This unhealthy dependency relationship some pts have w/ the Doctors needs to stop!

thinwildmercury · Apr 28, 2010

i completely agree with the op and don't think you are biased at all. i have thought this same way long before i was ever interested in healthcare. unfortunately, i also agree with the person who said no matter what you tell them, they are unlikely to change their behavior, so it's just something you'll have to deal with...

dscrn · Apr 28, 2010

It is also possible that the patient really only wants to share their information with the physician.

I know that I have experienced something similar with md visits-even though I know full well why I am there, as does the staff. Several of my md's are affiliated with a teaching hsp, so I frequently have residents "interview" me first...I swear, don't mean to hold back info, but I have a fairly involved hx, and my primaries are aware..When the attending comes in, invariably I remember a concern or two, probably because they are familiar with me, and know the right questions to ask

TDCHIM · Apr 28, 2010

It is possible that those Americans who are lucky enough to be covered by health insurance/Medicare/Medicaid have simply become used to the 10% copay. Or the 0% co-pay, in some cases. When it costs you very little to see the doctor, why not just go with the flow? We have come a long way from the days where a family member rode on horseback in the night to fetch the county doctor, and paid him in chickens.

This is a rather gross over-generalization, isn't it? People "lucky" enough to be covered by private health insurance often pay dearly in both premiums and sizable copays (for benefits packages that are vastly reduced from what they were five or ten years ago). There simply aren't many plans left under private care that allow people to simply go to the doctor without a care. Yes, there are people who don't pay attention to details about their medical history, but that certainly doesn't mean that all or most people covered by private insurance just run to the doctor constantly without worrying about how to pay or involving themselves in their care! Some people are just clueless, no matter what the cost.

(And whoever still has a 0% copay full coverage plan, please let me know where you work, because I want a job there too!)

rachelita · Apr 28, 2010

I have low thyroid and used to see an endocrinologist who would make me come in for a visit to get my lab slip then come back for another visit to see if my med dose had to be changed. It made no sense, so now I see a pcp who can handle it, much better with my $3000 deductible:rolleyes:

I know all about patients who have no idea what meds they are on or why. When I worked in the ER, patients routinely came in with CHF exacerabations because they had simply stopped taking their lasix. They were mystified as to why they were sick. They had no idea why they took lasix or what would happen if they stopped, ie pulmonary edema, etc.

Now I am working preop and have to ask patients what meds they had taken the morning of surgery. They often have no clue, both older and younger patients. They will say the yellow one or tell me to call their daughter/son or wife. The other day we had a gentleman who forgot he was not supposed to take his insulin that morning. His accuchek was 46.

AmaurosisFugax · Apr 28, 2010

I think you are making too much of this. 'Because the doc wanted to see me again' is easily interpreted as a follow-up visit, routine for a med change or to check pt's progress. What's the big deal here?
These people are being responsible - they were told another visit was necessary, the appt was made, and they arrived fot the appt. What more do you really want?!!! Just because they do not say 'well, one of my prescriptions was changed and the doc wanted to see if it made a difference' does not make them difficult or ignorant.
You are being a bit too sensitive - these are ordinary people who are doing the right thing. And maybe you are a bit biased because you are in the healthcare field. Just write down "routine follow-up" instead of giving everyone the 3rd degree!

I absolutely agree. A pt may not know how a disease progresses, or whether or not a symptom needs to be followed up. So they did the right thing, the doctor advised them to schedule another appointment, they did so & kept the appointment. In fact the problem among many (especially men)) is that they don't want to go to the doctor.

And one may not always want to go over his/her health issues over & over again, the doctor knows it & that's what sufficient for the pt.

brillohead, ADN, RN · Apr 28, 2010

This is a rather gross over-generalization, isn't it? People "lucky" enough to be covered by private health insurance often pay dearly in both premiums and sizable copays (for benefits packages that are vastly reduced from what they were five or ten years ago). There simply aren't many plans left under private care that allow people to simply go to the doctor without a care. Yes, there are people who don't pay attention to details about their medical history, but that certainly doesn't mean that all or most people covered by private insurance just run to the doctor constantly without worrying about how to pay or involving themselves in their care! Some people are just clueless, no matter what the cost.

It's not just the people, though, it's the doctors too. If a doctor tells you "you need to have this blood drawn" then you go have that blood drawn. For example, just today my husband got two lab orders in the mail from our PCP -- one for a lipid panel in two months and another for a testosterone and Vitamin D check in three months. (All related to lab results from his annual visit a week ago.) The doctor's office also called in three new prescriptions to our pharmacy: prescription fish oil, prescription Vitamin D, and testosterone cream.

I went to the pharmacy and cancelled all three. I bought OTC fish oil and Vitamin D (and now that summer's coming, Hubster will be getting sunshine too), and omitted the testosterone altogether. His testosterone levels were *barely* out of range and he's not having ANY symptoms whatsoever. When he found out his testosterone was low, you could have knocked him over with a feather -- not one single symptom, and yet he has some contraindications for testosterone supplementation (sleep apnea being the most worrisome).

My prescription copay is $50/month. Just for this one call-in to the pharmacy, we're talking $1800 a year (and that's not counting the metformin, fenofibrate, metoprolol, and that he's already taking!).

And the doc wants to check his lipids again in two months. Hubster is the most non-compliant eater you're ever going to find. A typical lunch for him is a Double Quarter Pounder Meal with Large Fries and an extra Double Cheeseburger. He doesn't g.a.s. about his own health -- checking to see if he dropped his lipids by 10 points since he started scarfing fish oil really isn't worth the expense of the lab work.

And the testosterone and Vitamin D labwork in three months? He'll be tanner than a tree trunk by July -- no Vitamin D shortage there. And if he's still completely symptomless regarding testosterone, and if we're not willing to pay $50/month for a drug to correct something that's not causing any problem, what's the point in paying the $$$ to check his testosterone level?

But the doc doesn't see what the lab charges us (and we pay it all, with a $1500 deductible per person plus a 20% copay on top of that), and the doc doesn't see what our pharmacy bills are. But he pretty much *has* to order all these tests and write all these prescriptions so that if Hubster keels over with a massive MI tomorrow, the doc has some defense against a malpractice suit. Lawyers are ruining medicine more than anyone else in the world!

(And whoever still has a 0% copay full coverage plan, please let me know where you work, because I want a job there too!)

Teachers in Michigan, people on welfare. I have friends with Medicaid for them and their four kids. They have been in the Emergency Room at least ten times in the past 18 months. My family has been in the Emergency Room three times in 15 years.

mappers · Apr 28, 2010

I had a patient once who had a colostomy that was several years old. I asked him why he had the colostomy to begin with. His answer was something like he had surgery. ???? Never did find out why. I think if a doctor gave me a colostomy, I'd know why.

Co-worker told me she had a patient the other day with a trach and had bed sores, black heels, etc. We were the third hospital for him in several months and he had been at a sub-acute one before us. He'd gone home from there and was back at our ER within hours. She said neither he, nor the family could tell her how it had all gotten started.

But you know it can be very hard. In my mom's last few years, she really declined. My sister or I tried to be at all the doctor's appointments. Dad just can't hear very well and Mom's memory was very bad. But we still had a hard time getting answers. They send them someplace for a test, but we often didn't get results back. Or if we asked the doctor would say, "It was fine." With hospital admissions/er visits we'd hear CHF or CRF, but then the doctors would tell us her echo was good or her labs were normal. I think a lot of times, doctors really have no idea what's going on, so patients don't either.

TDCHIM · Apr 28, 2010

It's not just the people, though, it's the doctors too. If a doctor tells you "you need to have this blood drawn" then you go have that blood drawn. For example, just today my husband got two lab orders in the mail from our PCP -- one for a lipid panel in two months and another for a testosterone and Vitamin D check in three months. (All related to lab results from his annual visit a week ago.) The doctor's office also called in three new prescriptions to our pharmacy: prescription fish oil, prescription Vitamin D, and testosterone cream.
I went to the pharmacy and cancelled all three. I bought OTC fish oil and Vitamin D (and now that summer's coming, Hubster will be getting sunshine too), and omitted the testosterone altogether. His testosterone levels were *barely* out of range and he's not having ANY symptoms whatsoever. When he found out his testosterone was low, you could have knocked him over with a feather -- not one single symptom, and yet he has some contraindications for testosterone supplementation (sleep apnea being the most worrisome).
My prescription copay is $50/month. Just for this one call-in to the pharmacy, we're talking $1800 a year (and that's not counting the metformin, fenofibrate, metoprolol, and that he's already taking!).
And the doc wants to check his lipids again in two months. Hubster is the most non-compliant eater you're ever going to find. A typical lunch for him is a Double Quarter Pounder Meal with Large Fries and an extra Double Cheeseburger. He doesn't g.a.s. about his own health -- checking to see if he dropped his lipids by 10 points since he started scarfing fish oil really isn't worth the expense of the lab work.
And the testosterone and Vitamin D labwork in three months? He'll be tanner than a tree trunk by July -- no Vitamin D shortage there. And if he's still completely symptomless regarding testosterone, and if we're not willing to pay $50/month for a drug to correct something that's not causing any problem, what's the point in paying the $$$ to check his testosterone level?
But the doc doesn't see what the lab charges us (and we pay it all, with a $1500 deductible per person plus a 20% copay on top of that), and the doc doesn't see what our pharmacy bills are. But he pretty much *has* to order all these tests and write all these prescriptions so that if Hubster keels over with a massive MI tomorrow, the doc has some defense against a malpractice suit. Lawyers are ruining medicine more than anyone else in the world!

I will certainly grant you that doctors practice defensive medicine and it ends up costing us all. However, the issue I have with your example is that you, personally, had the knowledge to outright dismiss a prescription for your husband. How many people actually have that level of specific medical knowledge? The internet helps people get information about issues, illnesses, and conditions, so that they can go in armed with questions rather than flying blind. At some point, though, you have to take your doctor's recommendations and accept them or seek treatment elsewhere. Otherwise, why go at all? As patients, people pay for expertise and training in treatment and evaluation.

Teachers in Michigan, people on welfare. I have friends with Medicaid for them and their four kids. They have been in the Emergency Room at least ten times in the past 18 months. My family has been in the Emergency Room three times in 15 years.

I was referring to private plans; Medicaid is by definition an odd case due to the population it seeks to help (and good luck finding and getting in to see a doctor who accepts it). And we all know many of the poor seek care in ERs because they can get it there without ending up with destructive medical debts. It isn't cost-effective, practical for health care professionals, or beneficial over the long term for patients, but at the moment it's the most feasible option some people have. I can tell you my family had to resort to it once while my husband was out of work! That family you cited might have ended up there because they have no other affordable way to get care in anything approaching a timely fashion.

And Michigan teachers must be fortunate; those in my area started paying 10% and 20% copays years ago. Teachers got those plum benefit packages because of their wage scale, but those packages have been harshly pruned of late!

brillohead, ADN, RN · Apr 28, 2010

I will certainly grant you that doctors practice defensive medicine and it ends up costing us all. However, the issue I have with your example is that you, personally, had the knowledge to outright dismiss a prescription for your husband. How many people actually have that level of specific medical knowledge? The internet helps people get information about issues, illnesses, and conditions, so that they can go in armed with questions rather than flying blind. At some point, though, you have to take your doctor's recommendations and accept them or seek treatment elsewhere. Otherwise, why go at all? As patients, people pay for expertise and training in treatment and evaluation.

Funny thing, that... I haven't even gone to nursing school yet! (Starting Sept 2010) In that respect, I *am* the same as the ordinary Janes and Joes out there, other than the fact that I'm smarter than the average bear in general, I'm no longer under the assumption that doctors are looking out for my best interests, and I'm redheaded enough to speak up and demand that my doctor listen to me and explain my options and take MY wishes into consideration regarding MY healthcare.

I developed an "orphan disease" in my early 20s that gave me a HUGE education in dealing with the healthcare system. Prior to that, I bought into the whole "doctors walk on water" crapola that society has fed us up until now. My disease is incurable and a royal pain in the buttinsky, but it's not fatal, and in the long run it has made me a better advocate not only for myself, but also for my son, husband, extended family, and friends. (I also think it will make me a better advocate for my patient when I do get my RN license.) While I wouldn't wish my disease on anyone, I do wish that more people could see that healthcare providers should be partners in our healthcare, not dictators.

And Michigan teachers must be fortunate; those in my area started paying 10% and 20% copays years ago. Teachers got those plum benefit packages because of their wage scale, but those packages have been harshly pruned of late!

Michigan's teacher union is unbelievably strong, and it runs its own insurance program, so it has a vested interest in both sides of the equation (which means the schools -- and therefore the kids -- pay the price). A year or so ago, a local school district, in an attempt to save some money, tried to change their policy from a $100 deductible per year per family to a $200 deductible, and a $3 drug copay to a $5 drug copay in the middle of a contract period. The union went to court and got an injunction to prevent the change. Those teachers are going to be in for a world of hurt if they ever go out into The Real World again -- my family deductible is $4500 with a $50 drug copay! :eek:

dscrn · Apr 28, 2010

I will certainly grant you that doctors practice defensive medicine and it ends up costing us all. However, the issue I have with your example is that you, personally, had the knowledge to outright dismiss a prescription for your husband. How many people actually have that level of specific medical knowledge? The internet helps people get information about issues, illnesses, and conditions, so that they can go in armed with questions rather than flying blind. At some point, though, you have to take your doctor's recommendations and accept them or seek treatment elsewhere. Otherwise, why go at all? As patients, people pay for expertise and training in treatment and evaluation.

Teachers in Michigan, people on welfare. I have friends with Medicaid for them and their four kids. They have been in the Emergency Room at least ten times in the past 18 months. My family has been in the Emergency Room three times in 15 years.

I was referring to private plans; Medicaid is by definition an odd case due to the population it seeks to help (and good luck finding and getting in to see a doctor who accepts it). And we all know many of the poor seek care in ERs because they can get it there without ending up with destructive medical debts. It isn't cost-effective, practical for health care professionals, or beneficial over the long term for patients, but at the moment it's the most feasible option some people have. I can tell you my family had to resort to it once while my husband was out of work! That family you cited might have ended up there because they have no other affordable way to get care in anything approaching a timely fashion.

And Michigan teachers must be fortunate; those in my area started paying 10% and 20% copays years ago. Teachers got those plum benefit packages because of their wage scale, but those packages have been harshly pruned of late!

case in point about abuse of ER's...story on TV about St Vincent;s hsp in NYC closing. A woman on the street had just come from the ER-taking her daughter in for a sore throat....the report said that the hsp was losing something like a million dollars a month...

diane227, LPN, RN · Apr 29, 2010

We have one GI doctor that truly has co dependent relationships with some of his long term patients. I have told him to fire the patient (there are 2 of them) but it won't do it. It is so funny to watch his relationship with these patients. I just go with the flow. He will come in to admit them and say "I am not going to give her Dilaudid" but I end up calling him within 2 hours and he ends up giving it to them. We always go through this dance.