Just a Minute!

The stupid doctor only spent ten minutes with me…

I hear the outrage from patients all of the time. They are upset about their previous doctor or a specialist that they visited. The problem is that ten minutes is only the tip of the iceberg when it comes to your healthcare.

Much of what we do happens behind the scenes. We try to insulate patients from the process because there is no sense in complaining about it. But I thought it might be useful to give everyone a better idea…

The first thing that takes time is charting about your visit. I like to be pretty detailed so that anyone else looking at the office visit will understand completely what was said and done. If you bring six complaints to the visit, that note can take me 20 minutes to write. I am also double checking that all of your preventive care is up to date (mammo, colonoscopy, immunizations, labs).

I have seen a major uptick in the number of medication prior authorizations we are getting over the past couple of years. Most patients do not know that those generally require 2-3 phone calls to their insurance company (with anywhere from 5-15 minutes each call) and one to two faxed forms to complete. That is to often get a denial. Then if we have to appeal it, that requires another 1-2 calls and possibly a peer to peer discussion (your doctor talks to the doctor or pharmacist employed by your insurance company to argue your case).

Similar calls occur when we have to get authorization for your MRI or other procedure. We call. We fax records. Sometimes it requires another peer to peer discussion. Often those are denied and we have to appeal.

Referrals are another big issue. In order for us to ensure patients get in with specialists, I employ a full time referral coordinator. They have to call certain insurance companies to get approval each year for each specialist you see and then provide that approval number to the specialist’s office. Scheduling your appointment with those specialists typically requires multiple phone calls. Most specialists don’t allow PCPs to schedule your appointment for you, at least in this area. Some want the records first to review before they will ever agree take you. They are then supposed to call you to schedule the appointment but often their staff does not do this, so we call them every day or two until we get confirmation that an appointment has indeed been scheduled and then make sure you have the information.

When lab work comes back after your visit, I am often reviewing prior lab results to compare, going through your med history. When I decide on a recommendation, myself or my staff will call you to discuss that. Often we don’t reach you and it requires several tries to finally communicate the information.

Similar phone tag scenarios occur when you call us with a question. My staff takes the message. I review and make a recommendation. Then, myself or my staff then tries to call you back.

Paperwork, like FMLA or disability, takes 5-15 minutes to fill out even if it is easy. Sometimes it is longer. Home health paperwork, school forms for medications, asthma plans, etc all require extra time outside of your visit.

Refills. When you ask your pharmacy to request a refill, they send an electronic message to me. Then I review your chart and approve or deny it, then send it back to them. If it is a controlled substance, that requires a phone call from my staff. Often we can leave it on the pharmacy answering machine but sometimes we need to speak to pharmacy staff. I spent 20 minutes on hold with a major chain pharmacy the other night, waiting to speak to someone…

When you make an after hours phone call, it is more than just having me pick up the phone. I have to pull out the computer, boot it up, log on, and look you up. There are plenty of scammers out there. I often get a call from a “patient’s” daughter saying they just landed at the airport after having flying emergently for a sick family member or a funeral but dad left his meds at home and they need a refill on his narcotic…or some other variation of the story. Interestingly, they are not an actual patient according to the electronic health record. Or there are patients who don’t remember to tell me that their kidneys don’t work well and they cannot take certain meds. AND there are people who wait until after hours to call for their asthma med refill because they don’t want to be hassled about coming in during office hours…once or twice, ok…but if you are making a habit of this it is not good medicine and you need to be called out for it.

Bottom line is that in the end you are getting way more out of the visit than a mere ten minutes, believe me! But if you have ill feelings about how little time you get to spend with your doctor, please tell them. Often we have no idea that you are upset. Maybe you need further explanation about something because you don’t understand it? Ask! I don’t know any physician that wants patients to leave unhappy or who gets offended when patients ask questions. Most of us really like to talk given the chance!

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