back in the good olde days

 

True story:

A couple of weeks ago, while I was with my family for Christmas, I came down with Covid. As soon as I tested positive, I left for home so I could get started on Paxlovid, ASAP. But it was Saturday morning, so of course, my doctor's office was closed. Instead, I spoke with the weekend triage nurse. He advised me to go to an urgent care clinic for evaluation. So, I did.

When I got there, I was told it would be a 2 1/2 to 3 hour wait...and because my case involved Covid, I had to wait in my car. I was told I should not leave the parking lot because if they called me in and I wasn't there, I would be ordered to the back of the line...for another 2-3 hours. Meaning I couldn't even get a cup of coffee or a little lunch to tide me over. Thankfully, I had water and a good book with me. I waited in my car for over 2 hours for my less-than-ten-minute appointment that day.

~Insight Patient Satisfaction Solutions~

While I was in exile the following week, I sent several messages via portal to my PCP asking for a call back to discuss the results of a test that been done weeks earlier. I already knew it was abnormal. But I didn't get a call back. Instead, I got a message referring me to a specialist. With no explanation. With no discussion. With no human dialogue.

The same thing had happened a couple of weeks earlier when I messaged the orthopedist who replaced my knee last year about getting a lift for my shoe. I suspected that a slight leg length discrepancy was causing my hip pain. I had questions. With utmost efficiency and speed a referral appeared among my messages, but again, there was no call back. No discussion. No opportunity to ask those questions. 

Trust me when I tell you it wasn't always this way! Back in the good olde days, when doctors ran their own practices, they took the time they needed with patients, they returned phone calls and answered questions themselves, and billed according to what they felt was reasonable given the patients' circumstances. Things were much different.

"If you are not in control of your time,

you are not in control of your results."

~Brian Moran~

When we launched our practice, the office was open and staffed five days, three evenings, and Saturday mornings every week. Someone was on-call 24/7. When patients called, appointments were available, and if not, we worked through lunch or stayed after hours to take care of them. We were known to have accepted a bushel of apples in lieu of cash if that was what the patient could afford. If someone cut their hand in the middle of the night, instead of sending them to the ER for stitches, we would climb out of bed, drive to the office, disable the alarm system, unlock the door, flip the lights on, and meet the patient there, ourselves. 

Nowadays, we don't see patients after hours in a pinch. We send them off to see someone else. We are tethered to a system that demands we see more patients faster. We labor under the mandates set in place by productivity quotients, the resource-based relative value scale (RBRVS...a rather arbitrary system that nobody understands, but is used to estimate what the physician deserves to be paid), and the constraints imposed by various insurers. Never mind the ever present threat of litigation. 

The corporate health care system that bought us out closed their primary care practices in the evenings and on weekends. This resulted in redirecting patients with non-urgent problems to emergency rooms. Reimbursement for the time we spent navigating a patient's mental health issues went away. Messages still often go unanswered. Compassion, connection, and communication are, apparently, no longer part of the equation.  

"America's health care system

is neither healthy, caring, nor a system."

~Walter Cronkite~

Back in the days when we would haul ourselves out of bed in the middle of the night to see a patient, when we spent every other weekend on call, when we stayed after office hours to get the job done, we were exhausted, all right. But we didn't burn out. We felt a sense of satisfaction and fulfilment. We enjoyed the fruits of self-discipline and service. Patients were appreciative. 

Contrast this with the dissatisfaction some patients feel today. Contrast it with the inconvenience, depersonalization, and frustration they confront when what they need is healing. What do you think is wrong? How would you change things, if you could? What is missing for you?

Rant over. Carry on.

"The simple act of caring is heroic."

~Edward Albert~

jan