family practice issues and general life events

Posts tagged ‘physician’

Why your doctor is running late.

I know it is a stereotype that seems to take effect over and over in real life.  You go to the doctor, and he/she is running late.  It is a standard joke, and I have even heard of others attempting to bill the doctor for the time they waited because the patient’s time is also valuable.  Which it is, but are we talking billable hours, quality hours, life saving time.  What kind of time are we talking about?

First of all, let me say, that if you doctor gives the impression that your time is not also important, there is something wrong.  However, there are legitimate reasons why your doctor is running behind.  And rarely even though based on popular opinion is it due to talking overly much to the drug rep who comes into the office bearing gifts, golf outings and fabulous trips.  I wish that is the easy reason why I often run late.  A paid vacation would be wonderful, but those days are long gone, and were before I was ever licensed.  And if I spend time talking to a rep in my office it is so that I can get samples of a medication that might help my patient.  End of story.  I don’t collect money from them, occasionally they buy me a pizza at lunch so that they might detail me on their product and why it is better than their competitor, but if I am going to write for a medication, I will do it based on efficacy.  First in clinical trials, and then based on my patients.  So no, I am not running behind because of the pharmaceutical rep.  And if they come in, and I am running behind, often the time spent is merely to give a signature between patients.

I do meet with reps, and I am not ashamed.  I think that they help with treating my patients.  It is not that I believe their entire spiel, I am not that dumb, but they help a lot by providing samples, which allows my patients to try products before they have to pay copays or even pay for the full prescription.  And it is necessary, because despite what the people at Wal-mart tell you, not all medications have a $4 equivalent, and in the case of COPD, there is not a medication that follows the gold standards for treatment that is generic.  There might be a couple of different brands, but there are no generics.  However, they actually take up little of my day individually.

Most of the time, I am not running behind because I slept in late, or just was moving slow.  While it has happened, it is a rare day for that to happen.  Most of the doctors in my town, start their day by rounding on patients in the hospital.  My husband sees anywhere from one patient a day to 16 yesterday.  Since he usually sits around two or three on the inpatient, the 16 took considerably longer to see than normal, so he got to work about 45 minutes late.  In our clinic, most of our schedules are made 6 months to a year before, so there would have been no way to account for that amount of patients on Monday when it looked like a possibility

Much of the time, running behind schedule has to do with the patient complaint.  They take longer than the front schedules for.  This is not to say that patients are doing something wrong, but more than once I have seen someone worked in for a sore throat, only to have them say as I am walking out the door- “Oh and by the way, I have been having these chest pains.”  Well, I cannot tell you what my malpractice carrier would say, if I answered that “oh by the way” with “well stop at the front desk to schedule an appointment to find out what might be causing that.”  I guess with that complaint, I could send them to the ER, but well I have already done the exam, and gotten vitals, and most of my patients would be very angry if I sent them to the ER.  (This is not to say that if someone calls to tell me that they are having chest pain and shortness of breath, my front office has not been instructed to advice them of heading to the ER to make sure they are not having a heart attack, it is a little different after the exam)  And I would estimate that at least 10% of my exams a day have an “Oh by the way.”  Not always are they so bad as chest pain, but usually they do tend to increase the amount of time of the visit.

I might also be running behind because a patient has come in for one reason and they tell me that they have not been able to sleep since their husband died last week.  I cannot see how as a physician or a human, I can just stop them and say, “Well that is nice, but why are you here?”  Or “well that is too bad, but the patient in the next room has a sore throat, and well your 15 minutes are up.”  That is not what I do.  I am a family practice doctor, and in my mind, giving them a sympathetic ear, and any other comfort I can provide comes with my job description.  I would hope that all citizens of the human race would do the same.

I might be running late, because frankly I over-booked.  As terrible as that might be to say, but I do it frequently.  Why?  Well first of all, I have patients that have chronic conditions that need to be see frequently.  Those appointments are set up at intervals between a month to three months in advance.  So they have been there.  Next there is a group of appointments that are following up from an illness, ER visit or hospital stay.  These are set at intervals between one to two weeks.  Now while we try to cap those visits at a certain number, there are also appointments made available that day for work ins/sick visits.  And truthfully, I would rather fit as many in that day for a sick visit that I can, than have my patients wait, or visit the ER or the urgent care.  I am possessive about my patients.  They are mine.  I know their allergies, I know their history, and I know them better than any other doctor.  So I want them to see me whenever possible.  And truthfully it is easier, if I take care of their sick visit, because then I don’t have to figure out what someone else did.

And that leads me to another delay.  The other patient went and say a specialist, went to the ER, discharged from the hospital, etc.  In the future when interfaces are seamless and electronic records are readily available, I will not have to figure out what happened where.  It is very common for an ER follow up, that the patient tells me that the ER gave them some white medication that didn’t seem to help.  If it is the Emergency Room here in town, I can get access to the records, otherwise I have to stumble through and figure out what treatment they received and whether they need to see another specialist, and whether there are any medications that need to be changed.

Then there is the various exams that are required for work, medical equipment, school, and/or various other agencies which all take time and have requirements that have to be met.  And often these are brought up during the routine medication refill.  Seriously there is no winning in these instances, because few patients are happy if you make them come back for the paperwork and rarely is the paperwork merely one or two pages.

Additionally, there is a seemingly endless requests for medication refills, lab results, and radiology results which all must be reviewed and determined what needs to be done.  This includes consults from specialists (some of which are not legible) and management of more referrals.

All of these reasons contribute to why, I often run between 30 minutes and an hour behind.  I am not crazy about running behind, and I do apologize.  Because I am sorry, and I don’t want to keep you waiting, but I have between 30-35 patients on an average day, that I want to give personal time and attention.  I want to give them the care that they deserve.  I would like your visit to be as personal and comfortable as possible as it is to go to the doctor, but at the same time, I want to give the consideration to everyone.  One of the biggest complaints you see about doctors is that they don’t listen.  Well maybe I don’t want to be that doctor, and maybe I listen for too long.  So maybe your doctor is running late because in an attempt to make sure that your problem can be addressed, they take the extra time to listen and address concerns.  Maybe they are trying to teach better nutrition, making sure that you are receiving quality care.

So the next time you are annoyed that your doctor is running late, ask yourself do they take the necessary time with you?  Do they spend time listening to your problems and concerns?  And if the answer is yes, realize that maybe they are trying to do it for all of their patients

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A light at the end of the tunnel (OH I do hope it is not a train)

Finally after 8 weeks of not getting paid by Medicare, and 6 weeks of not getting paid by Medicaid, maybe there is hope.  Talking to my fellow physicians have helped.  Sadly the fact that knowing I am not alone and the biggest idiot with regards to payment ever has comforted me. For the first time in my life the expresssion, misery loves company actually does apply.  Not that I wanted them to have any difficulties, but for a bit, I thought maybe I was alone.  Being alone, would mean that it was all my fault, having company means there must be something in the system that is tragecially wrong.

Anyway, the new company that we had contracted took over the Medicaid billing immediately, and did get us some cash, unfortunately the Oklahoma Medicaid site crashed on Friday, and was not back up until Wednesday.  It still is not fully functional, but at least claims can be inputted back in.  (Probably due to all the desperate physicians in the state who had been using a clearinghouse to submit claims jumping on in droves desperate for some cash flow, that is just my opinion, but it is as likely as anything else.)

And Thursday morning, we were told that all of the updates from both the EHR vendor and the interface were finally complete.  (These are updates that have been released since the first of the year, and probably since the date we found out there was a problem, not due to any negligence on my part.)  And we were free to resubmit all claims.  Which means we get to go through and find all of the claims that we have submitted since December 19, and start all over again.  What fun will that be!

I spent Friday with the company that we had hired to start doing our billing (because we had a problem before the 5010 conversion almost bankrupted me, it only made it worse).  We were showing them the ins and outs of our system, and while showing them how to do somethings, we were able to understand some of the issues that we have been having.  Unfortunately the person who was responsible for inputing payment in never brought that issue to our attention.  But it will be fixed immediately.

As for our Clearinghouse, I understand that you were probably overwhelmed, but seriously, couldn’t you have given at least a heads up.  Some of us were in the middle of a Medicaid audit so it took a little longer to realize the problem.  You should have posted something immediately.  You were only too happy to take my money.  And the email you sent me saying you were looking into the issue, still has yet to address any of the concerns we have.  And your customer service response of “well look at our website.”  Which we had already looked at, and it said nothing, left much to be desired.  So any thoughts we had about retaining your services have been removed.  We will probably convert from you over the next month, after being a customer for almost 6 years now.

To my elected officials, I will keep you lack of response in mind when it comes to your re-election campaigns.  I received one confirmatory email which the senator will try to respond in the next month.  I guess you all were too concerned about issues of birth control (both state and nationwide) to think about whether physicians would even still be in practice in 3 months to prescribe the pills.

For all of you with your kind words of support, thank you.  I do appreciate it, and send happy thoughts back to you.  This year, so far has not been the one that I would like to repeat so far.  This conversion has really opened my eyes about future conversions.  I am not worried about ICD-10 for the coding issue, but for the computer conversion issue.  IF this is a taste of what is to come when that happens, well I am not sure that I have the desire to continue.

Dear Center for Medicare and Medicaid Services

This is an email that I would send to the Center for Medicare and Medicaid Services, but since they don’t have an email address for themselves, unless I want to report fraud on either myself or another, well I will have to make do.

 

Dear CMS-

I would say that you don’t know who I am, but you have used my picture for the last year advertising your EHR Incentive program as the first clinic to receive the Incentive Bonus from Medicaid.  So you must at least have an idea of who I am.  That being said, you probably don’t care, but at least you know that I have tried to play by your rules in order to win that honor.

Couple that with the calls a couple times a month from the Office of the Inspector General looking for the physician whom we  agreed to become custodian of record for, well you have talked to at the very least my office staff.  And we have given you all of the information we have.  OR have at least indicated just let us know what you want, we believe that she left the country, given you the email addresses we have, but we don’t have what you are looking for.  Well other than the patients version of what she did.  But otherwise you have not had many dealings with me.

I have a practice of 45% Medicaid and 25% Medicare.  So all together about 70% of my practice is receiving “insurance” from your office.  Over the past year, we have done all of your recommendations for 5010 conversion, and per you and our systems passed them all.  We have performed the required updates, installed the needed hardware, software, implemented the required training, all that you have indicated as necessary.  So based on those, we were ready for the conversion January 1, despite the delay to March 1, 2012.  However, you decided to implement the conversion on December 19, 2011 and installed a firewall.  This firewall blocking all new claims from going through.  We didn’t notice it right away, due to a 2 week to 45 days delay from date filed to date paid.  So we didn’t notice.  Add to that the notification that claims would be delayed about 2 weeks, well it took a little while.  25% is a large chunk of income, but it would have been ok, for a short period of time.

On December 28, the firewall went up for Medicaid.  Again there was a slight delay in noticing, since the turn around is two weeks, plus we were told that there would be a two week delay.  However, this was somewhat more painful.  Added to that the insurance companies have all installed required firewalls, however, after three weeks, we are finally through and getting paid.  So we are receiving payment for 30% of the work that we do.  That does not even cover my staff or overhead.

My understanding is that I am not alone in this problem.  It is neither EHR vendor specific nor clearinghouse specific.  The only constant is that they are plans paid for under your umbrella, Medicare, Medicaid and Tricare.  And one message received was that I was fortunate, at least my problems only started in mid-December, not early November like some physicians.  Whatever.  I have not taken a paycheck since the middle of December.  That is no paycheck for either my husband (also a physician) and me.  Still had to make payroll for the staff of eight that I employ.  Well currently seven, due to a recent death.  But even she received a paycheck this last pay period.  So I have had enough to pay 8 people, well up until this week.  This week, I had to pay some staff out of personal accounts.  So now, not only am I working for free, I am paying for the privilege to deal with government regulations and bureaucracy.

Oh and did I mention that I experienced the privilege of an audit by Oklahoma Medicaid during this time, which other than a few minor problems, I passed.  One of those being something that I have no control over, being specialists not sending their consult notes to go with the referral that they got paid for, but somehow that is my deficiency, DESPITE CALLING AND ASKING FOR A NOTE!!

So anyway back to the point of this message that you will neither read, nor receive, but maybe someone out there will hear me.  I paid for the pleasure of working last week, PERSONALLY!!  And I wonder why I constantly have a headache, and the gnawing of an ulcer in my belly.  I own my clinic, and am personally responsible for the debt to go into business.  I don’t have a big corporation that can afford a short period of time to cover not being paid.  My clinic sees 68 patients on average a day, so I should not have a negative balance sheet, but I do because for 70% of them, I have not seen a dime since December 28, maybe a few more due to the small amount of TriCare that I also see.

I know that I am not the only one who is experiencing this, since this week we were 2017 in line when calling to see where the problem was.  (We were 1700 last week, and that ended with 7 and a half hours on hold, only to be told to check online for solutions, WHICH WERE NOT THERE!!!)

I scraped enough for payroll this week.  In two weeks, I may be able to do it again, even without payment.  But after that I will be done, I will have no choice but to close my doors.  I understand the theory that you should love what you are doing so much that you would do it for free, but I did that the first 18 months in practice, and 6 months in 2010, and an occasional pay period here and there.  But I cannot afford to do that for much longer.  And I definitely cannot afford to do it and pay to do so.  Currently I have $120,000 in Medicaid Accounts Receivable since December 28, and another $60,000 in Medicare. (that is not what I will receive, only what I am billing)  And if by some miracle that were to come through tomorrow, I now have back bills and creditors who would also like to be paid, so even if you were to fix it tomorrow, I will be working for free until May or June.  So my husband will have to spend more time away from his boys, and work more shifts in the ER so we will survive.

I know to some, this is what I deserve being a greedy doctor, though I have yet to make over $100,000 personally since graduating residency.  (My declared income is higher only because of my husband working in the Emergency Room)  I have bills to pay, and cannot afford to continue floating the payroll for the clinic.  So I am asking CMS to look at their firewall, and attempt to fix it, or the looming doctor crises will come in about 2 or 3 months instead of the 3-5 years that is currently anticipated.

 

P.S. If this is your plan to save Medicare, it is a really crappy thing to do.  You should look closer at where your biggest incidences of fraud occur, and not cause those who are playing by the rules to become financially ruined.

CMS blocks payments to providers through firewall

The Centers for Medicare and Medicaid services have found a way to save money.  They simply installed a firewall which blocked claims submission from providers who have complied with the 5010 conversion by January 1, 2012, which was their initial deadline.  And the best part, most providers did not realize the problem until the end of January.  In what has been one of the worst weeks in my life at the office, we received a phone call on Tuesday, from another office who used the same EHR and the same interface processing claims asking if we had been paid this month from either Medicare or Medicaid.  The answer was, yes.  Well initially it was yes.  Followed by “Well only by Medicaid.”  Followed by, “Well outside of our medical home payment about $18.22.”

WHAT!

Throughout this month, I have been watching the income come in.  And until about the middle of the month, it was about the same as last year, maybe even a little more.  And while I was not thrilled with that considering there was more patients 45 days before than there had been a year ago, money was still coming in.  And we had already found that there was a problem with a glitch in our billing and were attempting to locate it.  So I was already not taking a paycheck this month.  So at least my salary was not affecting the outgoing.

However, as the month went on, that number seemed to not change the way that it was supposed to.  Well, we are looking for it on the one hand, but last Thursday, we underwent an audit from Medicaid, so much of our effort went to preparing for that.  Making sure that all of our i’s were dotted and our t’s were crossed.  Knowing that no matter what they would find something wrong.  Realizing too late, that after our last COLA inspection, our CLIA certificate seemed to not be put back in the same place, and was currently MIA.  Which is not great news, especially since a computer glitch at CLIA has not allowed them to send new certificates out, and we are still waiting today for the request submitted two weeks ago.

So anyway, while the numbers were concerning, they were not in the front of our mind, until Tuesday.  When a call partner called, and we looked.  And then discovered.  We had not heard anything from our clearing house all month regarding claims.  So we examined further, and that $18.22 was from Medicaid secondary payment which was submitted to Medicare prior to January 1.

So we called our interface to find out what happened.  “You are currently 1,746 in line.  Approximate wait time is 7 hours 32 minutes.  Did you know that you can check wait times online visit www….”

Well that sounds, uh promising.  After utilizing a phone line for the entire day, we found out, that there was the problem, they were contacting our EHR, and no they don’t know when it will be fixed.  That was tuesday.

Wednesday, we found out that it was not just our EHR having problems.  It was multiple EHRs.  And we started looking for a new way.  We had recently hired a new billing company, who was in the process of creating tunnels and whatever else is required for them to extract our data over the internet and bill for us, would they be able to take our Medicaid claims and submit them an alternative way?  The answer was maybe, if we can figure out how to extract them from the mess, we currently were in.  (Then tragedy struck our office Wednesday afternoon, and to be honest, we just tried to finish our day)

Thursday morning, numb and still in shock, we checked by on the Gateway.  Still no payment, but there was something that had not been there in a month.  A screen of rejections.  We don’t know if that is a good sign or not, but it was something new.  Still no payment.  But a new screen.  And the interface was still working on the problem.  (However, this did not prevent them from drafting my account for payment earlier in the month)

Finally, Friday morning came some answers.  Calls to Medicaid to make sure that we would not get hit with a penalty for attempting to file claims multiple ways, which received a probably not, also had some news.  Apparently the day before, they received 18 electronic batches through interfaces.  While they did not know if they were ours, they said it was promising only because they had not received anything the entire month of January.  Nice.  And you could not have said anything to your providers?

And Friday morning, also provided word from our clearing house.  Apparently the 5010 conversion had caused this.  Despite providers, software vendors and electronic interfaces having had successful tests from the previous year, January 1, conversion did not go as planned.  A firewall at CMS enacted for this event, did not recognized claims that were in compliance or not.  It did not recognize NPI numbers, ICD-9 codes, or CLIA numbers.  In an essence, those who complied with the rules by the initial deadline were penalized and just not paid.  This included all federal government programs Medicare, Medicaid, and Tricare.  Well actually Tricare was worse, their firewall had been blocking claims since November.  And our situation could have been worse, there were Medicare providers who had not been paid since November.  And this is for those that comply with their rules.

Unfortunately for me, 45% of my income is from Medicaid, 20% from Medicare, and Tricare <1%.  So you can imagine what this is doing to us.  The only thing good with regards to Medicare is that we collected their deductibles up front, so we did get some of that.  Though there were also glitches with Blue Cross Blue Shield which is our 3rd biggest payor, which has a percentage close to that of Medicare.  So I guess that I am lucky that I am sitting at half of the number that I should be.  Next month figures to be worse, when you consider a 45 day wait time for Medicare on average.  If we can get claims through under Medicaid, I should get paid in as quick as a week after submission.

So the month of January, I have worked for free.  February, I will also not be taking home a paycheck, and I imagine it will be close to May, since March and April will require me to catch up on bills not paid this month due to the CMS firewall.  Which means more shifts in the ER for the hubby, so that we can survive at home, since my bills won’t stop.

So those of you who think physicians are just greedy, and should be willing to take a 27% cut in pay from Medicare (which would result in similar cuts from other insurances) consider this.  My overhead does not decrease, it increases.  I still have to pay my staff, rent, electric, water, etc.  And following this incident for being in compliance… it is no wonder that physicians don’t trust CMS.  I have not committed fraud, and have played by the rules.  But situations like this sometimes makes you wonder why you bother.

So before any of you call your physician greedy or just in it for the money, think about this.  Those that are self employed didn’t get paid this last month at all, and will probably not get paid this month (take home pay).  The fact that they don’t trust CMS results from issues such as this.  And that is not even looking at the cluster that is ObamaCare.  So I worked last month seeing patients for free, will next month as well.  Sometimes you have to wonder if that time wouldn’t have been spent better elsewhere.

So I guess CMS has come up with an ingenious plan to save money.  Just block physician claims from going through at all.  That way, their money is able to stay in their account and draw interest, and well unless providers close their doors overnight, their patients are still being seen at least temporarily.  So if you look at the numbers for January for CMS, I am sure they look the best in a decade.  Thanks CMS.

When did my career become a secret?

A couple of days ago I noticed something. When people ask me where I work, I don’t usually introduce myself as a doctor.  It was one thing, when buying a car, that I would off-handedly say, “I work at the hospital.”  You are always told adding Dr to your name adds zeros to every purchase, buying a car, building a clinic, buying a house.  Anyway, in purchasing, you just don’t do it.

However, this time it was different.  I was eating dinner with my children at the Olive Garden, when the waiter asked what I did for a living.

I was wearing scrubs, so the question was initially, “So did you work all day.”

“Yes.”

“So what do you do?”

It was not the waiters fault, he was perfectly hospitable, taking care that our table had drinks and attention that anyone would appreciate.  We talked about the iPad 2, since I happened to have both children’s and mine with me.  And if I thought it would be a good deal to buy one, and if we liked ours.  All perfectly pleasant.  It was only when he came over during a discussion with my oldest, as to why I could not donate blood at his school’s blood drive the next day.  (Previous years, I have, but this year it was on a Wednesday, and most Wednesdays I barely have time for lunch much less time to drive 30 minutes to his school, donate blood, and return to work)  So I pulled up my schedule on the iPad, and showed him how full it was.  Still not overly impressed, he said, what about after work?  At that point, I promised him, if by some miracle of miracles, I were to finish by 4 pm, I would donate blood.  However, since I have yet to get out of the office by 530pm on a Wednesday in about 8 months, well it probably was not going to happen.  And this is when the above conversation happened.

I don’t know why I stuttered.  I am not really ashamed of what I do.  Obviously I would not be blogging about it online if I were.  But stutter I did, as I admitted that I was a physician.  Admitted, is this what the once noble profession I dreamed of being as a child came too?  Or maybe it was that I was caught off guard, since it was an early dinner due to having to leave work early in the afternoon to take my youngest to speech, and then kill time between therapy and a skate party.  And maybe that I was worried I would have to explain.

I spend a lot of my day explaining things.  Why I don’t take call, why I don’t go to the hospital regularly, why I have no desire to work in the ER, why I leave early on Tuesday and don’t see patients on Thursday.  And maybe that was the reason.  However, he did not ask for explanations, he actually was reassuring that my career was not equivalent to that of a drug dealer, even though some days, I think that is what I have become, at least in the eyes of some patients.

Maybe I spend too much time online, reading the terrible things people say about doctors, how they make too much money, they rush in and out of rooms too fast, they take too much time to get to their room, that they just don’t care.

I heard a joke once in training that the person who yells out first “Is there a doctor here?” is probably a physician themselves.  And sometimes, I wonder if that is true.  The days, weeks, months, years of fighting public perception as a money hungry individual willing to throw their patient under the bus for a dollar on one side, and the fighting for the dollars rightfully earned trying to provide the patient care that they deserve may have worn us down.  The time spent fighting against liability claims and fear of lawsuits despite no wrong doing, maybe those have worn us down as a profession.  The stories of physicians who have stopped to help someone on the side of the road and despite no wrong doing receiving a lawsuit for a bad outcome.  Maybe that is why we no longer stand up and say I am a doctor.  Or maybe, I just I don’t want to be chased through the grocery store to look at a mole.

And in my case, where my husband and I made the choice where he would take my call, so that one of us could be at home at night with our children, maybe I just didn’t want to explain one more time, why I don’t go to the hospital.  It is not that I can’t, it was that I put my kids before my career.  It is the years spent justifying why I don’t do shifts in the ER like my husband.  It is the time spent alone, at night, wondering if I made the right choice.  Did I do what was best for my patient?  Did I make a difference for the better?  Or what am I missing on that patient?

For the most part, I love my job.  I like that I am in most of my patients’ lives.  In many instances, after they get a recommendation from a specialist, they come back and ask me what I think they should do.  Or if they could have a second opinion, not necessarily that they disagree with the first, but that it is a major decision and they would like to have another perspective.  I don’t make as much in my clinic, as my husband makes doing his shifts in the ER.  I see the reports as to doctors not choosing primary care residencies, and I understand.  The money is not as good, and most of us graduate with a large amount of debt.  And you have to spend a large amount of time fighting, fighting insurance companies, fighting for payments, and watching the general population equate your training with that of a midlevel.  Even though you have twice as much training, 4 times as much debt, and way more liability.  And then at the end of the day, you notice the pile of paperwork- not visit notes, but other paperwork.  Prior authorizations, home health messages, home health certifications/re-certifications, various forms for patients regarding why they cannot work, disability questionnaires, and random notes that the patient wanted you to write for them yesterday.  Add to that orders that the specialist decides that they want done, but don’t want to obtain the prior authorization themselves, despite having the pertinent data needed to get the test approved, and yet they don’t send it to you.  So I understand why students are not choosing a career in primary care.

And maybe it is just a combination of all of those reasons that I don’t introduce myself as doctor out in public.  At maybe, just maybe that is why I stutter when asked what I do for a living.

It is the little things that matter

It is too easy in medicine to overlook the simple things. Or what you think is not that big of a deal. With the never ending media around you at all times, it is hard to escape people talking about how doctors are greedy, people committing fraud, new rules and regulations, potential cuts of 29.4% from Medicare. It is easy to forget why one might have gone into medicine. And not the joke reason I told people the summer before medical school started as to why I was going to medical school either. I didn’t really go to medical school so that I could marry a doctor. I was just really annoyed by what seemed a ridiculous question at the time. (though that proved to be a self-fulfilling prophesy as well)

But really is it a ridiculous question? It is not about the money, and those that tell you it is, well there are easier ways to make a lot of money or to make a comfortable living, and I would not have gone over $150,000 in debt to do. Most of us go into medicine at least on some level with the desire to help people. Sure there are those that might have gone into it for the prestige or some other less noble reason, but for most at the core, it was probably the desire to help people. However, for those of you applying to medical school, everyone says some variation of that answer, so you might wish to find a more eloquent way to do so.

However, in the hustle and bustle of a medical practice it is easy to forget why. Even though that very reason is sitting in front of you wanting some reassurance, wanting answers, wanting, well some not knowing what they want, only that something is not quite right. And sometimes all they want is the what or a name for whatever is ailing them. And sometimes they want more than you can give them, answers you don’t know, or if you find them for them you have to send them to a specialist. And sometimes they come back from that specialist with a smile and a thank you, and sometimes with tears.

As a family practice doctor, I get to tell all kinds of news from pregnancy (which is hard to decide whether it is good or bad the day you are telling them) to cancer (which I really hate) to maybe they are being overmedicated and some of their side effects are due to medication that they are on. So why don’t we stop some medications, those are one of my favorites. But I get to share with them in everything. They still come back to me after they are told they need back surgery for my opinion. Sometimes I wonder why (on really bad days) but mostly it is flattering. Or sometimes, I find them a second opinion from another specialist especially on a major procedure.

I get to be silly with kids who are frightened because they don’t want a shot, and get to see the relief in a parent’s eyes when their sick kid starts feeling better. My day is filled with highs and lows, and my attention is constantly stimulated, which really helps my ADD more than any medication could. And most of the time I am just an ear, especially with my older patients. There are visits, I have no idea why I saw the patient when I leave the room, other than maybe they are lonely, and that is ok too.

Medicine is a calling where people let you into their most intimate moments, though sometimes drag you in would be the more appropriate way to describe it. IT is an honor to be there for them, even when giving them the bad news. And as computers continue to enter/invade the field of medicine, there is something to be said about the human touch, the compassion that a machine just cannot give.

Good times at the OOA

This weekend was spent in Oklahoma City obtaining some Continuing Medical Education from the Oklahoma Osteopathic Association. While it might not sound like the best time in the world, it does lead to some good times with some great people. It is funny that when you first get out you don’t realize that some of your biggest supporters are other doctors. I am not sure this is true in other professions, but in this one it is in many ways.

I don’t know, but it might be that as an industry, physicians generally don’t want a monopoly on patients. It is unrealistic and often feels like you are doing neither you nor the patient a good service. Son you know you need other physicians. It might also be something about how as an industry we are facing more and more regulations by agencies run by people with less education and training and understanding of what consistutes standard of care.

Though it is not easy to reach this conclusion. When you first start out, especially solo, you could think the world is against you. It is only through time that your realize that you aren’t. Physicians (generally) are willing to talk to others about a variety of topics, EMRs, financial planning, setting up an office, as well as medical aspects. I think that is wonderful. But unless you attend some of these meetings, you would never know.

The meetings are great for education and credits, and that is their primary function, but the social aspect and support cannot be denied. You hear about everyone’s families, the good and the bad and it is nice to have a sympathetic ear. Then you also get asked how you are doing, and often if there is anything you need.

The biggest concern, I heard this weekend, is what can we do for you? This was both at the national and state level. And while I am good right now, maybe that is the message we should be giving new physicians, how can we help you? I don’t know how much advice, I can give some one new coming out of residency, but I could sure tell someone everything that I did wrong. And that may be just as valid as how to do it right.

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