Sunday, October 1, 2017

Doctors Visits For The Low-Income, Less Educated, & Elderly Is Filled With Discontent

I grew up in a family that is amazingly full of healthcare professionals. If you walked through a family party you could bounce off a doctor or nurse or therapist like a pinball at any given pass. And as far as I know, they've all led great careers in helping, saving, and providing care to numerous patients. It's easy to tell how much they care about their jobs and the lives they affect because of the way they speak about their experiences, the love that their co-workers have for them, and appreciation their patients and their families exude towards these professionals. They are generally happy to be care givers and it shows.

I say all this as a background for what I'm about to rant about. I'm prefacing my disposition with this information because I don't want you to get the wrong idea about me. I am not intent on generalizing the entire industry, but highlighting unfortunate circumstances created by a select few.

I believe there are some underperforming doctors and doctor's offices who, sadly, seemingly don't care about providing good healthcare for all of their patients. In my opinion, they are in it for the money from the insurance companies. That's a bold statement. How could I say such a thing?

Have you ever been for a doctor's visit and spent more time in the waiting room than in front of the doctor? Have you ever made a list of questions for yourself to ask the doctor but felt so rushed that you forgot to ask something? Did you ever feel as if a doctor or nurse wasn't hearing your ailments but instead, jumping to a conclusion before you could spit out all the issues? I could not count on my hands the number of times I've lived through these experiences. I specifically feel as if the target are the elderly or the less educated.

Case and point, I help my mother-in-law (MIL) manage her medical visits. I do everything from setup the appointments to driving her to the offices to speaking with the doctors and nurses to having her medications filled at the pharmacy. I deal with a number of people along the way. I speak to the medical secretary, the nurse, the nurse practitioner, the doctor, the pharmacist, the techs, the lab, and anyone else I have to so that I can ensure that all the proper procedures are followed, visits are organized, and scripts are executed.

She's my MIL, so as you may have guessed, she's elderly. And in this case, she is also not as well educated as her children nor is she as fluent an English speaker as she could be. Every single time I take her for a visit, this is what I experience.

  • We are forced to wait in the waiting room for hours. In some cases, we may make the very first appointment for the day, and end up waiting for the doctors to even show up to the office. 
  • Once we get into the exam room, the nurses have no idea what the visit is for. They have not read the chart or the reason for the appointment. They revisit the list of medications and ailments, and on a number of occasions this information is not even correct and needs to be updated. 
  • When the doctor comes into the room, it's as if he didn't read the chart nor did a nurse give him an update prior to him entering. We start over. 
  • Then before we can complete our sentences about what the visit is for, he/she has already come up with a conclusion as to how we need to proceed. They advise X and Y with a side of Z. Take 2 of these, pick up your fries at the counter, and come back in 2 weeks. 
Without fail, this is the order of operations for a given appointment for my MIL. And believe me, I've complained about the process. I've corrected every error. I even need to slow the doctor or nurse practitioner down in their tracks. I ask questions and I clarify things that my mother-in-law does not have the capability to do either because she didn't understand the medical jargon, they spoke too fast, or because she just couldn't think to ask or clarify in the brief moments before the doctor said "see you next time." And if it wasn't for me slowing them down, I could see the advantage for doctors would take of my MIL. How so? 

The easiest way for doctors to make money is from insurance companies. In order to bill the insurance companies, a patient has to physically visit them. Simple as that. For any of the low income or elderly patients, I have to imagine that the doctors are in-the-money. In other words, they can't lose. 

If I wasn't around, they'd be getting multiple visits from my MIL. Each visit would go just as the previous (quick and unresolving), and each time the doctor would make a collection from the insurance company. And the more patients the doctors can treat in this fashion, the more money they can collect. So doctors are incentivized to move quickly. 

Let's just say for example, an average doctor's visit should be 15 minutes (actually face to face). For every hour they work, they would see 4 patients and in the course of an 8 hour day, 32 patients. BUT if they cut the time spent with each of their patients to 10 minutes, they can effectively see 40 patients a day. That's 8 more people than they should, but what dollar amount does that translate to? If you know anything about how much healthcare costs, you know that they made a pretty good chunk of change for saving a measly 5 minutes per patient. 

But what did the patient get out of it? Obviously they didn't receive the full potential of care. They were shorted 5 minutes. That 5 minutes could have been 2 or 3 questions that could change the course of their visits. Those patients were short-changed the amount of good information they could have been educated with. They were rushed or felt rushed and could not properly understand everything being discussed. They forgot the important things that needed to be heeded. They weren't given the time to clarify. And most importantly, they couldn't even reason with themselves to determine if the doctor was accurate in his estimations and findings. 

How many people take their elderly parents or low-income relatives or less educated friends / family to the doctor to ensure they're getting the proper treatment? I would bet not many. Because we are not their keepers. Because we think they can do it on their own. Because our parents think they are still capable of managing on their own. But there is a point in time where they start to miss things. Where they lose track of the important aspects of their visits. Where time is no longer on their side. They need help. 

And I believe doctors and doctors offices take advantage of this. If there was no insurance companies, I think doctors and other healthcare practitioners would provide better care and take more time for their patients well-being. Even if they charged a high hourly rate direct to the consumer, at least the onus would be on the patient to properly ascertain medical care with experts willing and able to do the right thing. 

If I could analogize it to the work of an accountant or lawyers, I'd give this example. Accountants and lawyers charge their clients on an hourly basis. They scope out the work to determine how long it would take and give their clients an idea of how much time is necessary. Clients then decide whether or not to engage the service provider. But when they do, clients know that these professionals are going to give them their best work and make sure that all realms of the scoped (and sometimes the out-of-scope) jobs are executed with the best interest of the clients in mind. 

If doctors took this route, I feel as if both the doctors and patients would mutually benefit. Doctors would be paid their just due, and patients would receive the best care possible.

So what am I asking for? Doctors - Take your time. Have some patience with your patients. Listen to what they have to say and answer their questions. Make sure they understand everything you explain to them. Give them the best care, the care that they deserve. (1428)

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