Tuesday, May 22, 2012

Crowded Exam Room

How many people are in the exam room when you visit your Doctor? You may be able to count one other individual, a nurse, though that doesn't happen so much anymore. 

What about all the other people you can't see but are there in force? Several people from your insurance company, at least. Maybe a human resources person from your work and your boss wondering when you'll get back to the office. There is usually a person or two from the state medical board, maybe someone from the AMA, an auditor. Could be a few Government people in there - Medicare, Medicaid. Maybe the front desk clerk from the doctor's office wondering why your doctor is running late. Again. There must be a lawyer or two - malpractice insurance. I bet you could count at least five or six local drug reps all with free pills to give away. Perhaps a few specialists, all thinking you now need to visit them for a test or two. Honestly, it is getting so crowded in there you might not even be able to see them all.

Who "owns" the relationship in that room? The trust between a doctor and his or her patient should be sacrosanct. It isn't very often anymore. It can be...

I've recently had a very different experience. Me and my doctor. He is different both in his practice of medicine and his approach to the business of medicine. He doesn't have front desk staff. When you arrive at your appointment time - you simply knock on his door and have a seat until he is ready. He is always on time. Your initial visit with him is 90 minutes. The follow up visits are 30 minutes. He actually takes your blood pressure, checks your pulse, eyes, tongue, heart. You actually talk and explore things in a collaborative way. He doesn't seek to mask symptoms, in fact he welcomes them as clues. He seeks to resolve problems. He has telephone consult hours each morning. He gives you his cell phone number for emergencies. He types up notes and instructions while you're sitting there - he prints them asks you to read them to be sure you understand. You both keep a copy. He doesn't take insurance. You write him a check when you're through. He writes the receipt by hand.

My Doctor practices medicine the way most people who go to medical school want to practice (based on my conversations with many physicians). I don't know any physicians that welcome the involvement and influence from the dozens of people all sent there courtesy of our current healthcare system.

What if healthcare could be like my experience? What if the relationship between patient and Doctor was an actual relationship versus a transaction? We wonder why there are reports of up to one-half of patients not following their doctor's advice (for diet, exercise, medication, physical therapy, rest). Who will listen to someone you spend an average of 7 minutes with? Who can possibly trust someone you don't even know. We have a populace that is very sick and getting sicker. All of the medical transactions in the world aren't going to make people healthier. And the cost pressures continue to mount which we still attempt to resolve through faster, easier, cheaper medicine.

When will we learn? Slower, meaningful, collaborative medicine could be the answer. When a Doctor and patient own the relationship together, good things happen.

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