Your appointment is only 10 minutes long...

Hoozdo, ADN · Jul 3, 2009

Here is how I solved all of the above problems. My physician went to concierge medicine. If you have never heard of it, here is a CNN weblink that describes it:

http://www.cnn.com/2008/HEALTH/09/18/ep.concierge.medicine/index.html

I get an appointment the same day I call. I have my docs personal cell phone number to call any time night or day. No time limits on office appointments. Granted, I have to pay an additional $1,600 a year - but I think it's worth it.

It is very important to me to be able to go to the doctor when I am sick. You have to wait at least 3 days or even a week or more to get an appt with a regular PCP in my city. Then you get the 10 minute bums rush.

I also made my 80 year old father sign up. When you are 80 and sick - you need to see a darn doctor.........and not in the ER!

Lovely_RN, MSN · Jul 3, 2009

Not taking shots at you because you're just telling the truth about the state of health care right now. I pay for insurance and for co-pays and I still need to hand over what amounts to bribe money to get decent care.

Well like mom always said: While some things change, others remain the same.

Yep this is the way of the world now as it always has been. Money talks and we all know the rest. :icon_roll

Guess I need to pull a few OT shifts and pay up for the extra attention; $1600 isn't that bad. Everyone else who can't afford can kick rocks I guess?

It stinks but it also makes me think of an incident one of my Nigerian co-workers went through while visiting his home country. His mom fell in the bathroom and sustained a head injury. There was no ambulance service in their rural area and he had to drive her for some distance to the city for care. Upon arriving he was denied entrance to one hospital because they didn't have the equipment. He called a friend and was told to take her to the one hospital in the area capable of doing CAT scans. When he got there they told him to pay $1200 in U.S dollars up front or his mom would not be seen. Luckily he was able to come up with the money and his mother was saved. Hmmmm wonder if things will ever get that bad over here?

Here is how I solved all of the above problems. My physician went to concierge medicine. If you have never heard of it, here is a CNN weblink that describes it:
http://www.cnn.com/2008/HEALTH/09/18/ep.concierge.medicine/index.html
I get an appointment the same day I call. I have my docs personal cell phone number to call any time night or day. No time limits on office appointments. Granted, I have to pay an additional $1,600 a year - but I think it's worth it.
It is very important to me to be able to go to the doctor when I am sick. You have to wait at least 3 days or even a week or more to get an appt with a regular PCP in my city. Then you get the 10 minute bums rush.
I also made my 80 year old father sign up. When you are 80 and sick - you need to see a darn doctor.........and not in the ER!

texas_lvn · Jul 3, 2009

This is going to sound very inconsiderate, and please do not take this any other way than a nurse that works in dr offices. I am currently working in a minor emergency walk-in type setting. It is a little different than an actual pcp. Our role is to get you to a pcp, but I do also rotate prn to dr offices to help out. Usually if you come in with a list of complaints/questions there is alot going on and absolutely they need to be addressed. But when you come in with more than 2 things going on, the patient is usually non-compliant (otherwise they would have already came in and evaluated the initial complaints). And this can be very frustrating for a provider. When you have a list of things that has been going on for a while, it makes the provider/nurse think "well, they must not be to worried about it otherwise they would have came in sooner."

Also, it can be overwhelming for the pt AND provider to make sure they went over everything they have a concern about. This is one of the reasons why the initial visit, a new patient, takes longer than a visit whereas you have a relationship already in place with the doctor. You are getting to know the pt and ensure that you can contribute to the healing factors in their life.

When a pt comes in with more than 3 concerns (ie well, my back has hurt for the past 3 months, I found a lump on my breast 2 years ago, I had a sore throat last week but it hasn't hurt in 5 days, when I walk I have a limp, I had a MVA 16 years ago and when I turn left my ear twinges and hurts, my vision needs to be checked and oh yeah, while I am here, can you irrigate my ears? and oh yeah, I have a funny smelling discharge from my lady parts for the past 8 months since I have had 15 partners in the last year, and I am feeling very tired so can you check my TSH level?) This was all from an actual patient last night. When I asked her what her 3 main complaints were, she said "well, I have a UTI, I fell 2 weeks ago and my ankle still hurts, and my toenail is growing green fungus for the past 3 months, can I have something for it?"

In the above circumstance, when I called the persons PCP to set up an appointment, and told the nurse of all the above complaints, she said that they will give her two appointments on two different days, and possibly may need a third to cover all her concerns.

Your provider was correct that they only allot 10 minutes for each patient. We only get paid a certain amount from your insurance company, and even less if it is medicaid or medicare for all the things that go on in one visit. Is it really fair to cram in 10 concerns on what we only really get paid for 3 or less, especially when the concerns have been escalating for so long? yes, in a way it boils down to money.

This is just the provider that you are speaking of. Think of the nurse that has to get the appoint. for the mammogram, do the labs, perform the x-ray, irrigate the ears, get the gc probe sent, call in the prescriptions, EDUCATE, get the nerve conduction study for the limp. and the MRI for the neck.......... It is overwhelming to EVERYONE. And then of course the front desk has people getting irritated with them because they have been waiting for 25 minutes and their appointment was 10 minutes ago...... wow, one person can really affect alot of people.

I understand the feeling of frustration you have, and I also encourage you to write the NP/PA and explain how you feel, but would you also have consideration on our part and understand where we are coming from?

realnursealso/LPN, LPN · Jul 3, 2009

That NP, should be ashmed of herself. Any practice that gives you the bums rush, should get one too. My Drs. office has no such policy, and if they did, I would switch. And, when I go to the Doctor, I see a Doctor. No NP's for me, not interested at all.:wink2:

texas_lvn · Jul 3, 2009

Went in for my 35 week prenatal visit and Group B strep test. I arrived on time at 10am and left at almost noon. I spent an hour in the waiting room before I was taken to an exam room where I had my vitals and FHR checked by a medical assistant. Then I spent another hour dozing on the exam table until the doc came in got the culture, briefly palpated my abdomen, and asked me how I was feeling. I think I spent a total of 10 minutes being seen between the MA and the doc. When I had my last child I saw a different provider and I switched because I had the same experience. Now I know that this is typical. I think it has something to do with the skyrocketing malpractice rates. Providers have to cram in as many visits as possible to keep the bills paid these days. Also forget about seeing the same doc at each prenatal visit unless you like to wait and wait and wait. These days you get seen by whatever NP, PA, or Doc that is available.
It's so different from when I had my first child almost 17 years ago. I meet the three docs of the practice but I was seen by only one. The visits were much longer back then and I actually had a rapport with the doc.
3:

Is it plausible to say that you got shotty care because the 3 people in front of you had medical concerns that have been going on for more than 3 months and decided they would bring it all in at one time, and YOU got the short end of the stick?

texas_lvn · Jul 3, 2009

That NP, should be ashmed of herself. Any practice that gives you the bums rush, should get one too. My Drs. office has no such policy, and if they did, I would switch. And, when I go to the Doctor, I see a Doctor. No NP's for me, not interested at all.:wink2:

Thats almost like saying you only want a RN doing your vitals instead of a MA or LVN............ They go to school, they pass a test, and they have back up to speak with someone.... a doctor..... if they are not sure of a diagnosis.

onetiredmomma · Jul 3, 2009

When making an appointment, tell the person what is going on and who you are willing to see. For instance, a f/u visit on a new med is a short appt with aN NP and should go well. For a laundry list, ask for a longer appt and tell the receptionist if you feel you must see your PCP. At the office we go to, the MDs are always waaaay behind but the NP seem to be able to be more on time. I agreen the OP should address the bluntness of the NP who saw her mother. Every one needs to learn good bedside manner and interpersonal skills!

metal_m0nk, BSN, RN · Jul 3, 2009

Your provider was correct that they only allot 10 minutes for each patient. We only get paid a certain amount from your insurance company, and even less if it is medicaid or medicare for all the things that go on in one visit. Is it really fair to cram in 10 concerns on what we only really get paid for 3 or less, especially when the concerns have been escalating for so long? yes, in a way it boils down to money.

Just wanted to point out that while it may have been by choice in the OP's situation, it isn't always. There are millions who don't have access to medical care, health insurance, and even publicly assisted or governmentally subsidized medical benefits. Some patients who see the doc with long-term, unresolved health concerns might do so because it's the first actual opportunity they've had to see a doc in years - and for all they know (judging by what they've become accustomed to) the last opportunity they'll have for years to come. Agreed, in a way it boils down to money - it's just that the scope of the issue might be a little larger than your personal experience can signify.

Off to figure where I hid those Oreo cookies now. Carry on...

Junebugfairy · Jul 3, 2009

i just want to say that i love my doc, absolutely love him.

he is an internist, and he is 'old school' about really sitting down with you and making sure that everything is okay. yes, when i have an appt i know that i should bring my laptop or a book for the waiting room because it will be awhile, but it is worth it. he takes his time.

realistically, time must be managed and allocated.

patients need to stop waiting until everything is broken down to see their doctor. there needs to be an annual checkup, and scheduling for follow ups as needed.

i have many health problems, and i see my internist 4-5 times a year to ensure that i am not 'bogging' him down with crap.

Hoozdo, ADN · Jul 3, 2009

Not taking shots at you because you're just telling the truth about the state of health care right now. I pay for insurance and for co-pays and I still need to hand over what amounts to bribe money to get decent care.
Well like mom always said: While some things change, others remain the same.
Yep this is the way of the world now as it always has been. Money talks and we all know the rest. :icon_roll
Guess I need to pull a few OT shifts and pay up for the extra attention; $1600 isn't that bad. Everyone else who can't afford can kick rocks I guess?

Yeah, the 1600 sucks. Plus it was really $3,200 because I paid for my husband too! That's why I always have a PRN job along with a real one (if possible). It's a sad state of health care. Money really does talk.

CoffeeRTC, BSN, RN · Jul 3, 2009

Okay...we all get it, but what about all the elderly or non medical people? I think we/ they need a better way of communicating this to the patient before they come in or at least have a better way of stating it during the appointment.

blondy2061h, MSN, RN · Jul 3, 2009

That is interesting, I didn't know anyone else has had that problem. Up until recently all my personal experiences with NPs have been wonderful, when I went in with one chief complaint. I was also quite upset when the same thing you report happened with my 85 year old mom. I actually went there twice with my mom just to make sure I wasn't imagining things, she was given the "bums rush". I don't think those quick clinics are set up for people with multiple problems. I won't go into details about why but for a three month period my mom did not have an attending. Unfortunately she did not stop being elderly and frail and needed checked. By now I have her switched to another doctor and things are going swimmingly. By the way, her insurance company actually pays more for a first visit because they know it will take more time, this new doc spent nearly an hour with her getting to know her. The next couple of visits went very smooth because we had that long first assessment.

They're not, but it's impossible to get sufficient reimbursement for longer appointments. That's why a lot of things get pushed to specialists. If the diabetes and hypothyroid get pushed off to an endo, that's 2 less issues the PCP needs to address.