Home > Dr. Ward's Newspaper Column Home > 2010
Between you and your doctor
November 01, 2010 It is not uncommon for patients to vent frustrations about their interactions with the institution of medicine. They don’t really say it that way. They may say, “Dr. X didn’t seem interested in what I had to say,” or “Dr. Y’s staff only seemed to want to know what my insurance was,” or “Dr. Z always seems rushed and never looks at me.” In an oncology office it is more often, “Dr. XYZ is always running late.”
This article is about the things that get between you and your doctor. It’s about a work place where doctors are expected to rise above the daily grind and how patients can help.
First, there is the insurance thing. Patients can be offended by being asked about insurance, especially on the telephone. Often it is in the way it is asked, such as, “Do you have insurance?” This might be perceived that if you don’t, there is something wrong with you. Certainly it is better to say, “I need to ask you some questions about your insurance.”
What would be much too long to add is, “Because if you don’t have insurance, I will need to have our financial office call or meet with you to make sure you understand the costs. And there are some insurance plans that we don’t have a contract with and it will cost you higher co-pays to see us or perhaps they won’t pay at all. If I get this information now, we can streamline your visit by getting this information in our system ahead of time. We will check your benefits now to make sure we don’t need referrals or pre-authorizations for visits or tests that may need to be done.”
It would be easier if we all had the same insurance, of course. But if patients arrive with a good understanding of their insurance plans, this discussion can go a lot faster.
There was a time, they tell me, when a doctor determined how he utilized his time. They called it “practice style.” In today’s world, it is very likely that your doctor has no say in appointment times. The physician who chooses to spend more time with patients has to compensate somehow. Rarely do patients realize how much time their doctor may spend reviewing charts or documenting their care. For every minute I spend with a patient, I spend at least that much providing care for them in ways they don’t see. I can spend extra time with patients if I review charts before the day starts or if I delay dictations until after it ends.
When being well organized doesn’t work, the only way to accomplish everything may be to run behind schedule. Physicians do have medical emergencies, but many times it’s an emergency of compassion for a patient who needs more time than the 15- or 30-minute appointment. Patients can help their doctor immensely by doing some preparation of their own. Keeping a list of active medications and bringing it to your appointments is invaluable. Also helpful is a list of the physicians you are actively seeing.
A new complaint I hear from patients is about the computer. It has been said that the electronic medical record (EMR) will save modern health care. There are wonderful things about an electronic chart. It is readily accessible, for example. If you are my patient, I can access your chart from the office, hospital, home or anywhere else in the world that has Internet access. It means fewer assumptions, and fewer assumptions mean fewer errors. But it was widely believed that the EMR would mean efficiency. Physicians roundly agree, however, that even after the learning curve of a couple of years is over, an EMR slows them down by about two office visits a day.
The computer also has the potential to be a distraction that comes between you and your doctor. I try to be acutely aware that when my eyes are on the computer, they are not on the patient. I use the computer not just as a chart, but as a tool to educate and share with patients. Don’t be afraid to tell you doctor to close the computer if you need his undivided attention.
The byword in medicine right now is teamwork: teamwork across specialties; between hospitals and clinics; and between nurses, physicians and pharmacies. But we all need to be acutely aware that the patient is part of the team, too.
Dr. Ward is a medical oncologist at Puget Sound Cancer Centers. He can be reached at (425) 775-1677.