that more and more of my colleagues are becoming so specialized
that they don’t “fix windows anymore because they only do doors.”
I recently saw a patient who had complained of low back problem and pain that was radiating towards the left hip. She was
tender on the greater trochanter and likely had Tensor fascia lata
syndrome or pain from affliction of the posterior branch of the lateral cutaneous nerve. This patient had to wait two weeks to see an
orthopedic surgeon after seeing one specialist already just to get
an injection of the greater trochanter bursa or get a good physical
examination to determine the cause for her pain. She had MRI
scan of lumbar spine and also of her hip while she was waiting
for the second consultation because it has become customary to
get many tests. Patients have learned to believe the importance of
tests. One patient had told me “How do you know what’s wrong
with me? You ran no tests.”
We are often told to refer patients to our colleagues so that everyone has some business and we are also told to generate more
income and code “correctly.” There is an incentive later. After all
incorrect coding “is only benefitting the insurance company and
you have done this examination anyway.”
I find that we sometimes act like we have forgotten the inconvenience of illness when the illness afflicts someone other than
ourselves. I try to remember my dislike of taking time off from
my work to sit in an office to be called by a number rather than
name and then to be referred to someone else when I know that
the doctor could very well have taken care of me but was afraid to
cross over into someone else’s boundary.
Recently I was sitting in a doctors’ lounge in one of the local
hospitals. I was able to see several of my younger colleagues and a
few older doctors stopped by to have some free coffee and donuts.
The conversation that we had was centered on the fact that “medicine was different in the days gone by.” I realized that lamentation
for the by-gone days is a common phenomenon among the older
doctors. We talked about the times when the doctor could sit on
the patients’ bed with a cigarette in the mouth and remove sutures
from scar of appendectomy while the patients worried whether
the ash from the end of the cigarette would fall on their stomach,
and thus they held their breath. Ya! Maybe multiple uteri and gallbladders got removed that didn’t really need to be, or that 25% appendices removed were normal, and radical mastectomy was the
norm of the day. I remember the times when we used to have mile
long EEG papers while operating on patients for seizures while
half of their heads were open for more than 14 hours and they
were awake and received IV nausea medicine and mild sedatives.
I remember, during my internship, one of the anesthesiologists,
used to eat apples as we would be operating, telling me “Time is
money boy, you better close a little faster.”
Many doctors addressed most women patients by their first
name knowing full well that they couldn’t call the doctor by his
first name, and many doctors threw anger fits in operating rooms
or threw x-rays across the rooms if they were not of good quality or to their satisfaction. Now there are rules about respect, and
better arrangements for helping physicians who are challenged in
their behavior or are impaired physicians.
These days collection of outstanding balance is more important
and performance per hour is a necessity to get good grades from
our employers and to be able to get a satisfactory Press Ganey
score. I was recently treated by couple of my colleagues for a problem with my elbow and then I was gone out of the country for a
while. The next thing I knew was to receive a phone call from a
collection agency from Florida because I had neglected to pay the
balance after my insurance had paid their part.
When I told the collection person that in all the years of my
practice I had never charged any additional amount