Wednesday, January 13, 2010

Things that make me grumpy

If I'm still prescribing medications for a patient, I want to see them once a year (give or take a month). I'll see them more than that if needed, obviously, but for a stable patient I think once a year is reasonable if I'm still the one writing their scripts. Dr. Darth, a neurologist downstairs from me, makes everyone come in every 8 weeks, and Dr. Ivyleague across the street requires monthly visits. But I think that's just digging for a co-pay.

Mrs. Bagge is an elderly lady who I see for benign tremor. I see her once a year, and refill her Inderal, and she goes on her way. But she always bitches and complains about her $25 HMO co-pay to see me once a year. I'm not that desperate for the $25, but if I'm taking the legal liability of writing her pills, I want to see and examine her once a year.

She was due for a return visit in early November, 2009, so I had Mary call her. Mrs. Bagge said she'd just had surgery on her bunions, and couldn't get in then. So, to be nice, I wrote her for another month.

So in early December, her next refill came up. This time Mrs. Bagge had family in town through the holidays, and so asked if I'd give her until January. I don't want to be Scrooge, so I said fine.

Last week another refill came up. Mary called her, and Mrs. Bagge wanted to make an appointment, but she needed an insurance authorization from her internist to see me. So Mary called Dr. Internist (twice) to ask for one, and said she'd call Mrs. Bagge to schedule the appointment as soon as we got it.

In the meantime she was out of Inderal. I told Annie to give her 15 days worth of pills, and no more until she was seen. Annie argued with me that Mrs. Bagge is on a fixed income, and we shouldn't put her in the position of having to make 2 medication co-pays for one month of pills. Since we were in the process of getting the auth for her to see me, and I'm a soft touch, and (most importantly) because I never argue with Annie, I said fine. Give her a whole month.

So yesterday afternoon her insurance auth showed up for her visit, and Mary called her.

Mrs. Bagge refused to make the appointment. She said she was tired of dealing with my greedy office, and accused us of harassing her with phone calls and holding her Inderal hostage. She then sent over a request to fax her records to Dr. Darth, because she has an appointment with him next week.

Good riddance.

33 comments:

Necandum said...

I don't think that one is very good at da maths. I guess if you don't pay much attention, every 8 weeks might look longer than every 1 year.....

Grumpy, M.D. said...

Oh, yeah. That's why I say good riddance.

I'm sure she'll call in a few weeks asking to come back and claiming there was a "misunderstanding" (which she'll say was our fault, of course).

Chrysalis Angel said...

Wow.

Old MD Girl said...

See, whenever I think about doing Psychiatry instead of Neurology, I remind myself that there is plenty of Psychiatry IN Neurology already.

Grumpy, M.D. said...

OMDG- Oh yes.

That's actually the historical reason why neurology is a residency, and not a fellowship.

Anonymous said...

Please tell us you won't take her back when she wants to reestablish as a patient.

Grumpy, M.D. said...

Hell no!

She pissed off Annie. Once you piss off Annie, you're TOAST!

Dr. Phil said...

My favorite line is "I can only afford the prescription or the office copay but not both". (I think that means I am supposed to feel sorry for them and just give them medicine without providing good medical care.....You get what you pay for! I agree with you- once or twice yearly for stable lifelong conditions is reasonable.

Make me an appt (for 2020) said...

I think y'all got played!

By the craftte bagge.

Grumpy, M.D. said...

Oh, I know. That's part of why I'm pissed.

Warren Buffett said...

"Annie argued with me that Mrs. Bagge is on a fixed income, and we shouldn't put her in the position of having to make 2 medication co-pays for one month of pills."

Annie sounds like a sweetheart, but seriously, who isn't on a fixed income?

Celeste said...

I'd WALK those records over to Dr. Darth, smiling all the way. I love that she made this decision herself, clearly without any research, and with some bridge-burning thrown in for good measure.

thegooddrlaura said...

Fk her. She can see another neurologist. And when she does, she'll realize how good she had it with you.

Cheryl said...

Oh, for pity's sake. That woman is a basket case. And if you ever take her back, I don't let you do my lobotomy!!!!

stewbert said...

Oh my hell. I LOVE docs who only require once a year appointments, but most of ours require more often than that. Which does at times seem like they're digging for a co-pay. Good riddance indeed.

Anonymous said...

@Cheryl lately I find more basket cases, we get played about once a week.I think people are paying higher premiums and feel entitled to greater services and get grouchy and manipulative in their attempt to get whats coming to them. They think providers are getting the money. But it is very depressing when relationships are so broken down that patients readily assume the worst of a provider without considering their role in it. Oh and they are encouraged to do so by the media ( all the dont let your doctor get away with that articles do add up)

Clark Kent's Lunchbox said...

In the words of Homer Simpson, "D'oh!"

Give her a couple months - she'll blame the other guy and be back... on second thought, given her line of thinking she'll probably think him much better.

GradStudent said...

She won't be missed.

I really, really dislike dr's who dig for co-pays (but then again, who doesn't?). I needed a refill on a prescription and told the at the beginning of my appointment, about 20 seconds after he walked into the room. Then he told me that I needed to ask for refills at the check-in window BEFORE my appointment or he won't write a prescription. And he didn't. He told me to make another appointment and that's the last I ever saw of him (and the last he ever saw of my co-pay).

Anonymous said...

No good deed goes upunished! CP

A Peach said...

Man, this makes me appreciate my doc even more... at my last appointment, my doc worked with me to figure out the best way for me to get my 90-day injection without having to come to the office and pay the co-pay each time... she was *awesome*.

So, I'd probably love you as a doc, to Grumpy!

Susan said...

Seems like the ones you bend over backwards for are the first ones to dump you....

Grumpy, M.D. said...

Susan: Yes.

dan said...

1. I wish I didn't have to go in every month. Shoot, I would even take the eight weeks.
2. I wish my doctor would call in the prescription for four months in a row while waiting for me to come in.
3. I would like the $25 copay too.

The Mother said...

Another happy reason to be a pathologist. Your blog reminds me, every day.

ERP said...

Too bad this did not happen with one of your Migraine/Fibro/Chronic Fatigue/IBS/ETOH Withdral Seizure patients.

storkdok said...

Gah! Someone beat me to it. No good deed goes unpunished. When I practiced, I was continually beat over the head with this by my partners. I was a sucker many times. If you think neurologists see a lot of psych, you should visit an OB/GYN office. I was a Borderline d/o magnet.

Well, she'll probably realize her mistake and come crawling back. The question is, will you make the mistake of taking her back? Life is too short to put up with this kind of crap.

Love your blog!

Lipstick said...

Oh that's just terrible...I think you are right-good riddance. We see this situation all the time at the pharmacy with our faxes. The MD writes "must make appt" and then the pt just calls another MD. So tacky of them.

River said...

Some people just have to learn the hard way.

charmcity said...

It has been my experience that the patients who threaten to leave, almost always keep coming back to torture me. I no longer do the happy dance in my head when they stomp out of the office.

Anonymous said...

Oh, I just LOVE it when the difficult patients leave our plan! LOVE. IT. It is hard not to stifle a cheer when they inform me haughtily that they're leaving. Or sometimes I'm afraid I'll say out loud, "Don't let the door hitcha!" Or, "You'll be baaaaack!"

Loren Pechtel said...

8 is greater than 1. Of course she made the right choice! <G>

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