Five Things I Can't Stand About Going to the Doctor, part 1 of 5
Today kicks off a new blog series entitled, "5 Things I Can't Stand About Going to the Doctor." Each day will focus on a new thing that I just can't stand. I am sure many of you will share my experiences and if you do, I would love to hear about it. Also, feel free to post about your own things that YOU cannot stand about going to the doctor. As a disclaimer, I love doctors. They are who help us when we are sick. So if you are a physician reading this, please don't take it personally. One of the reasons I am writing these posts is because I hope some physicians may read these posts and reconsider the way they run their practices.
With that said, the first thing I cannot stand when I go to the doctor is when they try to do a bait and switch and have me seen by a physician's assistant or nurse practitioner instead of the doctor. Now, I don't have anything against anyone in these fine professions, but when I make an appointment to see the doctor, I expect to see the doctor. Call me crazy. A perfect example of this happened a few months ago when one of my family members had an appointment with a neurologist. We made the appointment by phone and received a letter in the mail saying "Your appointment with Dr. Smith is on such and such date and time." Again, call me crazy, but when I get a letter from Dr. Smith's office saying we will get to see Dr. Smith, when I get there, I better see Dr. Smith or I'm going to be angry.
So after sitting forever in the waiting room we were finally called in by a nurse practitioner. She began to ask us questions about symptoms and I stopped her and asked if we were going to see Dr. Smith. She said no and added that we will be seeing her and that she works in consultation with Dr. Smith. This is code for telling us that she does the entire evaluation herself, determines the impression and plan, and that we may or may not see Dr. Smith at all. What Dr. Smith will do is look over some scans and co-sign the notes that she writes. Having the nurse practitioner is a way for Dr. Smith to see more patients and run his practice more efficiently, but at what cost to the patient?
Remember, we made an appointment to see a physician who did special intense training in a particular field of science. As great as nurse practitioners are, there is no way that they know more about neurology than neurologists do. So then I had to pull the "doctor thing" and tell her than I am a doctor and that when people call my office to make an appointment to see Dr. Carone, they expect to see me and not someone else. The woman was obviously annoyed, feeling we did not think she was smart enough. But it really wasn't about that. It was about insisting that we be seen by who we were told we would be seen by. I would not have a problem if Dr. Smith told patients that they will be scheduled with a nurse practitioner ahead of time, giving people the option to refuse if they want to. What I don't appreciate is sandbagging patients at the last minute like this and then putting the patient in the uncomfortable position of confronting the medical staff. We held our ground and insisted we be seen by the neurologist. Sure enough, Dr. Smith walked in 10 minutes and did a full evaluation on my family member. Sometimes, you have to stand up for what you believe in. Click here for the next post.
posted by MedFriendly | 11:07 PM
11 Comments:
I agree with you.
You are correct and there should be full disclosure at the time the appointment is made as to who the patient will see. Physician extenders become more mainstream every day and it is a shock to patients. They are common in primary care specialties as well as ob/gyn. They are becoming more common in ortho, neurosurgery and other specialties too, so there should be some ground rules that everyone follows.
It's nice to see others acknowledging the politically-incorrect view that NPs and PAs are NOT physicians and, in fact, do have less training & expertise.
All too often we hear of subspecialists' offices relying almost solely on mid-levels to see patients. I haven't heard of this in primary care offices - mine certainly couldn't afford one.
What's worse is hearing feedback from a patient that a cardiologist's NP or PA denigrates the PCP for sending them a patient with [fill-in-the-blank] that should've been handled without a consult, like their training provides even 1% of the training & judgment gleaned from a medical residency & primary care practice.
Just yesterday I overheard a reply from an NP to a patient's family in a nursing home inquiring about their role: "An NP has the knowledge of a doctor but the compassion of a nurse"!!!
Just today that very NP made a medication error & even wrote it on the wrong patient - luckily i caught it, or the patient would've had an even worse iatrogenic hyperthyroidism.
With the inevitability of the growth of minute-clinics, primary care will seemingly be replaced by NPs and PAs, who will happily dole out antibiotics for colds, work excuses, etc., all with "the knowledge of a doctor but the compassion of a nurse".
Hurrah for consumerism.
I agree with you regarding who sees who in the office. I am a nurse practitioner working in a family practice and when patients call and ask for appts the office girls say right up front "who would you like to see? The nurse practitioner or the doctor?". No miscommunication in our practice. It's common sense.
Another reason to object - being expected to pay the top-tier "specialist" copay or deductible, when one is not even evaluated by an MD, let alone a specialist.
I abandoned a practice for pulling this stunt.
When will the economics of physician care of patients change so that doctors can see less patients, can spend more quality time with them and be more responsible for the direct care of the patient? I teach first and second year medical students "Introduction to Clinical Medicine" and our curriculum is all about doctors personally attending to and being personally responsible for their patients and nothing, nothing, nothing about simply being some sort of a "responsible" supervisor.
For those who want to read more about what the general public hate about doctors, I have a thread "I Hate Doctors" (that title came from a visitor) on my Bioethics Discussion Blog. ..Maurice.
Interesting. I am a Physician Assistant in a surgical subspecialty. The billing code is less for a PA than that of a doctor. For that reason, many patients prefer to see me. And what about the several dozen other patients who state they would rather see me over any of their six other doctors? I would never dream of stating that I have the knowledge of a doctor. I'm NOT a doctor. But I DO have medical knowledge and authority to see and treat patients. The most important thing is for physician extenders (PA's and NP's) to not act like they are doctors and to KNOW THEIR LIMITS. If that is the case, I think it is perfectly okay to be seen by one. Also, for patients who want to see only the doctor in our office, the wait is sometimes 3-4 weeks out. So PA's and NP's make it easier to be seen sooner. As far as the NP writing the wrong prescription, are you saying that doctors never write wrong prescriptions??!! That is an individual situation, not a profession as a whole.
"Interesting. I am a Physician Assistant in a surgical subspecialty. The billing code is less for a PA than that of a doctor. For that reason, many patients prefer to see me."
thats bullshit. Its true that the billing codes for PAs pay less, but the patient never sees that and they pay a set fee regardless of whether they see an MD or a PA.
the insurance company may remburse the PA a lesser amount, but the patient pays the same cost regardless of who they see.
Thats why its ridiculous to pull a bait/switch and get stuck with a PA unless they reduce the copay. No practice I know of that uses PAs charges patients a lower copay if they are seen by the PA instead of hte MD. They charge the same copay regardless.
the patient is paying full price, they deserve to see an MD if they want.
I cannot agree with you more about how inappropriate the bait and switch technique is.
I am a PA working in the same specialty practice (dermatology)for over 10 years. I left the first dermatology practice after working their for only a few months, because I felt it was unfair to the patients to expect to be seen by the physician, and then being switched off to a PA without prior authorization by the patient. As a practitioner, I certainly don't want to see a patient that is unhappy seeing me before I have even said hello. I am sure you would feel the same as a physician. No matter how correct my evaluation or treatment plan was, the patient may still feel that their care would have been better if it was from the MD or DO, regardless of how correct or incorrect their assumption.
I am also old enough, and experienced enough to "know what I don't know." What I don't know is many of the esoteric dermatologic diseases that some of the physicians know, and I still don't know everything about reading pathology. But, the day that I feel I do know everything about dermatology is the day that I should no longer see patients. That is why any patient that I see where there is any question of diagnosis or treatment, gets another evaluation from a dermatologist in the practice, either immediately, that same day or, another day that is convenient for the patient. In our practice, every patient that I see has booked with ME because that was their choice. I work with five other dermatologists, a pathologist, and three other PAs, so prospective new patients, or returning patients certainly have their pick of the litter.
On the other hand, what I do know, and what many physicians are reluctant to understand, or at least admit to, is that knowledge is gained in various formats. In fact, a resident, working 80 plus hours per week, at 36 hour clips has been proven not to be the optimal learning forum. My residency in Dermatology has been more than 10 years, working One-On-One, with one of the most knowledgeable dermatologists in the state. I will probably never have the same level of dermatology knowledge that he has, but I will always strive to get to that level. And, Yes, I think I DO KNOW more about dermatology than most primary care docs.
I started practice in primary care, and worked there for several years before moving to dermatology. OK, so I consider that I did two years as an intern in a private practice, rather than 1 year in a hospital. My knowledge base was not even close to that of my supervising physician in primary medicine when I left, but then again, what intern knows what the attending knows? Does any doctor know EVERYTHING about medicine? That is why primary care doctors refer to specialists, and why specialists refer to sub-specialists. What my primary care employer told me when I moved on to dermatology was, that in a few years I would certainly know more about dermatology than he did. He also said that he felt comfortable knowing that any patient that he referred to me would be taken care of appropriately, either by myself or, by my new supervising physician.
One thing that would be good for some doctors to know is, that they didn't learn everything about medicine in medical school. Continuing education is a fact of life in medicine, and if you think you learn better because you have an MD degree, my friend you are sadly mistaken.
You are more than welcome to visit my practice. I will be able to see you within a few days, rather than weeks or, even months for a doctor. You will wait no more than 10 minutes to see me (unless you take 30 minutes to fill out the ungodly paperwork - my pet peeve). The staff, and nurses will be friendly and courteous, they will bring you in to a comfortable exam room, and unless you want a full body check, you will remain clothed until I walk into the room. You will have the full benefit of 15 years practice experience, and best of all, you will have someone examine you that has a great bedside disposition - that is, unless you don't like humor during an exam.
Is there a law regarding this disclosure? I am an NP and have acurrent issue with my PCP. All year I have seen the PA for "work ins", and do not trust her judgement. She dx'd me with a sinus infection and argued with me about it even though I did not have one. She also asked me how much I was making! I stuck with the practice because I really like the Dr and was looking forward to my yearly physicial so I could talk to her. My husband was scheduled a week before and was supposed to see the MD but was changed to the PA's scheduled without notification. I called and found my appointment had been changed also. I told the receptionist that I had not seen the dr in a year and wanted to see her. She told me their office policy was that we see the PA every other physical. After some arguing, she changed the appointment to the MD. She called later on to thell me the office mgr had changed the appointment to the PA, and told me I could see the DR on a certain date at 0930. THen the office mger called later to tell me she needed to change the appointment to 0830. I asked if it was with the MD, she said no. I argued with this woman for 20 minutes. I let her know that in my office the pt's are informed and have a choice to see the NP or MD. I also let her know that I had issues I did not feel comfortable discussing with the PA. She said the reason the physicals are scheduled with the PA was so that I could "get to know her and feel more comfortable". I told her I did not want to get to know her. I kept the appointment so that I could get refills I was needing. I had a folow-up scheduled with the MD. I just got a call from the receptionist that the office mgr changed me to the PA's schedule again!!! SHe wanted to know if I wanted to try to reschedule with the Md again and hope the office mgr didn't change it! I said don't bother I will find a dr I can actually see. I hate that because I really do like the Dr but this is crazy. I really would like to lodge a complaint, but with whom? As an NP I am not against seeing a PA or NP but did not trust this one and feel I should have a choice!
I found a very good prescription discount card at www.rxdrugcard.com.
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