Why Not Call? (Exhaustion and Economics of Phone Calls)

A reader writes:

Why do I have to take time off of work and make an appointment for my doctor to explain test results? Wouldn't it be much easier to do over the telephone?

It would be easier to discuss this over the phone, and cheaper. Your doctor isn't paid for talking to you over the phone. Getting info over the phone is always a win for patients and a loss for doctors.

Primary Care Doctors (like Doctor D) for whom much of the job is educating you about your health are making a less and less every year (we're the green line) and we started out as the lowest paid physicians. Primary Care clinics are just barely scraping by, so when it comes to discussing your labs they can either do it over the phone for free, taking time away from seeing patients, or bring you in and get paid by your insurance to have the same discussion. The economic solution usually beats the common sense solution.

Now, I don't want this to sound like one of those Happy Hospitalist I-don't-get-reimbursed-for-all-I-do posts. Primary Care is still a good job and Doctor D doesn't have to worry about keeping food on the table.

But when Doctor D worked at Crayzee Clinic he spent many hours every day getting patients results, refills, and forms without pay. He did his best to call patients when he could, but if he knew it was going to be a long talk he usually had you come to the office. Doctor D had to keep some work during office hours—as it was he barely saw his wife or son while working primary care. Of course, some docs avoid phone calls because of greed, but most in primary care are just exhausted having to see more patients faster and faster while doing more paperwork in the evenings. An appointment to follow up tests was usually pleasant and easy, and didn't keep Doctor D in the office later at night after office hours.

But for the patient, it sucks! You have to get off work and drive to the doctor's office, just to get information you could have gotten over the phone. You can and should ask if your doc can call you the results without an appointment. Your heathcare is already too costly without extra visits. But please realize that this is harder on you doc, so don't abuse it. If you are the sort that needs to ask lots of follow up questions please schedule a visit instead of tying up your doc on the phone for 20 minutes!

Okay, after a long blog post about money and reimbursement Doctor D feels dirty and must go bathe the Happyishness off of himself.

This is one of those annoying situations that forces either you or your doc into a financially frustrating situation. The solution proposed on most doctor blogs is billing for phone calls.

What do you think? Would you be comfortable being billed for phone calls? It would save you costlier office visits. Or do you want to keep phone contact free?

Should I Get A Medical Alert Bracelet? (Upselling Healthcare)

A question from WarmSocks:

When should someone wear a medical alert bracelet? Nobody has ever recommended that I should consider it, but my med list seems awfully long so I'm wondering if it would be appropriate?

The purpose of the alert bracelet is two-fold:

1. To provide vital information in an anticipated emergency.
2. To make money off of people with illnesses.

Should I wear a bracelet? Do you have a condition likely to cause you to be found unconscious, and have something about you that would make your care different than the average unconscious person? You should probably carry a brief list of your medical conditions and medicines, but most of those things don't require a bracelet.

These bracelets are marketed to people with things like insulin-dependent diabetes or heart rhythm problems. The bracelet basically says, "This is likely the reason I'm unconscious and this is what to do!" I've seen a lot of diabetics and heart patients with such bracelets, but I've never seen these bracelets make much difference. Paramedics always check blood sugar and heart rhythm as soon as they find you in such situations, so in my experience people with and without these bracelets get about the same care.

The best reason I can see for a bracelet is a rare condition that rescuers aren't going to be thinking about. Diabetics need not worry—we check a sugar on everybody that's unconscious, bracelet or not. (Other reasonable situations to have a bracelet would include: severe anaphylactic reactions to medicines or if you don't want to be resuscitated if your heart stops. )

The second reason for bracelets is to stimulate the economy. The healthcare industry is massive and you—the patient—are the cash cow. If you stop consuming all the medical accessories and extras then the Healthcare economy might shrink! Proven, effective care can be a narrow margin business, but all the physical and pharmaceutical accessories that you see marketed keep the Healthcare Business healthy even in lean times.

If you call a bracelet company they will say that your daily aspirin or history of ankle sprains should definitely qualify you for a bracelet. "Let's bill your insurance, and for a bit more you can get a stylish 14 K gold band for it!"

Your doc should be able to tell you if your condition really needs a bracelet or not.

But be careful if you doc is offering bracelets or any other "value added" products in their office for your convenience! With Primary Care profit margins razor thin, a lot of doctors are going over to the darkside and letting corporations talk them into adding "secondary income streams" to their practice. If your doctor is selling something (bracelets, supplements, skin rejuvenation, etc.) other than medical care you should run the other direction. Your doctor should be an advocate for you, not the spokesperson for some product line.

Is Doctor D may be alone in his righteous anger about MDs who sell extras in their practices? D was highly offended when Little D's doctor was selling vitamin products at the clinic. Mrs. D told Doc D to quit being a pinko Commie and accept that capitalism works this way. Do you mind if your doctor makes extra by selling products?

Review Of Systems

A question sent to Doctor D:

"Why do doctors ask for information that has nothing to do with what I'll be seen about?"

Doctor D asks his patients superfluous questions all the time. You come to Doctor D with ankle pain and next thing you know you are answering questions about your breathing, how much alcohol you drink, if you have fevers, and your sex life. Doctor D asks these questions because he is nosy.

Doctors are nosy, but the more pertinent reason we must ask those questions is because we are lazy. Doctors, like most people, have a nasty habit of jumping to conclusions before thinking carefully. To combat mental laziness the MD powers-that-be came up with the "Review of Systems" where doctors ask a whole lot of questions about your body that don't directly relate to what's bothering you. It forces your doctor to think outside the box. Usually it turns out to be the obvious diagnosis, but the Review of Systems helps your doctor recognize when it isn't.

Doctors also do this because we are greedy: insurance won't pay for your exam unless at least some Review of Systems is done. Fortunately this is one of those situations where your insurance company actually does something for your benefit. They know a Review of Systems is cheaper than a CT Scan.

When you come to Doctor D with a swollen ankle without any injury it is probably gout. But questions about your breathing or your genitals force Doctor D to at least consider that non-traumatic ankle swelling can be caused by a blood clot or a gonorrhea infection.

So now you'll know why we ask all those crazy questions.