Okay MD's, explain yourselves!

<p>I try to keep a very positive, polite attitude around healthcare people. A few years back, I had a bike accident on Martha’s Vineyard. It was totally my fault and I was in a LOT of pain. We didn’t have a car so we had to call an ambulance to come get me. I was determined to stay as cheerful and polite as I could during the entire ER visit. I managed to walk out on my own, and the nurses gave me a round of applause! It blew me away. I guess they were used to grumpy, rude people or something. I didn’t do anything THAT unusual.</p>

<p>But @FlyMeToTheMoon, you came to your appointment with probably with just your personal issues on mind, and one was dental, or maybe a few other issues, a family member at home, bills what have you.
Doctors have their own issues, their patients’ health issues, office equipment issues, office issues, insurance billing issues, medical supplies issues, patients who canceled at the last minute, and their hospital patients.
Some doctors also teach and do research to help improve and save lives.
If your doctor forgets to apologize to you, doesn’t mean he didn’t apologize to the next patient. OP assumed that just because she didn’t get an apology then doc is rude.</p>

<p>@LanaHere, I think was post was misinterpreted. I apologized because of what I am learning from this thread. I in no way am the type of patient that gets upset if my doctor doesn’t apologize to me after a 40 minute wait. In fact, I’d prefer he/she didn’t, and get on with my examination. I understand that stuff happens and that I will need to wait. There are times when I’m that one who keeps the doctor longer than I should, and makes other patients wait. It’s life.</p>

<p>EK,
The patient cannot assess what is “necessary”. Thas a medical determination. And if someone is a high risk pregnancy, or there is a need to screen for fetal development for any of a variety of reasons (defer to PG to address that one) then it will be done. If its just “for fun”, insurance will not pay for what may be deemed “lack of medical necessity”. The attitude that they are doing it just to run up unnecessary charges is a bit offensive. Maybe its time to hit that medical marijuana and chill a bit? Sorry, but your post really offended me. Many say they don’t like traditional medicine until they need it or want something from it (like a prescription ).</p>

<p>@flymetothemoon. I understand. :)</p>

<p>I wasn’t talking about you when I said OP. I was referring to the original poster- Mommaj .
She started this thread, looking for doctors to explain themselves.</p>

<p>I understand that others want to believe that physicians always use the expensive equipment in their office only when it is really needed. And not just because it there, like some police departments find a need for their military supplied tanks and bazookas. Perhaps the physicians even convince themselves that is the case.
If the test isn’t going to change treatment, why is it needed?</p>

<p>My ob-gyn was a sole practitioner. He used to be present at every birth. He told a story about how he came back from Fire Island to NYC 3 times over one weekend because of one pregnant woman’s false alarm. In order to take time off, hee would turn away any pregnant woman who had due date in Aug (or some where around it). I wasn’t going to take any chance, so my girls have Jun and Nov birthdays. Pizzagirl’s H may want to consider it.</p>

<p>My mothers Dr must have been miffed that she went into labor early, forcing him to leave his golf game ( seriously),
So when her labor stopped, he administered Pitocin so as not to waste his time, even though it meant I spent a month in the NICU.
She switched Docs for her next pregnancy.
( I never had my OB for either one of my deliveries. :frowning: the first was because I was transferred to a hospital with a level IV nursery, and for the other, my OB was home on maternity leave!)</p>

<p>EK,
Testing is done to monitor the pregnancy and may very well change treatment. Especially now, with improvement in technology, they can see great detail and potential problems early on. There have been remarkable in-utero surgeries to repair cardiac and other deformities, and save what may have been an unviable fetus. If a problem or potential problem is seen on ultrasound, a referral may be made, the patient may be monitored differently as now a high risk pregnancy, etc. But if you want to believe that the drs are just doing ultrasounds to get cute pictures to post on facebook, well, go right ahead.</p>

<p>Maybe i am mistaken about the implication, but I am pretty sure doctors can’t refer patients for testing on procedures. they can make a profit from. At least in California. </p>

<p>Maybe it is just “discouraged”. Here is what I found. </p>

<p>"Federal Health Reform: The Patient Protection and Affordable Care Act (ACA)</p>

<p>The Stark Laws were intended to provide clear rules for limiting physician self-referral; however, the complexity of the laws, which include major exceptions, has resulted in unclear boundaries and variable interpretations, making compliance and enforcement difficult. Section 6001 of the ACA addressed some of these limitations …"</p>

<p>Edited in case it was a TOS issue. </p>

<p>In general though, I think most of us are MUCH less inclined to do tests than our patients. And what is REALLY ironic is that so many times I am noticing folks here on the parent’s forum instructing others to go and get so and so test or medication or evaluation, and to not back down. It feels like “so many times” to me, but in reality, it is probably no more common than a doctor who makes you wait 45 minutes and doesn’t apologize. </p>

<p>I recently saw a young lady who had a three year history of seeing doctors for numerous multisystemic complaints. Earlier this year she went to a homeopathic doctor whose opinion she seemed to value because he had done numerous “tests”, including one that she says found her to be allergic to more than 100 things. He has prescribed a list of twelve supplements, and as far as I can tell, is not doing much better, but the “tests” made her feel better. She was referred to me for an “antidepressant”. </p>

<p>Here I think thats true too. No longer are they co owners in a diagnostic clinic they utilize.</p>

<p>

</p>

<p>They can if the diagnostic procedure is “in-house.” </p>

<p>“You can assess " really needed” when the patient has an indication that suggests it is needed."</p>

<p>Not every disease, ailment, etc. “presents” with visible symptoms. Do you think people have pop-up stickers on their foreheads that say “test me, I have high blood pressure / high cholesterol / a fetus with an abnormality” etc.? Do you believe in mammograms or pap smears, or do you just want to “wait” until the breast lump is large enough to be felt by the woman?</p>

<p>And you don’t understand the medicolegal standard of care. Let’s take pregnancy. If the standard of care is a first-trimester ultrasound, then a doctor who doesn’t do one is VIOLATING THE STANDARD OF CARE. It is of zero consequence that “most” pregnant women’s ultrasounds reveal nothing other than normally-developing baby. In the medicolegal climate of the US in 2014, “most” isn’t good enough. My H can’t roll the dice and say - well, I didn’t bother to do this ultrasound on this lady because “chances were” everything was going fine. Do you not get it? A plaintiff’s lawyer would tear him to shreds. “You know the standard of care, and you just didn’t bother to apply it to this patient because you figured that chances were that she would be just fine?”</p>

<p>“Why do I have osteoporosis despite not having risk factors?”</p>

<p>Seriously??? Do you think that there is a 1:1 correlation between having risk factors and having something? Bad things happen to good people. Take it up with God or your deity of choice. </p>

<p>“My mothers Dr must have been miffed that she went into labor early, forcing him to leave his golf game ( seriously),
So when her labor stopped, he administered Pitocin so as not to waste his time, even though it meant I spent a month in the NICU.”</p>

<p>That’s a very incomplete medical history. Perhaps your mother was “too far gone” that it was more dangerous to keep her pregnant than to deliver her and put baby in the NICU. </p>

<p>My labor was induced (with Pitocin) – and I had twins in NICU for 2 months. That, of course, is an incomplete medical history, because I had a situation that absolutely required labor induction even though I was early. I think you think you’re proving something, but you need a real medical history for anyone to conclude that what was done was wrong or not-wrong.</p>

<p>“Why is it that when physicians don’t know or understand something, they dismiss it as unimportant?”</p>

<p>EK, my impression is that it is not dismissed as unimportant, it is just that the priority is given to things that might kill you either right away or over time. Once those things are ruled out either clinically or with a consultation or “test”, there might be a sigh of relief. And after that, things that cause significant morbidity, that you can help with, without causing a bigger problem, and then things that cause major morbidity even if you CAN’T help without causing a bigger problem. </p>

<p>At this point a lot of what is left in medicine are things we do not understand. I think most physicians, especially psychiatrists, accept that. Often it seems patients do not. </p>

<p>Just to add 1 more point. A M.D. with 30 years of experience is paid same as the person right out of residency. This is true for psychologists and social workers. </p>

<p>“At this point a lot of what is left in medicine are things we do not understand. I think most physicians, especially psychiatrists, accept that. Often it seems patients do not.”</p>

<p>Nodding head yes and clapping hands!!! </p>

<p>“Just to add 1 more point. A M.D. with 30 years of experience is paid same as the person right out of residency.”</p>

<p>True and considering the downward trend of reimbursements from third party payer, the most a physician might earn in his/her career is what is earned right out of residency. </p>

<p>Physicians in practice for 30 years now are earning much less than they did when they first started. </p>

<p>This is an opposite phenomenon for some careers where a person starts at the bottom of the pay scale and is rewarded for hard work and experience by moving up the pay scale over a career. </p>

<p>Thank goodness for the docs who choose to hang in there for the sake of their patients and their professions, and the new bright ones who want to practice medicine. </p>

<p>Well, my post about doctor courtesy (hilariously referred to as “bashing” by one poster) certainly turned into an exhaustive discussion of the current state of the profession! </p>

<p>Back in the day, the docs were the richest people in my town, the ones who did indeed drive the Mercedes and take the European vacations. That’s not the case today, and I think there’s a lot of resentment and defensiveness on the part of those who embarked on medical school with the assumption that following their “calling” would provide a very affluent lifestyle and now find that managed care means they won’t be at the top of the heap financially. Perhaps the many undergrads still desperate to get into medical school will enter the profession with more realistic expectations.</p>

<p>My wife worked with three different physicians in family practice who were chronically late getting into patients’ rooms. Most have run about on time, maybe 10 minutes late, typical for our area with people who tend to walk in for appointments exactly at the specified time.</p>

<p>Dr1 ran behind by 45 minutes even if you had the first appointment in the morning. It was Dr1’s display of social dominance, my time is more important than yours. For a 9 am appointment, Dr1 would show up t the office at 9:15, check messages, go through the mail, read a magazine until 9:45. It is a busy, well-respected practice. Established patients know they will have to wait and adjust accordingly.</p>

<p>Dr2 is an excellent clinician but is a talker. Afternoons could be 2 hours behind schedule with some patients walking out or volunteering to see other providers. The patients that have stuck with Dr2 tend to be emotionally unstable women who use their medical appointments as therapy sessions. People in a hurry should avoid.</p>

<p>Dr3 lived the high stress life, seeing lots of patients and working long hours. Dr3 also developed a 20 year Demerol addiction that eventually got out of hand and impacted the patients. Great bedside manner, well-liked with a loyal patient base, but a sad story for all involved.</p>

<p>So it may not be applicable to anyone’s experience here, but it does supply a counterexample to the prevailing thought that the excessive wait is out of the Dr.'s control.</p>