<p>I had to see a medical specialist recently. I was referred from my primary doctor and this specialist has very good credentials. This doctor has an office within a large medical center, performs surgery, and teaches so much of the work (ie: reporting back lab results, explaining treatment plans) is done by a nurse practioner. </p>
<p>The office was so inefficient that it amazed me. I had to call to inquire about any prep I might need to do before my visit (no instructions, but I knew I was going for some testing), the receptionist gave incorrect information about when the NP had hours so I could get results for some lab tests, the NP seemed miserable and over worked when she did call, I tried to get my medical records by calling and had trouble just getting a medical release form so I put the request in writing and faxed the request (that is when I got the form). I asked the NP a couple of very basic questions about treatment and she did not know the answer (I don’t see that as her fault, but a lack of complete explanation/training from the physician).
The only things that I found streamlined was the actual visit, and their billing (got an insurance notification regarding this visit with lightning speed).</p>
<p>I am wondering if this was an isolated experience or a new trend. I have not seen anything but very good medical care from my primary doctors, and fortunately I am pretty healthy so I have only had about 3 medical things to deal with over the last couple of years that required specialists (nothing major though), and really next to no medical needs pior to that.</p>
<p>In my experience, no matter where I go, I witness competencies and incompetencies regarding professionals, service, systems and processes. A data point alone can’t make a trend line. One individual in charge can make all the difference in the world. </p>
<p>Why do you expect it to be going downhill? Is it the nurse-practitioner thing? I can’t imagine even wondering about any kind of trend based on one experience. But maybe I would if I had some sort of underlying theory to explain it. So I assume here I’m missing something you’ve been contemplating with this situation.</p>
<p>Not the NP thing at all. My first experience with a NP was when I was a college freshman and it was a fabulous experience and that is why I still remember it!</p>
<p>Well, to elaborate, this facility is relatively new. I can’t say what type of office this physician practiced in prior to this. I would say this was my first experience at a facility that appeared to be a cross between a hospital and a traditional medical office (ie: simple day surgery can be done at this location, although not in within the office that I visited). </p>
<p>This office was my first experience with a lot of disorganization. I left out in my initial post that the NP had me confused with another patient who had undergone other rather serious procedures (she apparently came to the phone before reading my chart, and had to go get it when I told her that I did not have the treatments she mentioned)! That is what I guess prompted me to post. I am wondering whether if this is the beginnning of more and more of this type of mistake as less staff is hired for more patient care because of insurance pressured, less reimbursement.</p>
<p>Please disregard any multiple typos. Really typing this on the run!</p>
<p>There are a lot of changes that I’ve seen in medical care in the 15-20 years I’ve had some involvement with it, but nothing as black-and-white as “it’s gotten much better” or “it’s gone downhill”. If there is one dominant theme I have observed, it’s a cat-and-mouse game where one faction is doing what it can to pay less and another is doing what it can to squeeze more. The party that this industry is supposed to represent is for the most part secondary to both those factions.</p>
<p>Considering how healthy I am, I have been to the doctor a lot and overall have been very impressed and very happy with my care. I see my primary care guy once a year, a urologist once a year (was every 6 months but everything seems ok, so once a year now), dermatologist twice a year and more frequently for some minor surgeries, eye doctor for routine eye exam, went to the specialist/colonoscopy guy last year and even went to the ER once when I stepped on a rake and they gave me a tetanus shot. </p>
<p>Everyone seemed to know what they were doing, counter help has been courteous and efficient… really, no complaints. The one thing that I think they are doing that will be a big help in the future is implementing software that will coordinate care and make it accessible online, so any of these doctors will be able to get my total picture in one place and I can also see it all online.</p>
<p>I see the service industry going downhill- trying to do less for more shall we say?
My mother recently died and the mortuary mishandled her remains so badly that the executor sued & they had to pay her estate $20,000.</p>
<p>No, I have the opposite experience. I am continually amazed at the quality of the staff and treatment where I get my health care. They serve a very large number of patients, and the number of mistakes or bad treatment I have observed is astronomically small. I don’t know how they do it.</p>
<p>My experience has varied - it seems to depend on the particular practice. Some doctors’ offices are run well, and others are horrible. We HAVE changed doctors on occasion because of the offices’ ineptitude.</p>
<p>Not a sign of change- problems have always existed with isolated individuals and circumstances. Perhaps your chances of a bad experience finally caught up with you. Electronic medical records are a mixed blessing- be sure you review yours for accuracy (it can be a pain to get the computer program to yield the exact diagnosis/surgery to be entered from your past). They make it easy for everyon eto have a clear, readable list of things, plus access by you at home to information about your labs, tests et al.</p>
<p>As a nurse, I would say that it appears that, depending on the facility, medical care is indeed going downhill. Many hospitals have significantly increased the nurse to patient ratio, even in some critical care areas. This trend really ups the potential for medication errors, nurse burnout, and decreased patient satisfaction. I know many nurses who have left the hospital environment for this reason. They take pride in their nursing and can’t stand to feel that they are not giving the patient what he deserves. Additionally, they know from a medication error standpoint, they are putting their licenses and patients’ lives on the line every time they go to work and are assigned too many patients.</p>
<p>15 years ago my doctor almost went to jail for getting a patient to lie to a judge about him, and his office staff was the rudest, surliest it has ever been my displeasure to have to deal with.</p>
<p>My current doctor is amazing, and is building an amazing practice with all manner of treatments available within the practice (massage, chiropractic, nutrition, reflexology, etc).</p>
<p>So I don’t think you can read anything into how one single practice works.</p>
<p>I have some fear for the future though, but it is not related to how individual practices are run. It is so expensive to become a doctor now, and pay levels for many areas such as primary care or family practice have been driven so low that I worry there will be a major shortage of doctors in the next 10 years. </p>
<p>On top of that, Obamacare now requires that insurance companies spend 80% (or is it 85%) of all premium dollars on medical care. I don’t know if any of the private insurance companies can survive operating under those margins, so what kind of turmoil will that lead to? I fear we are headed to a single-payer system, and I do not believe the gov’t can run health care better than it is now.</p>
<p>I think we are headed to very much toward a caste system healthcare system. If you have a lot of money and are smart enough to navigate the healthcare jungle you will have superb care. Then there will be many “levels” below that. Few are going to be pleased with what they have and/or are paying.</p>
<p>I haven’t been to the doctor for many years but I’ve used vision and dental services over the years. My dentist has all of the latest high-tech stuff and it’s wonderful to get that kind of care. They take care of all of the insurance stuff, send a postcard a month in advance and call a day in advance of appointments. My insurance only covers $1,000 a year and he charges above R&C so sometimes I will pay a few thousand out of pocket if I have a lot of work done. My vision care folks do a fine job at updating my glasses.</p>
<p>I think that the healthcare system has always been a caste system and that it has always had problems. My mother was a nurse for 50 years and knows the inside of the system when she worked. I worked in a med-surgical ward (and sometimes the ICU and Pediatrics) for several years and things do go wrong. When you have three or four people looking after a whole ward of patients, a bad confluence of events can cause critical problems.</p>
<p>One thing that I do see is that technology is available to do incredible things today but it has to be used correctly and it has to be affordable. Obviously it isn’t the latter for a lot of people. Our life expectancies have gone up a lot (despite deaths due to non-medical causes) and I think that’s one metric in that we are doing better overall.</p>
<p>I think that Americans should work harder to avoid health problems down the road but that’s a fairly difficult thing to accomplish.</p>
<p>Even with insurance, it’s getting grim. Two of my children required psychiatric care this year, including a hospitalization and weekly doctor’s visits. Our insurance premium was over $1,000 a month, for a $5,000/person deductible. In addition to the premiums, we have spent about $26,000 this year for medical expenses (that includes braces, dental care, and optometrist visits). We were fortunate to have a good year with our business. Last year, this would have broken our back. It’s very scary.</p>
<p>I don’t think that it would make a difference in the caste system. My former boss in the UK had their universal care system there but she paid an additional sum (not insignificant) to get a higher level of coverage - I don’t know if this was part of the public system or if it was through a private provider. I think that they do it this way in Australia too.</p>
<p>You can see the difference in the way that the administrative staff talk to you when you are discussing services. They are very focused on insurance including how much you have for the rest of the year and if your plan pays them enough to meet their requirements. You may have insurance here but your carrier may not provide a reimbursement rate high enough for the service provider. If you want their service, you have to convince them that you will pay the difference. In many cases, they will just turn you down after they find out who your insurance company is.</p>
<p>Whether you like it or not, if nothing changes, a single-payer system is in your future. You go on Medicare when you turn 65. However, your doctor’s office does not get the advantage of such, since it will still have to deal with dozens of different insurance companies with obscure different rules for reimbursement because younger patients will have them.</p>
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<p>How is that any different from now?</p>
<p>What it does mean is that if you want to minimize the pain (physical and financial) of dealing with medical care, live your life as healthily as you can (clean diet, exercise (both cardio and resistance training), no legal or illegal recreational drugs except possibly limited amounts of alcohol, etc.).</p>