Dear patient,

I agree with "usually." People have no idea what a mess healthcare really is. All parties can take some blame, but docs and patients are the ones who suffer for others' idiocy.

1. Making You Come in All The Time

Is there some reason that multiple visits couldn't be combined? For example, if I go to have a breast lump checked, and it's coming up on my one-year anniversary for the usual oil change and winterizing, can they do the oil change, winterizing, and the mammogram/ultrasound combo all in one day? I mean, I could understand it if the boob check had to be done in a different office, but where I go it's all rolled in to one giant clinic. Yet, I still have to make about four different appointments: one for the boob check, one for a blood draw, one for an oil change, another for the winterizing. I am fortunate enough to have a reasonable number of paid sick days at work, but lots of people are not. I do think it's reasonable to try to schedule non-urgent things all on the same day. For many people, it means the difference between getting a non-urgent but necessary checkup or Dx procedure done vs. not getting it done. I'd also feel a lot better about coming in all the time if more doctors did open access scheduling, so that it would be possible to see my doctor about a semi-urgent condition today, as opposed to in two weeks when she gets a chance.

2. Not ever giving discounts

Unfortunately, I've met many docs who swear they would never turn anyone away just because of a lack of insurance...but also don't give cash discounts AND charge uninsured people way more than insured people. Having been on the uninsured cash-paying side AND the insured side of the business equation, I have a lot more to say about that, but not appropriate for a blog comment.

3. Getting lost in notes

I do believe there are medical electronic notebooking software options out there, all with relative pros and cons.

4. Obsessing about money
Agree. It sucks.

5. Not seeing you in the hospital
Would standardized electronic medical records help with the communication issue? I suppose what disturbs me a bit with this one is that I rather suspect standardized e-records would help considerably with the communications and patient transfer issues, and yet instead of pushing for modernization of communication and recordkeeping, the push is instead to give patients the shaft. This is a bit like what I see with many mainstream media and NEJoM editorials and such, where in the event of (insert medical screw-up here), the onus is often put on patients to be more educated, ask more questions, manage their own medical billing, get third opinions and so forth, things which are not the patient's job and which are also not reasonable solutions for someone who is ill. Here, you're sick, injured, stressed and upset--let's give you a full-time job as a paperwork specialist, insurance intermediary, and medical librarian! Um, no.

6. Acting paranoid
Is it really patients' duty to pushback on the DEA? I'm not convinced it is.

i passed the point of fed-up when my husband and i traveled an hour to go to a specialty pain clinic, only to be treated like narcotics seekers and be told there was nothing really wrong with him but maybe the "other" doctor in the practice would see him, maybe sometime in the next 6 months.

turns out he had a very legit problem that is not easily diagnosed and really was in all that pain they told him was all in his head. i understand the importance of keeping narcotics off the streets, but when other drugs fail, they are there for a reason.

even with glaringly ugly x-rays of my own injury, my doctor was too nervous to give me something to help me through the early stages of corrective therapy. i'm not nearly as compliant as i should be, i could barely walk today through the pain so i'm not inclined to do any of the therapy tonight.

Lora: possibly the reason you have to make more than one booking is that the machine used to perform one or other of your tests is already booked when you go in. If you call a good bit ahead and get them all booked up in a row, it should work.

Is there some reason that multiple visits couldn't be combined? For example, if I go to have a breast lump checked, and it's coming up on my one-year anniversary for the usual oil change and winterizing, can they do the oil change, winterizing, and the mammogram/ultrasound combo all in one day?

This is the sort of thing that's driven the rise of multidisciplinary breast centers. Where I see patients, this can often (albeit not always) be accomplished in one day. The problem is, such centers are expensive to operate and not always that efficient, given that slots have to be held open (and sometimes not used) for patients seen the same day by various docs.

There's no doubt that "conventional" medicine could do "customer/patient" service better, especially a lot of the academic centers. Private docs, for instance, will often have evening hours once or twice a week and weekend hours a couple of times a month, something you'll almost never find in academia.

Private docs, for instance, will often have evening hours once or twice a week and weekend hours a couple of times a month

I kind of wish we could move primary care away from a 9-5 model. I get that doctors want to work standard hours like everyone else, but it seems to me that it's becoming harder to take time off from work for necessary things like doctors, dentists, banking, and whatnot. My dentist offers evening hours one day a week (there are four dentists in the practice and I think they rotate who take the evening shift) and it's quite popular.

I kind of wish we could move primary care away from a 9-5 model.

I remember when it was standard practice for barbers to be open Tues-Saturday (and didn't doctors used to be barbers? :-) ) The point being that maybe doctors could shift their hours, not extend them.

Living in PA where we're losing all our docs due to lawsuits, I totally get it! Thanks Orac for the link, and thanks Dr. Rob.

I think this post should be distributed to all the altie loonies who choose altie care because, you know, evil "regular" docs are big pharma shills and don't have time to hold your bottle and your blankee and have all these secrets they don't want you to know and . . . oh never mind.

The point being that maybe doctors could shift their hours, not extend them.

Yes, that's what I was thinking of. A single doctor shouldn't have to work more than 40 hours a week. But a larger clinic could have rotating shifts and actually be open more than 40 hours a week.

Thanks for the links. They are so right. Primary care is in collapse. We are leveraged to the hilt; as are the other primary care practices in my town, and I hear similar stories in trade journals, and recently, even the mainstream press. I know one family doctor who just shut the doors. It's not for lack of patients; it's that you can't see enough patients to pay all the staff needed to process the mountains of government and insurance paperwork, in addition to the usual costs of running a business. Also, the charge the patient sees, is not remotely what the doctor actually receives, after write-offs and insurance and Medicare contract specifications kick in. My husband can rush people through in fifteen-minute increments (hardly enough to cover a complex case) all day long, and still struggle to pay the bills. And yes, we have evening and weekend hours. The man works six days a week.

Fortunately, none of our kids are interested in going into medicine. We would discourage them from it.

I'd also feel a lot better about coming in all the time if more doctors did open access scheduling, so that it would be possible to see my doctor about a semi-urgent condition today, as opposed to in two weeks when she gets a chance.

The problem is, such centers are expensive to operate and not always that efficient, given that slots have to be held open (and sometimes not used) for patients seen the same day by various docs.