Why Doctor Visits are Frustrating and What You Can Do About It

You wait weeks to see the doctor. You could have scheduled a visit sooner, should have scheduled a visit sooner, but life and time got away from you. It has been so long since you have been in and you want to make the most of your visit so you make a list of the things about which you are concerned. Not all of the things are major or important but you figure you might as well bring them all up, because it may be a while before you make it in again.

The receptionist was in a hurry when you called so you did not bother to tell her all of the issues you wanted to address, you mentioned the back pain and the blood pressure that you have been ignoring since the last time you were seen 2 years ago. You will bring the rest up when you see the doctor.

After a 30 minute wait in the waiting room and another 15 in the exam room the doctor hurries in. He greets you briefly before turning to his computer. “I see you are having some back pain and your blood pressure is still high,” he says without turning to look at you, “How long has your back been acting up?”

You want to give him the full story, so you begin to tell him about how it all started 4 years ago lifting boxes at work, and how it has been bad off and on since then but has been really bad for the last 3 weeks. He interrupts you 15 seconds in, “How long for this episode?”

“Three weeks, but it all start…” interrupted again, “Any weakness or change in your bowel or bladder?”

“No, but…” you reply, “Let me have you sit up here,” again interrupted, you sit on the table and the doctor does a quick exam on your legs, checking your reflexes and strength. He doesn’t even look at your back. Within what seems like seconds he tells you that he is going to give you an anti-inflammatory medication and send you to physical therapy. If you are not better in 3-4 weeks you are to come back for a follow up visit.

He then tells you that he wants you to check your blood pressure at home 2-3 times a week and return in a month for a follow up blood pressure check as you may need medicine. He says you also need lab work and tells you to pick up the order at the desk on your way out. As he reaches for the doorknob he says you also need a mammogram and a colonoscopy and that he wants you to pick up the paperwork for those at the desk as well.

“Okay, but there were a few other things I wanted to talk to you about,” you plead.

“We can discuss those when you come back in a month,” he replies as he disappears out the door.

The entire interaction took about 10 minutes and you are left wondering what happened. You are walking out with several recommendations you did not ask for, little attention for your main issue and no attention at all to the remainder of your list. You ask yourself, “Is this why I have health insurance?”

Welcome to modern medicine, where the doctor does what he is required to do and the patient feels as if nothing has been done at all. Here are the things you need to know to help you understand and navigate this seemingly uncaring healthcare system.

1-      Routine visits are scheduled 15 minutes apart. Most doctors do not type well and electronic records are horrendously slow and inefficient, so the time available for the doctor-patient interaction is a net of 10 minutes or so. If there are two issues to be addressed, that is 5 minutes each. Very few doctors can effectively treat more than a few complaints at a time, and you really don’t want them to!

2-      Longer visits cost the doctor money. In a perfect world physicians would make the same for one 30 minute visit as they do for two 15 minute visits. The world is not perfect and they don’t. Under many insurances a long visit may only pay an additional 50% over a short visit. Doctors can do the math, so instead of scheduling long visits they ask you to return if there are many issues to address.

3-      Common complaints don’t usually require much thought or attention. Back pain in a healthy person without weakness or incontinence is almost NEVER anything to worry about. It will go away in 3-4 weeks with or without treatment. MRI’s and X-rays don’t change this fact. For many mild illnesses and conditions there is not much to do. If lengthy discussions and examinations don’t change the treatment plan, why do them?

4-      Doctors are responsible for your preventative health screens, whether you are interested in them or not. We get evaluated based on the percentage of patients who have mammograms, colonoscopy, PAP smears and appropriate immunizations. As we do not know if or when a patient will return for follow up we are forced to squeeze time for these recommendations into other visits. The result- We may not have the time for everything you wanted to discuss.

5-      There is much more to a doctor’s day than patient visits. Doctors spend a minimum of 2-3 hours a day working on issues outside of the exam room. Medication refills, phone questions, review of test results and lab results, disability and FMLA forms, home health orders, consult requests, referrals and appeals of insurance denials are endless. Doctors get paid for none of this work. We frequently try to do some of this work between visits, which further cuts into patient care time.

While this explains why your doctor is hurried and grumpy, there is still the question of how you get the care you desire. Here are somethings you can do to help your doctor take better care of you and get your health issues addressed.

1-      Take responsibility for your preventative screening needs. Schedule a wellness visit and ask what you need. Write it down, or save a link to recommendations. Enter the dates in your calendar or cell phone and then get the screenings done. If you take the time to make sure you are up to date your doctor won’t have to.

2-      If you have a number of issues you want to discuss, prioritize them. Tell the receptionist and the nurse the issues so the doctor will know when she comes into the room. Tell the doctor the items that are most important to you and be willing to come back if more time is needed.

3-      Don’t expect a lengthy visit for a common problem. Doctors sometimes see simple complaints such as acute back pain, bladder infections and colds as short visits that allow them to catch up when they are behind or to gain time after a complicated visit.

4-      If you do not feel comfortable with your visit, let the doctor know. Try saying something like, “I sorry, but I am confused. Could you explain this to me?”

5- If you need a lot of time, ask for it! You may need to come back, but most doctors want to help and may be willing to spend the extra time you need.

- Bart

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The Day I Learned Not to Trust Doctors

When I entered medicine I believed I was entering a field comprised of noble professionals committed to taking care of others. I did not expect to encounter doctors who would put personal convenience before the needs of a patient. When I did, I did not handle it well.

I remember well when I first learned that not all doctors put the patient first. It was 1991 and I was an intern working on the OB floor. It was a Saturday and I was responsible for managing the residency program patients who were in labor. There was an experienced obstetrician supervising me, there to observe and provide guidance and to be available should a c-section be necessary.

I had been managing the care of a young woman whose labor had not been progressing well. There had been no significant change for a few hours and we were debating giving up and performing a c-section. The decision was made for us when the woman developed a significant fever and the fetal monitor showed early signs of distress. I went to the charge nurse to make arrangements for the surgery and was told that we could not go to the operating room, that a doctor had scheduled a c-section for another patient who had presented in early labor with the baby in breech position. As both patients “needed” surgery and the other doctor had asked first she told me that I would have to get the other doctor to agree to being “bumped” if I wanted to take my patient back to the operating room.

I asked a few questions about the woman with the breech baby and learned that she was in very early labor. Her cervix was only dilated 1-2 cm, which meant that there was no urgency in performing her surgery. As it was clear to me that my patient’s need for surgery was more pressing I sought out the other OB for what I assumed would be a simple and collegial conversation. I was wrong.

When I presented him with the details of the cases, he replied, “You will have to wait. My patient is breech and in labor!”

“She 1 cm and contracting irregularly! Why not get her an epidural, keep her comfortable, and wait the hour until our case is done? There is no risk to your patient but there is risk to ours!” I was incredulous.

He repeated his same assertion. I was dumbfounded. I was just an intern, but I was a good intern who was knowledgeable in the management of labor. This was not even a close call. It was a no-brainer. Good medical care demanded that he allow our case to proceed. I went to the charge nurse and asked her to tell him that he had to wait. She refused. She might have agreed with my position but in a debate between an attending and an intern she knew who was going to win. It wasn’t me.

I was overcome with anxiety. A million agonizing thoughts and questions were racing through my mind. Was I supposed to just give up? How could I? I was supposed to advocate for my patients, to fight for there care. But how could I fight when I had no power? The obstinate obstetrician was an established member of the medical staff and a faculty member in the residency program. What would happen if I pushed back to hard?

I decided that personal consequences were irrelevant. It was about my patient and her baby. I went back to the resistant obstetrician to again plead her case. I asked him for details about his patient and why should could not wait. He got angry and told me I was out of line. I wish I could say that I took it well. I didn’t. I told him in no uncertain terms (and with significantly elevated volume) that he was willfully and knowingly putting my patient at risk and that if anything happened to her it would be on him. Defeated but realizing I had done all I could I went back to check on my patient.

I walked away disillusioned. I had honestly believed that the other doctor would do what was right. I later learned that his recalcitrance was based on the fact that he had family plans that would have been disrupted if he waited. Knowing that a patient was put at risk out of convenience was unfathomable to me. I had looked up to this doctor before, had sought his counsel and learned from him. My trust and confidence were permanently damaged. The fact that my patient was not ultimately harmed by the delay did little to ease my frustration.

My frustration increased a few days later when I was called in to the office of the Residency Director. He sat me down to lecture me on my impertinence, telling me how inappropriate it was for an intern to challenge an attending physician. In typical Barrett fashion I did not back down. I apologized for my tone but made it clear that regardless of my standing or level of training I would always put the patient first.

As we talked, I realized that he didn’t really disagree with me. He knew that the attending was in the wrong. He also knew how the world worked. In order to run a residency program he needed faculty, and the only source of faculty he had was the medical staff at the hospital where we were located. Not all of them were noble and excellent but they were all we had. He admired my convictions but wanted me to understand the need to carefully choose my battles.

It was a difficult lesson for me to accept and it is one with which I continue to struggle. I have lost many battles that I should have known to be futile, died on too many hills trying to do what I believed to be the right thing for my patients. I have also saved lives by speaking out. I have learned that most doctors are good people but we are still people, with all the selfishness and inconsistencies personhood brings.  The learning process that began 24 years ago on that OB floor continues to shape me. Although I use less anger and volume one thing that has not changed is my commitment to doing the right thing.

- Bart

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6 things you know that your doctor doesn't

We doctors may be intelligent but we are not always smart. Some things that are obvious and well known to our patients completely escape us. Here are some important things you know that we probably don't.

1- Our explanations are so confusing that you have no idea what we are talking about.

We think you understand us, but we are often wrong. We are so accustomed to using big words and medical terms that we can talk for 10 minutes and not say anything that makes sense. I recently observed a student interview a young patient about migraines. She asked, "Do you have an aura?" The patient replied, "No." I then asked the patient if he knew what an aura was- "Nope!" He had no idea! This kind of  poor communication is common. Tell us when you don't understand. You deserve an answer that makes sense.

2-How much your medication costs.

Medication costs vary widely and many doctors have no idea how expensive a prescription is. I have seen patients pay $115 for a prescription at a major chain pharmacy that could be purchased for $10 at a discount store. I have also seen dermatologists prescribe an expensive brand name acne antibiotic instead of a generic version of the same medication. The difference in cost- $900 a month! The dermatologists had no clue! Tell your doctor when your medication is expensive and ask for other options.

3- How rude or nice the office staff is.

Doctors are often very poor business managers. They are frequently unaware of the customer service provided by their staff. They probably don't know how long you were on hold, how abrupt the staff was when you arrived, are how long you waited before your needs were addressed. Before leaving and finding another doctor (with equally rude staff), let your doctor know how you are treated.

4- Your Name

This one is embarrassing. I frequently encounter patients while out at the movies or shopping. Many times I am better at remembering diagnoses and medications than I am a patient's name! On more than one occasion I have made my wife hurry down a different store aisle to avoid seeing a patient whose name I could not recall! Be kind and reintroduce yourself!

5- What your insurance covers

Most doctors contract with multiple insurance plans, all of which have different rules, provider networks and conditions for coverage. We just can't keep up with it all. You may be more likely to know which lab to use, what hospital to go to or what your co-payment is than we are. It is wise to confirm with your doctor or insurer before getting tests or X-rays done or before seeing a specialist.

6- How worried and frightened you are

We deal with illness every day. You don't. As a result we may forget how frightened you are of a serious diagnosis. We sometimes say things like, "We want to make sure it isn't cancer," and think we are being reassuring. What the patient hears is-"You might have cancer!" Fear and panic may set in. Cancer may be low on the list and we may just be being thorough, but our words cause needless worry. If you are worried or fearful, tell us! 

 We are doctors and we are educated, but we are still people, with all of the limitations that come with being human. Communication is a common weakness. Our patients are uniquely equipped to help us do better, because you know things we don't!

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