“This note is born out of a bit of frustration. First, a little background about my practice. I am an independent solo practitioner. I am an Emergency Medicine Board Certified physician with extensive experience in integrative and functional medicine, functional endocrinology, nutrition, weight and metabolism management, laser assisted surgery, genetics, and the study of and practical application of epigenetics, and finally, all round practice-what-I-preach kind of doctor. In other words, I love and thrive in medicine. It is what I do, it is what I teach, it is what I live. It is how I make a living. I do not bill insurance companies. I do provide initial letters of medical necessity to patients who want to try for insurance reimbursement at no charge. My clinic is open 6 days a week.
I usually spend a few hours on Sundays researching, writing, reviewing medical charts, and patient requests for medical information, and medication refills. I look at and review patient requests for my expert opinion on certain medical issues. This past Sunday was a bit different in that I had an unusual amount of last minute refill requests and medical information requests from patients. One particular patient had run out of thyroid medication she ‘so desperately needed,’ and requested information on alternative medications she may be able to use. As per standard procedure, we called her to set up a 15 minute telephone appointment to speak with me about her request and to discuss her refill. She had not had a follow up appointment with me in over a year. As I walked by the front desk of my clinic I heard a member of my staff speaking with her and could see significant frustration in her face and manner. She held an even and calm tone in her voice while speaking with the patient. After she hung up I asked her what was wrong. She told me that the patient spent 5 minutes yelling at her for quoting her the usual $35 telephone consultation fee for the needed follow-up appointment. Apparently $35 seems to be too much to pay for my expertise, experience, and time to ensure her safety.
‘My insurance won’t cover this. It’s only a refill request. Can’t he just call it in? Don’t you have form letters you can just print up? I only need to talk to the doctor for 5 minutes!’ These are some of the common statements made to my staff and to me. Let’s say 10 people (like today) want ‘5 minutes to talk to the doctor’ and say it takes 10 minutes to gather the information, charts, and calls: That would be a total of 1 hour and 40 minutes. This assumes each call is really only 5 minutes. Most calls are usually 15 to 20 minutes. 20 minutes times 10 calls is 3 hours and 20 minutes. Now add the 5 minutes it takes to process a refill or research a chart to cross reference medications or other medical data and now the total is up to 4 hours and 10 minutes . Now let’s say 1 out of the 10 calls is a complicated call (crying patient, serious medical issue, multiple problems needing to be addressed, etc.) that adds 30 minutes to total time now we are up to 4 hours and 40 minutes. One more additional consideration, the first call was in the morning which delayed my regular schedule. That call was the complicated call. My entire day is now filled with a late schedule. This was actually how my day went today.
Don’t get me wrong. This is not a note of complaint. I thrive on this kind of complication. What I want to discuss is the myth in our current healthcare system of expecting high quality advice and service at low or even no cost. There seems to be no appreciation for the service of health care. We think cost is a co-pay or even no-pay. I do not get paid to review charts and do medical research on Sundays or each evening like I do, but it is necessary in order to provide quality care for my patients. One patient actually told my staff we were ‘gouging’ when we told him there is a $75 charge for a 30 minute complex telephone consultation with the doctor to discuss their complex lab results and a plan to improve his lifetime health. There is no appreciation of experience and service when discussing medical advice. In the world of ‘Google Medicine’ people think they can glean medical care online and apply it to their physiology and expect a good outcome. Now add to that the lack of a health care system to support the need for telephone discussion between patient and doctor.
This country wants to force people to buy health insurance from companies that set the prices and the rules of how to provide health services. The rules do not support prevention of disease, rather it supports ignoring your health until disease is present, and you are paying for that. In fact, you are paying a lot and will be paying more in 2015.
How long does your regular doctor ‘covered’ by your government-mandated insurance talk to you about how to improve your metabolism or optimize who you are in the next decade of life? What does your doctor tell you when you ask how you can improve your diet to decrease your use of your medication? Healthcare is wellness and prevention. Wellness and prevention is what I teach. Wellness and prevention is what I provide. This is how I make a living. Wellness and prevention is what our healthcare system is supposed to provide. This nation expects it but does not want to pay for it. Our healthcare system is set up to wait until disease happens. And when disease happens of course people are willing to pay anything to fix the problem. Yet they complain or refuse to pay a $35 or $75 phone call backed up by years of education, real experience, and daily maintenance of knowledge that can be the key in preventing the disease in the first place. Am I worth it? Read the first paragraph again.
If you or someone you know needs wellness care, contact a doctor today to schedule an appointment.