Friday, May 9, 2014
Great attending quotes from training
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"If a patient demands to have daily office appointments with you, let them. They're the ones paying for it, and you have to be there anyway. They'll get bored and stop after 1-2 weeks. This is a war of attrition, and you'll always win."
A Blog detailing the insanity of my medical practice and the stupidity of everyday life.
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This blog is entirely for entertainment purposes. All posts about patients, or my everyday life, or anything else may be fictional, or be my experience, or were submitted by a reader, or any combination of the above. Factual statements may or may not be accurate. I could be making all this up. I may not even be a doctor. The only true statement on here is that I probably drink more Diet Coke than you do. A lot more.
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Cast of Characters:
Annie: My Phenomenal MA
Mary: My Awesome Secretary
Ed: The office fish
Dr. Pissy: The guy I share an office with
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Note: I do not answer medical questions. If you are having a medical issue, see your own doctor. For all you know I'm really a Mongolian yak herder and have no medical training at all except in issues regarding the care and feeding of Mongolian yaks.
Cast of Characters:
Annie: My Phenomenal MA
Mary: My Awesome Secretary
Ed: The office fish
Dr. Pissy: The guy I share an office with
Mrs. Grumpy: My Boss (also the world's greatest school nurse)
Frank, Craig, and Marie: The Grumpy Tribe
Garlic and Riley: The Grumpy Dogs
Questions? Comments? Biting sarcasm? Write to: pagingdrgrumpy [at] gmail [dot] com
Note: I do not answer medical questions. If you are having a medical issue, see your own doctor. For all you know I'm really a Mongolian yak herder and have no medical training at all except in issues regarding the care and feeding of Mongolian yaks.
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9 comments:
I'm sure the folks that run the reimbursement programs all agree with that, too.
What? You say medical insurance reimbursement only pays for actual medical care for actual medical needs? How unfair.
stay safe.
Has this ever happened to you?
Why on earth would anyone want to go to the doctor every day?
You'd be surprised.
Grumpy:
Wow! Are you sure they don't need a psychiatrist more than you? (I think with that anxiety...they might!)
Maybe they'll get that visit free since you referred them. (sorry I loved that other post, too!)
As long as there is a legitimate reason to bill for visit, go right ahead! I used to have a patient who came weekly. She was lonely and lived very close to the office I worked at. I had to explain that I really could only see her when she had a new medical problem or if I was monitoring a change. She also was on Medicaid and had no copay. I told her that I was actually paying for her visits as a taxpayor and it was killing my wallet. Luckily, she thought that was funny and stopped coming in so often.
I have known patients in primary care who want to be seen daily or a few times a week. I've never seen them do it for very long as it seems to mostly happen when they've been recently diagnosed with something that scares them and then once it's stabilized they go back to their normal routine.
As for the reimbursement, most providers won't turn down a patient who wants to be seen, granted they have an opening. If the insurance company can prove that it doesn't meet medical necessity they can refuse payment and the patient will be responsible for the charges. You might think that having to pay out of pocket might deter them but in some cases I really doubt it would. Whether they just want reassurance or because they have a serious condition, in their minds it might be worth it.
I used to get irritated by this elderly patient who used to come in almost every day asking to be worked in. Maybe 90% of the time he didn't need to be seen but it eased his mind temporarily. I don't know how I would take it if I had to deal with even half the medical problems he had.
Besides, it's not that much worse on insurance companies than the patients who come in every three to six months and undergo preventative testing only to completely ignore our advice once they walk out the door, those are a lot more common than patients who seek treatment too often. Or the ones who run to the ER with the sniffles. Or the ones who want everything they see on the "Medicare will pay for it and we'll take care of the paperwork" TV commercials, stuff like power scooters and penis pumps (yep, penis pumps are apparently DME according to the Pos-T-Vac company). Wasted money is wasted money.
Insurance companies sometimes waste their own money, Humana has recently decided to send out risk assessment nurses to the patients homes so we can get a report full of information we've had on the patient for years. Some companies like to send out mass mailings to notify PCP's that their patient is due for certain tests or that they're taking drugs that have a cheaper alternative. I don't know how doctors managed to keep people alive all those years before the insurance companies stepped in and told them how to do it.
Personally, I have been the patient that showed up every day to annoy my PA wanna be a doctor. He refused to give me a referral to see the Endocrinologist, even though I have a known thyroid condition and require replacement meds for it. It took over 3 weeks of appointments and daily walk ins before he gave in and wrote the referrals that I had asked for. Then the 3 different specialists that I saw ripped him a new one for not sending me in right away. I needed more than just Endocrinology. I have a new PA at the moment now, and I'm having the same problem with her, but I live 20 miles from the office so I don't have the ability to drive her insane every day. She isn't the brightest. She actually told me that she didn't think stage 4 thyroid cancer was a real thing! *insert face palm here* Considering that you can look it up on The American Cancer Society website, I'm thinking I did not mix up the family history. She's really going to hate life at my next appointment when both my mother and my older sister come in with me with their medical records. My sister is attorney and not so nice when you call her a liar.... and my mom... well, Retired Army Explosive Ordinance Disposal (Bomb Tech). Enough said. I think that people would be more willing to trust the "doctors" if the PA's would stop trying to act like specialists, or trying to brush off patient concerns when we have reason to be concerned. Then again, my current PA missed the fact that I had bronchitis on my routine check up, but talked to me about seeing a Dermatologist for my acne, while refusing to send me to see the Endocrinologist for my thyroid. I ended up in the ER the next week for the bronchitis that I had had for over 3 weeks. My health care is taxpayer funded, because I'm a college student, and I don't make enough to pay for food most of the time. The sad thing is, if she had caught the bronchitis on the routine, I wouldn't have been admitted to the hospital for 24 hours. If she would send me to the Endocrinologist, I wouldn't have acne. This is really where tax dollars are going. I've had blood work done every 2 weeks for the last 8 months for her to act like she's a specialist while missing basic illnesses. She's given me referrals that I don't want to see specialists that I don't need, but won't send me to the 1 that I do. I can't wait to graduate and finally have a decent paying job so I can pick my own doctor and get properly treated instead of wasting taxpayer money on the excuse of a PA that I have now.
Beside being certain Nichole was at the band camp meeting, I am fairly certain your old attending had a flock of residents taking care of walk in clinic...
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