Call the doctor. Good luck with that!

What happened to the doctor- patient relationship? Will he call you back?

Paul Goldfinger, MD, FACC   (Board certified in Internal Medicine and Cardiovascular Diseases)

A woman with a urine infection decided to call her urologist. Her problem had been under control, so she thought that she could call  him as needed. She last saw him in 2018.

She called the office and got the familiar triage recording.  It said, “I’m away from my desk or busy with another patient. So leave a message. ”

The patient left a message explaining her situation and asking if she could drop off a specimen and then speak to or see  the doctor.

Later, she received a  call back from a Nurse Practitioner who said that the doctor will not deal with her problem because she hadn’t been in since 2018. There are no openings in his schedule, so, if she is not feeling well, she should go to the ER or to an Urgicenter.  Or they could see her in 3 days.  They could have seen her, and the time spent would have been 10 minutes by the NP or the MD.

But the practice of scheduling patient care has become so rigid as to be dangerous. Flexibility should be part of the practice landscape, but the bottom line does not allow for flexibility.

She then called her internist, and the call was taken by a receptionist.  The conversation  went like this:

Ofc:  Hello, Dr. Y’s office.

Pt:   Hi.  I am a patient of Dr. Y, and I have a urinary infection. What should I do?  Should I bring in a sample of  urine or can I speak to the doctor?

Ofc:  Why would you bring a urine sample when you have an ear infection?

Pt —No, it’s a urine infection.

Ofc–I’ll check with the doctor and call you back.

CALL BACK 2 hours later—

Receptionist: The doctor doesn’t want a specimen.  (and, unsaid–The doctor doesn’t want to speak to or see you either.)  He will call in a prescription for an antibiotic and then, 5 days from now, you can stop by and give us a specimen.

Some doctors are willing to take an interaction like this and bill insurance for it, so there is an incentive to improve efficiency in this way. I’m not opposed to doctors  billing for phone visits, zoom visits, or visits in the ER after office hours. But no billing if the doctor does not talk to the patient. Despite what business managers think about office medicine, not everything requires a code and a bill.

If you want to be shocked regarding new billing procedures, get ahold of an itemized hospital bill and you will be shocked.

Conclusions:

a. Many doctors are willing to treat an acute problem without speaking to the patient, examining the patient, reviewing her past GU history, requesting records from the urologist, or discussing the the treatment which is being ordered.   He did not ask if she is allergic, advise her of side effects or take a relevant  history from her.

Multiple aspects of this situation could be considered substandard care.

b.   It has become routine now that a patient calling in with a problem will not be able to talk to the doctor–only to an answering machine or a receptionist. You may or may not get a call back.

Policies like this are sweeping across the medical practice landscape like a pandemic.

Becoming new and routine does not mean that such policies are an improvement, and some traditional  and basic tenets of medical care are being swept away by efficiency priorities aimed at the bottom line.

d. When that urologist’s office abandoned this patient, I believe that the charge is negligence if things go wrong.  It used to be common for specialists to be receptive to “as needed” calls or appointments. But now you are required to come back regularly even if there is no reason why your primary doc can’t trouble-shoot a urine problem, calling in a specialist as needed.

A receptionist cannot even begin to consider the depth of pathology which might be present related to a urine infection.  In my office practice (30 years) we would always see someone with a problem even if they were new to us or a prn patient  (as needed.) We specialized in cardiology, but it’s best to shoot first and ask questions later.

When I was applying to medical school, an interviewer at Penn said to me, “Why do you want to be a doctor, and don’t tell me you want to help people.”

I thought that would be a perfectly good answer. A doctor’s first impulse should be just that.

What is the point of having specialists in the medical community if they are so fussy as to whom they will see that they will turn their back on sick people?  What would Hippocrates say? What does the AMA say?

Meridian can set them up in a special wing with guards at the door and a phone system that will only answer certain calls.  And why are doctors allowing non-trained individuals to screen medical calls and decide when it is safe to put off a visit? An error in scheduling could cause serious harm.

As Groucho said, “That’s the most ridiculous thing I ever heard.”

On Blogfinger we say,  “Enough!.”  I will comment here when I see patient care compromised, especially when  sloppy and risky  practice styles emerge and become the new standard of care.

OK,  enuf!   It’s time for some music from Grease and wondering about “lacy lingerie,” slutty pedal pushers and a heart attack for Mom.