Part One | Part Two | Part ThreePart Three – The Waiting Game
By: Jean Johnson for Medtech1
We’ve all been there – the relatively well-appointed rooms with the big plants in the corner, the basket of toys and the tattered magazines. If it’s a first appointment, we even arrived 15 minutes ahead of time to complete the requisite paperwork. Then we were invited to take a seat and informed that the physician would see us soon.
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Fast facts on medical liability:
In 2004, the Department of Health and Human Services found that of the $1.6 trillion spent on healthcare, between $60 billion to $108 billion were expenses traceable to legal liability fears.
The cost of medical malpractice law suits to healthcare spurned debate in the 2004 presidential election: The Bush-Cheney ticket supported a cap on non-economic damages in liability cases; the Kerry-Edwards ticket supported a shift to a mediation system and sanctions against lawyers with a history of frivolous lawsuits.
Some medical liability insurance premiums can reach $200,000 a year, according to the American Medical Association.
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The New York Times article on the interminable waits so many patients endure focused on a rather extreme example of physician disregard for patient interest. Freddie Odlum, a Los Angeles breast cancer patient, had a CT scan to see if the cancer had spread to her lungs. The physician, who had been in her family for years, told her that he was going on vacation in two days and “that we needed ‘wrap this up’ before he left for a few weeks.” Not only did he not call before he left – despite messages Odlum left on his voice mail – he didn’t bother to get back to the woman after he returned. “This physician’s wife had breast cancer and was treated by the same oncologist as me,” Odlum said. “I never spoke to him again.”
Waiting for a phone call that will essentially tell you how long you have to live is right out there on one extreme. Perhaps on the other end of the spectrum is the waiting that goes on daily in physician’s offices. It’s that more innocuous and insidious form of waiting that Body1 will explore here.
“On my mother’s 87th birthday we went to the eye doctor since she’s had trouble reading the newspaper. When she sits in a wheelchair for extended periods of time, she gets shooting pains that start at her neck and go right down to her right foot,” said Merrit Bramon, a retailer in Tucson, Arizona. “Anyway, we waited an hour and half. By the time she got for her eye exam she was in tears. What rankled me, though, was the doctor’s response. ‘Gosh, you should have come at 9:30. I was sitting around with nothing to do. Then everyone came in all at once.’ The implication was that the guy didn’t have any control over his scheduling. I found his remark insulting and told mom she ought to look around for someone else. I’m not sure how you screen doctors for being on time, but if anyone comes up with something, I imagine everyone would jump on it.”
Bramon noted that he’d heard of the new spiffy practices where physicians charge patients annual premiums – some as hefty as $15,000 – for timely access that includes some phone contact as well as taking fast tracks through waiting rooms like you’re coated with Teflon. He imagines, though, that for those of us with average means, there’s little recourse.
Not so, according to medical director of Providence Health System’s Integrative Medicine program in Portland, Oregon, Miles Hassell, M.D. “The waiting room issue is extremely simple; having respect for patients means you do your very best see them on time.” Conversely, Hassell explains that patients need to respect his situation as well. Usually this means he sees a lower volume of patients, so a visit to Hassell runs around 20 percent more than most physicians charge.
“Certainly some emergencies cannot be planned for. If someone’s been bitten by a dog or has crushing chest pain, I see them first. But patients understand that, and it’s not what they are complaining about in my opinion. In general 99 percent of why people are waiting is that if you have a full waiting room, no matter what happens you’re going to be making money every minute.”
“The lady that schedules a half hour appointment for a cold and then bursts into tears because her husband just left her is kind of normal in what we do,” Hassell said. “So if you’re goal is to have an empty waiting room like I do, you have to build those kinds of situations into your scheduling. The down side is that if a patient doesn’t come in, you end up having to use the time to catching up on paperwork or whatever. So it’s not a way of running a practice that your accountant would say is most efficient financially. Even with my somewhat higher office visit fees, I have to accept a lower overall income. Having said that, I should stress that I am quite happy with my income and role. There are very few jobs I can imagine that are as fulfilling as mine.”
Hassell underscores, though, that no amount of money is worth treating people – even patients – disrespectfully by making them endure extended periods in waiting rooms. “Treating people with courtesy is just good conduct, and that demands physicians see patients on time.”
Heather Beck, a Georgetown University medical student bemoaned the “erosion of the traditional relationship of trust between doctor and patient” as a “distressing trend… in which health care is seen more and more as a service industry… run like a restaurant business,” in a letter to the Times responding to the article on wait times. “Doctors are forced to see more and more patients because of soaring malpractice premiums, which increased by as much as 25 percent last year, and declining rates for medical services.”
At essence, Beck agrees with Hassell. The bottom line is that most physicians at least in part go into their line of work because it has paid very handsomely historically. During the present era as rates of physician take-home pay – that in some instances run over $1 million annually with most physicians in the lower-paying Portland area bringing in around $100,000 annually – are increasingly threatened, most practitioners have done the sensible thing – book so heavily that they have a string of patients ready at their beck and call. Then they turn around like Bramon’s eye doctor did and say, “Gosh, not my fault. Everyone came at once.”
Where the answer lies in this controversy, Body1 doesn’t presume to know. Still, the next time we need to see a physician, we thought we’d figure in the time it’d take to fly to Portland. It just might be quicker – and even more efficient dollar-wise when you consider time lost from work – to book an appointment there with Dr. Hassell or one of his counterparts should any of these physicians be taking new patients.
