money he used to make with far less hours. (Thank you Obamacare.)

    On a side note: Gone are the days of small family clinics; most of the hospitals and larger clinics are run like businesses rather than a place that actually cares about their patients. They don’t care how much time the doc spends with each patient…all they think about is the bottom line: How much money is this doctor bringing into the clinic…lets give him more patients…is he worth keeping…etc.

    Here’s another thought…perhaps the girls/women/ladies/people (trying my best here to stay PC) who work for your doctor are not doing their jobs. Maybe your doctor didn’t even get the message you left. (Another thing my dh [dear husband] complains about…those people NOT doing everything they were hired to do.)

    Dealing with the insurance companies is another story. Some docs have lost many of their life-time patients because the clinic they work for no longer accepts whatever new insurance said patient (sadly) ended up with after OC.

    My dh is sick of the whole mess, as are millions of other doctors out there. What are we all (patients) going to do when they quit or take an early retirement because the system is so screwed up?

    Good luck, stay healthy, and hope you have a safe trip!

    Sharon

    • Thanks, Sharon, for sharing the perspective of that rare medical professional who is still . . . professional. I’m not the least bit surprised to learn that your DH does not remotely fit the emerging mold. If he brings half the discipline and commitment to his profession that I know you to bring to yours, then he of course would not fit the mold I was describing. The problem, however, is that your DH is a disappearing “relic” swimming upstream against the tide. There will always be the kindred exception, but they are becoming fewer and further between, which is really the point I was trying to make.

      Our political “leaders” and the lobbyists to whom they cater have made a complete mess of health care in our country, for the doctors and their patients alike, while those who voted for Obamacare (almost none of whom read, let alone understood, it) walk around patting themselves on the back and professing that they are the heroes who have brought us universal coverage (in spite of the fact that the universal coverage they have brought us is not worth having. And that’s today. Wait until tomorrow.)

      See also my reply to Elliott’s comment posted above (meaning after yours).

  • Elliott Balbert

    Well this was an interesting story. Unfortunately it is too common place. My first suggestion (excluding a political reply) is to go find another GP or primary doctor. Even specialists will, on some occasions, accept a patient for GP work depending on the individual or the circumstances. If you have a particular doctor you like ask him or her if they would consider handling your everyday needs and point you in the right direction for specialty situations you need form time to time. Add, that basically you would like and need “1” doctor who will be your primary care doctor where everything can be fed into one point.

    If this sounds like a Concierge service it is……and in some cases a physician will provide those services at no extra charge. Clearly we all need a patient advocate but it starts with you. If that isn’t your type personality, then have your wife, brother, sister or someone you trust very, very much to help you look out for you. Think of it as the executor of your estate on your will……but this is before you die (haha).

    My wife and I decided several years ago that this was the service we needed and wanted. So, we found a “Concierge Doctor” and for the two of us for $5,000 per year we signed on. We have his home telephone number and his mobile number. We were told to try the office first during normal business hours and “ANYTIME” other than office hours call his mobile and he answers that personally. He would take an active role in our well-being for both preventative care as well as normal office needs. when we have a cold or any normal medical need we don’t need to make an appointment for him to tell us we need to fill a cold prescription and get to bed. That is a waste of everyone’s time and money………we discuss it together, determine from the conditions and severity what is the next step and then act on it. There is no extra bill for this service. If absolutely necessary he will make a home visit.

    On two separate occasions my wife and I required immediate medical assistance. He told us to head to the hospital emergency room and he would meet us there and coordinate treatment. He did and what a comfort that was. There are more types of specialized care that is provided and so I could go on at nausea. The question to answer yourself is this worth $5,000 more or less a year. Personally I’d pay twice that for proper medical care, maintenance and observation. Yes, you will still get your regular office visit charges when you go, ad pay for x-rays, MRI’s etc. To me it is the “total package” that has meaning. Oh, one other thing, if you call for an appointment before 10:00 AM in the morning he can still see you that same day…with no waiting in the waiting room. The first question someone might ask is “How do you pay for that”. My response is “How can you NOT pay for it.”

    If any one is interested am happy to pass along their name and contact information. The medical profession and its services are changing dramatically in real time. Get ahead of it while you still have the chance. So, Ron, don’t know if this addresses your plight, or others reading this, but hope it stirs some thinking.

    Elliott

    • Thanks for sharing your insight and experience of one way to get past the mess that now serves as our country’s healthcare system.

      In an attempt to make my blogs more intimate than they might otherwise be, I often, if not typically, write from a first person point of view, even if that requires me to take some literary license to achieve that intimacy. I am aware of the concierge approach you describe. Note the comment in my blog: “Think I’m going to check into the local hotel. At least they offer concierge service.”

      Like you and Cheryl, and many of our friends who also use concierge services to circumvent the woefully sad excuse for health care that prevails across our country today, Barbie and I are also able to avail ourselves of a concierge solution. Beyond that, I have the fortitude, as well as a delicately and tactfully applied skill set, to achieve proper medical attention when we need it. See, for example, precisely how I broke the logjam in the case I described in my blog.

      Aside from the referenced intimacy technique, my blog was not intended to complain about Barbie’s and my circumstances. My concern was not for the 1% who can afford to write the $5,000 per year per couple concierge premium that you and Cheryl are paying (or the $15,000 per year per couple concierge premium another couple with whom we are good friends is paying). This is a non-issue for the 1% who can write the check to buy a solution, and not adversely impact their standard of living one iota in doing so.

      Rather, my concern is for the 99% who can’t afford to pay those concierge premiums. What about them? In theory, more people are insured today than before Obamacare, but at what cost? The coverage they have is of questionable true utility and, to achieve that questionable utility, an entire dying middle class out there is now paying more premiums for dramatically less (and often inferior) medical service than used to be available to them.

      You speak of diligent effort to find the needle in the haystack doctor who will still provide service like we could all obtain in decades gone by. Perhaps there are a few heroes still out there, but they can’t begin to dent what is needed. See the comment of Sharon Ricklin Jones below.

      Other than for the 1%, I’m afraid the solution we need is not concierge “band aids” or the occasional hero. I know you began your comment by saying that you were not attempting to provide “a political reply” or solution, and that you just meant to constructively offer an alternative to those who can afford it but might not be aware of it. I appreciate that and I know that many of my subscribers will as well, but, again, my focus was directed at the greater number who can’t afford that alternative and how we are going to make things right for them. I don’t have that answer either.

  • Fred Taber

    We fax a request to our primary care physician/office to kindly refill our expired prescriptions with the Medicare mail order pharmacy about 1 month before they are due. This usually works!

    • Thanks for sharing your experience Fred. The key seems to be maintaining a handle on when each of your meds requires a renewal and then faxing a request to your doctors WELL in advance. Maybe I should send my doctor a bonus because she only requires one week’s lead time.

      • Fred Taber

        Our mail order pharmacy has an app which is pretty good about letting you know when prescriptions are expired.

        • So does ours, bu the key is in the modifier “pretty.” It doesn’t always work. If you rely on it, when you find out you need a renewal quickly, the doctors don’t respond quickly enough. I’m not picking on the doctors per se; they’ve been dealt a tough hand, but the problem is they’re still looking for everyone else to do their job, namely their patients and the pharmacies. I remember the good ‘ol days when the doctors did their own jobs, and in a much more timely fashion. I guess those days are gone. Sigh.