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Casino.  Paul Goldfinger Blogfinger.net. You may have seen this photo before, but our Casino posts are all about lifestyles with an emphasis on Ocean Grove.  Anyone can do a search at Blogfinger.net to see more Casino fun and games.

Broadway cast recording from Cabaret..

Paul Goldfinger, MD, FACC.    Editor; Blogfinger.net. 2023 re-post

Have you noticed that your mobile phone has become an indispensable part of your life?  In the past you could take it or leave it.     We had “land lines” at home  and we generally had no need for  a mobile phone.  If someone wanted to leave a message you had an answering machine. And there were always phone booths.

Here’s a Blogfinger link you might enjoy:

phone booth remembrance

At first our mobile phones were novelties, and we didn’t consider a text message or an email to require immediate attention.

For me I would look for voice mails or emails or texts when it was convenient for me,  and I often didn’t carry my phone with me.

I was the master of my electronic fate.

But all that has changed.  People contact you by texts or emails and they expect  your immediate attention.  They don’t like to phone you because that requires  an actual conversation, and they want immediate access without dialogue.

And some get annoyed if you do not treat their texts as emergencies.

In healthcare, I now  find myself receiving texts and emails from  doctors’ offices,  and  information and messages from corporate communicators such as RobertWoodJohnson/Barnabus “MyChart.”

These sources badger you with their endless emails and texts. All of a sudden we are compelled to respond to our mobile phones, often several times per day, and their messages often give us jobs such as  to read the latest note from “My Chart.”

These people send you links to their sites every time anything occurs in your record.  For example if you have a phone conversation with a nurse in a doctor’s office, a written record of the call appears in your on-line “chart,” and you are notified by text or email and ordered  to read it. The RWJ conglomerate is particularly annoying that way.

Or if you have an office visit, a link is sent to you within an hour to read what the doctor had to say at your visit. This deluge of information generated by corporate healthcare and sent to your device interfere with your life on a daily basis and makes your iPhone a  primary focus.

Why is this happening?  Beware of mind control by these providers.  Their main interest seems to be  to document services that they  bill for  such as a phone conversation with a medical assistant.

The biggest problem that I see is in the area of outpatient communication: There is  a confusion of ways to communicate with doctors’ offices using mobile phones.  The  issue becomes  apparent when  you try  to call your doctor.   A patient will often find this to be challenging and frustrating.   Providers do not want to converse with you. Corporate management wants you to do it all on line.

The industry hasn’t figured out exactly how to deal with medical office inquiries by phone. Whereas you may be  trying to reach your doctor with  important medical questions,  in the doctor’s office their  priority seems to be to block you from making contact with your physician.

Calling on the phone  you are often confronted by robotic devices and robotic people who pick up your calls.  And medical offices have a variety of ways to handle patient inquiries.  So you are not sure what to expect.

Doctors will often  not call you back, and often their assistants (nurses or medical assistants) may not  return calls either.

This is my biggest gripe because the phone dopes who pick up calls  at the front desks are often clueless, and no one seems to be doing critical triaging; so you may find yourself frustrated and angry  as you keep checking your phone for a response to your  call.  It seems that office personnel have been trained to avoid allowing patients to speak to their doctors.  And the are often not medically trained.

Doctors do not call you back because they don’t get paid for phone calls and they are too busy and understaffed.  We expect to find expert information by calling our doctors, but that is often impossible, and the idea of putting the patient’s best interest first is being abandoned.  If you read drug information, they always say, “If you are having a problem with medication, call your doctor.”   Really?  Not!

Consider some of the variations I have experienced in trying to get to speak to my doctor:

Type A:    You call your doctor’s office,  and  today my call was picked up by a machine which said, “Can you please hold on a moment, thank you.”    I hung up after about five  minutes of silence, which I think was the desired outcome.  There was no opportunity to leave a message and no human to pick up the phone.

Type B:  You call the office and get a machine which lets you leave a message.  You have no idea who will handle your message. And you may or may not get a call back.  The latest meme in this situation is that you are expected to wait 24-48 hours before receiving a call back.

Type C:  You call and someone answers the phone. You ask if you can leave a message for your doctor.   She resists and says, “The doctor is not in this office today.”   She tells you he will be there in 2 days.

You ask her to send your message to him, not to wait till he catches up to your message in two days.  She takes the information.   But you have been speaking to someone who has no inkling of what you are talking about.  No one calls back after two days.

Type D.    A person picks up your call.  You begin to speak when you are interrupted with something like, “What’s your birthday?” You respond and try to continue your explanation, but they cut you off again, “The doctor’s nurse is with patients.  She will call you back.”  Maybe!  You hope to talk to the nurse since you have given up hoping to speak to the doctor. But the nurse doesn’t call you back.  You are left with an empty feeling—-what happened to American quality healthcare where the patient comes first?

Type E .  A machine answers your call and says, “We are very busy. Call us back later.”  There is a small  chance that anyone will answer your call when you call back.

Type F.    “We are at lunch from 12-1. Call back later.”  No one  will talk to you during that hour. There is no way to signal that you are in bad shape.  Better call 911 or go to urgent care.

And there are other variations on the theme. I could go on and on, but you had better carry your phone everywhere.   We-the- people are forced to respond to this electronic deluge or miss important information.  I welcome the information, but I want control over how I process it all.

Corporate healthcare is taking over traditional care,  and the results suggest a decline in quality,  an increase in patient frustration, and a financial priority. The nurse strike at RWJ has been going for two months.  A disgrace!

Some large practices offer text access and responses from “general practitioners,” and some offer tele-visits which are also useful and rewarding.

Such communication concerns should, I hope, be fixed by improved electronic methods and industry wide procedures.

But putting barriers between patient and doctors is wrong and  unfortunately becoming routine.

I have not seen statistics, but I wonder if  the frequency of malpractice cases has risen dramatically.

As for my iPhone,  it has become too heavy, and I am always putting it down and losing it. Now I have an over the shoulder holster with a special disc on the phone to help me locate it. I really dislike my phone.

I’m glad I am not practicing medicine any more.  Doctors no longer control their professional lives, and burn-outs and early retirements are rampant.

And all of us folks must carry a mobile phone—I hate that.

Calm down and hear some music:

Caetano Veloso (vocal) and David Byrne (guitar) at Carnegie Hall. “Linda.”

Amaryllis photo by Eileen Goldfinger. 2/15/26. One click to enlarge.

This plant, amaryllis, is usually purchased with  wax coating which has all the nutrients required by the plant. After  blooming for 8-10 weeks, cut off the flower stem, peel off the wax coat, and then plant the bulb so that only the bottom third  is in well drained potting soil.  Leave the green leaves on the plant until they turn yellow and wilt.

Then cut off the yellow leaves and eventually new green leaves will start to grow and then a flower stem will appear around December/January.

6 years ago at Christmas time,  Paul  gave this plant to Stephen Goldfinger.  The bulb was wrapped in wax from Wegmans.      He followed the recommended procedures with great care,   and now the plant continues to bloom each winter.

“Flowers” by Miley Cyrus.

The New Yorker.

By Paul Goldfinger, MD, FACC.   Original post Sept. 2023.

And I also posted a piece about communication in healthcare in October 2023.  I apologize for any duplication and for the length of this post, but I am angry!

https://wp.me/pqmj2-SEp

I am a retired physician who has now experienced healthcare at the receiving end and I am not happy.  When Obamacare rolled in I wrote editorials on my site--Blogfinger.net,  predicting that quality will be negatively  affected, and my conclusions were  based on the ancient concept of always placing the patient first:

I find that the changes which are rapidly taking hold in healthcare  may result in declining aspects of  quality.  I don’t want to be unfair, but often when I interact with healthcare  I look around and  find issues to complain about.

It’s usually not a problem of technology or facilities—that has been remarkable, but it has more to do with basics that are the same now as 50 years ago when I started working as a doctor and it is  now often about new management methods  mandated by corporate healthcare giants.  I read of one company in the midwest which owned 100 hospitals.

These companies want to change everything. Sometimes the changes are innovative, but often they are about maximizing profit, leaving patients wondering “why?”   And management medical decisions may not include input by physicians.

Four  of my favorite Monmouth County doctors have left practice early.  At a national level, doctors are leaving medicine in droves, many suffering burnout, and most practicing doctors would not pursue medical careers again according to one survey.

Protect yourself by questioning and doubting what you are experiencing regarding your diagnoses, treatment, access too care, and doctor-patient relationships. If you can’t ask questions find someone, a patient advocate,  who will help you navigate your situation.

When in doubt, get a second opinion.*

Here is an incomplete list of some of my concerns. Consider this a warning flare bursting in the sky.

a. Doctors often no longer own their practices, so they are now employees who must take orders, such as my pulmonologist who was ordered to spend only 10 minutes with each office patient. That is ridiculous. Physician  flexibility and control  are being compromised.  Only a small percent of practicing doctors, perhaps less than 30%, actually own their  practices.

The management of medical  practices is often via corporate  efficiency experts whose main priority is to maximize reimbursements..

b. You can call a medical  office and ask to receive a call-back from your doctor, but you often receive resistance, deflection, or else a “physician assistant” or just “assistant”  calls back and her priority often seems to come between you and the doctor.   It is unusual for the doctor to call you back these days, and the person calling you back may not even be a nurse. So who will answer your questions? Better make an appointment if you can get one soon.

Speaking to the patient on the phone is discouraged because it doesn’t pay.  Sometimes an office may make you wait 2-3 days before returning a call. And this may occur when the situation warrants an immediate call back. Phone consultations may provide a solution to an issue without having to have an office visit, but that approach has been buried.  Saying that the doctor is very busy, “seeing patients,”  or is in another office may be the truth, but those excuses  should not be acceptable answers.

If you call an office you may be greeted by a computerized triage system where someone with no medical training is empowered to make  decisions about your care such as when you might be safely seen by the doctor.

Front desk phone answerers may, without any medical credentials, ask you questions such as, “Where is your pain and what does it feel like.?”   Sometimes you are given an appointment which may be scheduled for one or two months away.  (“We have an opening.”)   Who is making that triage decision?   To me this is practicing medicine without a license.

I recently spoke to one of those front desk flunkies.  I wanted her to leave a message for the doctor to call me back, but I needed to speak to someone medically responsible to run with the ball.  As I tried to explain to her why it was essential to be responsive to my concerns, she got angry at my questions and she hung up.  I had to speak to the office manager to make sure that someone responsible would call me back.

c.  If you seek a physician’s care you may be offered a nurse or a PA as if they are” just as skilled as a doctor.”   That is a lie, and the AMA agrees with me.

d.   Some doctors belong to medical groups which have affiliated with a large  corporation, such as the Robert Wood Johnson Barnabas Health.   This company, based in New Brunswick,  has been striving to access patients from Monmouth County and they have their eyes on our area including Ocean Grove and Fort Monmouth.

What you are seeing  is corporate takeover of healthcare in communities.  It’s been awhile since I have heard the name  “regional healthcare planning.”

Some  physicians who have  contractural affiliations, such as with RWJBarnabas Health,  may have a conflict of interest by insisting that the patient go, for example, to Monmouth Hospital instead of Jersey Shore or by referring patients for specialized attention to their referral centers out of this community.

For instance, RWJ provides some specialized services in New Brunswick. You could be sent to such a place when there are  providers nearer your home. Going to New Brunswick can be difficult especially where RWJ hospital is located. What about placing the patients best interests first?

e.  And who is providing your care at Jersey Shore University hospital?   I have been to the Jersey Shore ER  recently  where highly qualified attending physicians/specialists were not visible despite the hospital’s list of consultants.  And the ER staff was overwhelmed.

In the past, if you  were a  patient in an ER  or medical surgical hospital in-patient  unit, you could expect your doctor and/or consulted specialists to manage your care in person.

One medical  group in Ocean has affiliated with RWJBarnabus Health and resigned from Jersey Shore.  As a result, they do not go to Jersey Shore even if you are brought there as an emergency.  And if you live in Ocean Grove and need surgery you will be sent to Monmouth Hospital by that group.  Taking such decisions out of the patient’s  hands is not in the patient’s best interest and there is a glaring conflict of interest interfering with quality care.

And if you are an inpatient, find out who is the attending physician named on your chart and see if he comes to see you or if your care is by unknown unmarked  proxies:  resident physicians  or medical assistants.  And such practitioners are of uncertain competence, and you often are not informed as to who is who. Not knowing who is in charge of your case is scary.

See if board certified specialized care is available  and then demand such attention if needed.  Patients need to pay attention to try and judge the quality of their care ins the hospital.

And take a look at who is billing your insurance company for your care.  Look at your EOB’s (explanation of benefits.) Are some doctors billing who never actually showed up at the hospital, relying instead on covering house staff  who are not fully trained or poorly trained.  This is obscene, and Medicare should investigate.

And don’t believe billboards:   Monmouth Hospital says that it among the best in the country at  educating doctors, and Jersey Shore says that it is one of the best hospitals in New Jersey.  Never believe those phony surveys.  And that includes those lists of “best doctors.”

f . Record keeping  has become onerous for  doctors in the office typing on a computer keyboard while trying to take a complete history, perform a physical exam, analyze your case, and give you advice. There is never enough time.

The doc is expected to create a competent and complete chart note before you leave. Some actually do, but they may not succeed with that, but who is going to judge the result?   Request those notes, especially if a consultant is involved.  Those notes should explain the diagnosis, the prognosis,  treatment options, and the current plan.   Once reason for the long notes is that insurance companies won’t pay unless the office submits  reports that meet expectations.  That’s why your dermatologist may check your pulse and BP, use a stethoscope, and ask about COVID vaccine boosters.  Do doctors sometimes say they did it, when they didn’t?

Some practices use scribes to take care of the chart work freeing up the doctor.  But are such chart  notes trustworthy?  You can read  those scribed notes, but unless you are a physician you won’t be able to judge the result very well. Ideally the doctor should create the chart notes.

In my group practice we were compulsive about charts  and we had 2 full time typists working on our notes which we dictated, often in the presence of the patient.

Many doctors’ offices, run by efficiency experts, encourage passing patient care tasks down to a lower level.  For example, a “mid-level” may be ordering meds from pharmacies without supervision.  I know of such a case where the assistant was not careful and ordered the wrong drug.

If there is a consultant involved, request a copy of the  consultation report.

The use of “My Chart” apps has advantages, but they will text or email you repeatedly and pressure you to keep responding to their electronic messages, and I find that badgering to be oppressive.

g.     Watch for manipulative marketing such as the billboard in Red Bank which says that Monmouth Hospital is one of America’s best “teaching hospitals.”     Or the cynical use of the term “university hospital.”  Be aware that the best interests of patients may not be the top priority by your providers who may become more “mad men” than physicians.

h.   Watch your billing.  The hospitals are now beginning to bill you or alert you  on line for services you haven’t yet received. Make sure that they have all your insurance documentation.  For example if you have Medicare, make sure that they know your secondary coverage.

Some incompetent billing offices fail to bill your secondary insurance. Then you will be balance billed and you don’t want to deal with billers who are out to collect and make you crazy.

And keep in mind that some providers like hospitals may be “up-coding” to get the most from insurance companies. This scandal will emerge soon…..I hope. Ultimately it will affect the cost of care and the cost of your health insurance premiums.

Here is a link to a Blogfinger post about second opinions:*

Second opinions BF article.  *

And there is much more.  Watch for more posts as I make discoveries in the swamp known as American healthcare.

Make sure that you choose wisely for those who would watch over the health of you and yours.

Phillip Smith is a world famous trumpet musician, formerly with the NY Philharmonic Orchestra who spends his summers in the Grove, and here he is with Joseph Turrin on piano:   Gershwin’s “Someone to Watch Over Me.”  He has performed this piece in the Great Auditorium.

Phillip Smith of Ocean Grove and the NY Philharmonic Orchestra.

Timothée Chalamet as Marty Mauser. Full review to follow. Paul Goldfinger still images from the film”Marty Supreme.”

Gwyeneth Paltrow. All still images by Paul Goldfinger from the movie.

THE BOSWELL SISTERS

Paul Goldfinger. Sunday, Sundown, Winter.    Central Park South, NYC. Click to enlarge. 

THE HARPTONES   (A 50’s New York City Doo Wop group.  Remembered by Cousin Brucie who has a Saturday night show on 770 am.)

Paul Goldfinger

GORDON TURK    Recorded in Ocean Grove. “Cantilene”