Stop by and see me some time

Yesterday I expressed some frustration at new hoops I’ll need to jump through in my career. That sort of whining is unlikely to garner sympathy from anyone other than my fellow internists. What I do hope is that non-doctors get a glimpse of what is going on behind the scenes. Given that we are all going to be patients at some point, it’s important to know what bedevils your doctor.

One of the complaints I most often get is from patients who want me to help them out but don’t want to come to the office. This is understandable. Doctor’s visits aren’t free, and with high-deductible plans becoming the norm, more of the cost is the responsibility of the patient.

But there are two very good reasons to practice medicine face-to-face. The first is simply practical: doctors, unlike lawyers and other professionals, cannot bill for time on the phone, email or other sorts of interactions. We simply cannot keep the lights on if people don’t pay for the services we provide. It’s also morally wrong to expect me to work for free. In our culture, payment shows you understand the value of a service.

I do provide free care through a local charity. They send me patients, but not so many that I can’t deal with it financially. Sometimes doctors will work out arrangements with uninsured folks, but when a patient is insured, discounting a visit can lead to legal trouble with insurance companies.

The most important reason to avoid phone-it-in medicine is that it’s “phoning it in”. If a patient needs a long-standing prescription refilled, it can almost always be handled over the phone. But nearly anything else is asking me to use my professional judgement to help a patient. Medically it’s a bad idea.

If you have long-standing hypertension, this needs regular monitoring. Hypertension often worsens over time and treatments need to be adjusted. Asking me to simply prescribe something indefinitely is asking me to practice bad medicine. A visit in person allows me to look for the signs of damage done by hypertension, and to spend the time talking to you about obvious and subtle symptoms.

It’s hard to tell the difference between bronchitis and pneumonia over the phone. Bronchitis doesn’t require antibiotics; pneumonia does. In the office I can listen to the chest and if needed get an x-ray. Sometimes just looking at someone helps tell me how sick they really are.

When your doctor puts off treating you over the phone, she’s doing it for a reason, one that is usually in your best interest.

5 Comments

  1. “Doctor’s visits aren’t free,…”

    They also aren’t quick. Every time you require a person to come in for a face-to-face visit, you are demanding that they take a few hours off of work for the appointment. And many of your patients simply do not have that luxury. One of the most booming industries in my city right now is those instant care, 24 hour minor emergency clinics. Five years ago there was one. Today there are numerous locations each for four different chains, not counting the clinics that are opening in the grocery store pharmacies. Those instant clinics do not require a person to take time off during their work hours, sacrificing income and possibly jeopardizing their employment. The reality for you physicians may be changing but you have to accept the reality for your patients – private physician visits have become a time luxury that many people can not afford. I

    • While i sympathize, this isn’t enough to justify 1) working for free, and 2) practicing bad medicine.

  2. Many doctors now offer visits outside of regular hours. I have evening and weekend hours. Even so, I still have patients who want me to treat them over the phone.

  3. Ross

     /  April 8, 2013

    Thank you so much Pal MD for putting your words to my exact feelings about this. I also remind people that my employer is paying me and they expect to be compensated for my time with patients

  4. In trying to find something, anything, else to read about besides the terrible events in Boston, I found this on the NYT. The claim is that increasing use of (breathtakingly expensive) ER care is due to middle-class, insured patients who needed care after hours and on weekends for things like UTIs.

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