anonymous said...Happy, I keep coming back to yor blog because I am addicted to Marty and Cooper's pictures. They are adorable.
You, however, are getting on my last nerve. Why is it that the patient never gets the benefit of the doubt? Why is it that you have decided all patients, unless they are so critical that they cannot speak, are lazy, entitled assholes that do not understand how horrifying difficult it is to be a doctor? I know it is difficult to deal with sick people, people who are not at their best, people who are vulnerable, people who are dissapointed in a system they do not begin to understand. I get it that you are not overpaid. But must you be always patting yourself in the back over how well you dealt with some stupid patient who had the audacity to question a treatment or complaint, or *gasp* demand more than you think they deserve or they paid for (or the government/you as the taxpayer paid for)? Sometimes I wonder why did you go into medicine. It was not because of the money, because this is not the most lucrative profession. Why did you?
I guess I am also having a bad day.
Julia
You, however, are getting on my last nerve. Why is it that the patient never gets the benefit of the doubt? Why is it that you have decided all patients, unless they are so critical that they cannot speak, are lazy, entitled assholes that do not understand how horrifying difficult it is to be a doctor? I know it is difficult to deal with sick people, people who are not at their best, people who are vulnerable, people who are dissapointed in a system they do not begin to understand. I get it that you are not overpaid. But must you be always patting yourself in the back over how well you dealt with some stupid patient who had the audacity to question a treatment or complaint, or *gasp* demand more than you think they deserve or they paid for (or the government/you as the taxpayer paid for)? Sometimes I wonder why did you go into medicine. It was not because of the money, because this is not the most lucrative profession. Why did you?
I guess I am also having a bad day.
Julia
the happy hospitalist said...Julia, my experience with upset patients, for the last five years, has everything to do with them not getting what they want and nothing to do with them not getting good medical care. My job as a physician is not to make people happy. My job is to give them good medical care. My hope is that by giving good medical care, patients get better and will then be happier. But for some people, that logic doesn't fly. Some people are only happy with money. Some are only happy with family. Some are only happy with religion. What makes a person happy often times has nothing to do with the quality of their health care services.
So I've learned in my five years on the job that my job is not to make everyone happy. Nor do I care. I can't care, otherwise I would be buried in wallow all day long. If you get good medical care and you're still unhappy, it's not my job to fix you into a happy person. That's on your shoulders. And good medical care should not be confused with great service.
If you want great service you need to book a room at the Four Seasons. They will do everything for you at the drop of a hat. You can have lobster delivered at 3 am. They will make sure of that. But it will cost you. And it will cost you dearly. If you want a decent room with four walls and a console TV, you book a room at Motel 8. You get your basic service. But you can't complain when nobody answers your call at 3 am. And if you try and complain, you will look like a fool.
If you want to be happy with your medical service, you have to join a concierge practice where doctors will kiss your ass every second of the day. You will get the service you desire. Why? Because you will be paying them to kiss your ass. In the current third party model, you get what you don't pay for. You may pay huge premiums, but those premiums don't get you service. They get you protection from $100,000 hospital bills. I've never seen an inanimate object (a hospital) that coud kiss ass.
You may feel that you pay 10 Grand a year in premiums and everyone should kiss your ass and do exactly as you want, five minutes ago. You may demand that your doctor, who has already left the hospital, interrupt their clinic because you missed them this morning and drive back to talk to you. You may even want to demand a 0/10 on the pain scale.
You may or may not realize that your physician has been squeezed to oblivion in terms of payment. And the resultant volume of services, both by visits and procedures is the natural result of that squeeze. Since the physician is the one that communicates, your 10 K in premiums mean nothing to your physicians. I don't care if you spent 5 K a year for premiums or 15 K or if you have a 10K deductible. Your insurance is between you and them.
The feelings that patients have when they tell me their premiums are so high and they don't get exactly what they want is that entitled feeling I am talking about. Talk to the hand. I just don't care. If you want service from your physician, you have to pay for service. And third party payments to your physician do not buy you service. They buy you medical care in a volume mill. They buy you Motel 8. If you want more time to communicate, to feel better and giddy inside about your relationship, to feel like a Princess, then you need to leave the third party system and pay your physician directly. You need to sign up for the Four Seasons Plan. And if you can't afford it, then you need to accept what you get, or move on to another doctor. But more likely than not, the same third party issues exist in every doctor in your plan.
Dr T and Half MD said it in far fewer words. You get what you don't pay for.
Also, I had a very busy day, but not a bad day. That makes up for the other three days I was done with rounds by 11 am. We have slow periods and busy periods. I have learned to accept the busy ones with a grain of salt. I go home at the end of my shift and have no responsibility when I sign out. That's my reward for working very hard during the day.
Julia, I'm sorry you feel offended by what I say. It's not me. This is the culture of health care delivery in the third party model. Don't believe for a second that what I wrote here is limited to my beliefs. It is almost universal in the third party model of payment. I'm here to tell you that it exists and it's everywhere and either accept it or fight back. Comprehensive care doctors are beginning to take back their profession by leaving the Medicare system at the expense of granny. They are leaving for the greener grass where patient and doctor have a payment plan and service plan agreeable to both.
So I've learned in my five years on the job that my job is not to make everyone happy. Nor do I care. I can't care, otherwise I would be buried in wallow all day long. If you get good medical care and you're still unhappy, it's not my job to fix you into a happy person. That's on your shoulders. And good medical care should not be confused with great service.
If you want great service you need to book a room at the Four Seasons. They will do everything for you at the drop of a hat. You can have lobster delivered at 3 am. They will make sure of that. But it will cost you. And it will cost you dearly. If you want a decent room with four walls and a console TV, you book a room at Motel 8. You get your basic service. But you can't complain when nobody answers your call at 3 am. And if you try and complain, you will look like a fool.
If you want to be happy with your medical service, you have to join a concierge practice where doctors will kiss your ass every second of the day. You will get the service you desire. Why? Because you will be paying them to kiss your ass. In the current third party model, you get what you don't pay for. You may pay huge premiums, but those premiums don't get you service. They get you protection from $100,000 hospital bills. I've never seen an inanimate object (a hospital) that coud kiss ass.
You may feel that you pay 10 Grand a year in premiums and everyone should kiss your ass and do exactly as you want, five minutes ago. You may demand that your doctor, who has already left the hospital, interrupt their clinic because you missed them this morning and drive back to talk to you. You may even want to demand a 0/10 on the pain scale.
You may or may not realize that your physician has been squeezed to oblivion in terms of payment. And the resultant volume of services, both by visits and procedures is the natural result of that squeeze. Since the physician is the one that communicates, your 10 K in premiums mean nothing to your physicians. I don't care if you spent 5 K a year for premiums or 15 K or if you have a 10K deductible. Your insurance is between you and them.
The feelings that patients have when they tell me their premiums are so high and they don't get exactly what they want is that entitled feeling I am talking about. Talk to the hand. I just don't care. If you want service from your physician, you have to pay for service. And third party payments to your physician do not buy you service. They buy you medical care in a volume mill. They buy you Motel 8. If you want more time to communicate, to feel better and giddy inside about your relationship, to feel like a Princess, then you need to leave the third party system and pay your physician directly. You need to sign up for the Four Seasons Plan. And if you can't afford it, then you need to accept what you get, or move on to another doctor. But more likely than not, the same third party issues exist in every doctor in your plan.
Dr T and Half MD said it in far fewer words. You get what you don't pay for.
Also, I had a very busy day, but not a bad day. That makes up for the other three days I was done with rounds by 11 am. We have slow periods and busy periods. I have learned to accept the busy ones with a grain of salt. I go home at the end of my shift and have no responsibility when I sign out. That's my reward for working very hard during the day.
Julia, I'm sorry you feel offended by what I say. It's not me. This is the culture of health care delivery in the third party model. Don't believe for a second that what I wrote here is limited to my beliefs. It is almost universal in the third party model of payment. I'm here to tell you that it exists and it's everywhere and either accept it or fight back. Comprehensive care doctors are beginning to take back their profession by leaving the Medicare system at the expense of granny. They are leaving for the greener grass where patient and doctor have a payment plan and service plan agreeable to both.
I don't think she said she was going to stop reading, only that your rants were getting on her "last nerve."
ReplyDeleteI think, as patients, we tend to personalize what you doctors say when you blow the steam valve (as is your right), and think you're talking about every single one of us. Sometimes it's not entirely clear that you differentiate between the particular patients who aggravate you and those who are less demanding or "entitled," so it seems as if we're all being blamed for the bad behavior of the few (I think you would probably quibble with me over how "few" there are, but that's the word that fit). For our part, I think we patients sometimes forget that your intended audience is not so much us as your fellow doctors.
Whatever. It's your blog. You have no responsibility for catering to the feelings or expectations of others. Nevertheless, you've chosen to make your opinions public, so don't be surprised when some of us bristle at being treated like the adversary.
And we are, believe me! Read his rant again! And read the blog (yes, only the dogs hold me here) once a week or so. It's one big bitchfest. It would not hurt you to make us happy, Dr HAPPY! You're so damn happy. What makes us happy is timely attention, a delusion of competence in the doctor we are talking to (or even the reality of it), our own language spoken competently, a sip of water in 10 hrs in the ER even though you have not "gotten" to us yet, some decency, maybe use our name (it's written down there). ETC! No one is asking to dip strawberries in chocolate--but we are asking, as your fellow human, for a minute's decency and not some condescending doubletalk or a lecture or blame. A cure or remedy--icing!
ReplyDeleteUhm... okay, the views of anonymous 1:42 are not those of anonymous 11:04. Or whatever time stamp is on this post.
ReplyDeleteHappy, anon#1 is correct. I did not say I was going to stop reading your blog. I like a lot of what you have to say and I feel for you and all the third party system mess we have to live in. My problem is that sometimes it sounds like you have never been sick, been scared to death or angry because you feel your life is in the hands of somebody who clearly does not care. It is not about having it your way. It is about a minimum of respect and consideration, that is all.
ReplyDeleteBesides, you are much better at telling funny or touching stories. So I will just keep on reading and waiting for those.
Julia
happy, great post. i think there is often a disconnect between patient's perception of what may be happening to them healthwise, and being happy with a service.
ReplyDeletegetting to the "bottom of it" should be the goal... figure out why the legs are swelling and your short of breath... why you have fever and cough... why you have chest pain when walking up a flight of stairs etc. from what i've seen so far, there are many patients (not all) would rather have a handshake and a smile, regardless of what's actually done to/for them... people want to feel like they're getting a ton of stuff, whether or not it actually makes a difference in the outcome is irrelevant to them.
and to me, that in many ways is the crux of the matter. the patient (and oftentimes the family of the patient) want to see a whole bunch of things going on- x rays, labs, cts, specialists... so they feel like they're getting the special treatment, regardless of whether or not it makes a difference.
there are some doctors who will cave to the pressure, order all sorts of tests and consults just to appease the patient (and family), without an expectation in changing management of the patient. however, it seems as though docs like you and i see it a bit differently. if it's appropriate to order a certain test, or getting a particular specialist involved will make a difference in management, that's all well and good. but if it's not going to make a difference, there's no point in ordering the test or getting that specialist. but alas, many patients (and families) don't want to hear that, and don't care. because as you said, they want that 3 am lobster delivered not now, but right now.
e: "There are some doctors who will cave to the pressure, order all sorts of tests and consults just to appease the patient (and family), without an expectation in changing management of the patient."
ReplyDeleteThis confuses me, because it doesn't seem like patients and their families should get to call the shots as to what tests or consults are ordered, etc. I assume we're not talking about family members who are medical practitioners, but members of the lay public?
Why would doctors cave? This just helps drive up the cost of healthcare for everyone, and places the doctor in a subservient position relative to the patient or family, neither of which is a great idea?
Does this have anything to do with Press-Ganey scores?
"Why would doctors cave? This just helps drive up the cost of healthcare for everyone, and places the doctor in a subservient position relative to the patient or family, neither of which is a great idea?"
ReplyDeleteIt sounds like you've never dealt with a truly difficult family. Like one with rampant mental illness affecting many family members, and some people saying that their loved one is receiving inadequate care, so this person is using a cell phone to photograph the nursing staff "for a lawsuit." Yelling on the phone at the physicians. Using obscene language to berate the office staff. The easy thing to do is pretend to do lots more tests to make them shut up.
Oh, okay. So it's a crisis management technique, in other words. Thanks for the response.
ReplyDelete