Is this a new trend in dr's offices?

[pinkmomagain]

So I went to an orthopedist today as a new patient. When the assistant took me back and asked about why I had come I mentioned an issue with my hand and a separate issue with my back. She said that I had to pick ONE to talk with dr about this visit and I'd need to make another appt to talk about the other. Sure enough, when I checked in, the guy ahead of me said that he had been in to see the dr yesterday to talk about his back and returned today to talk about his shoulder. Huh? Really? My dh also encountered this at the dermatologist's office a month ago. He wanted a body check and for her to take a look at a lesion he had on his nose...he had to pick ONE to address at that visit, not both.

I'm really suprised at this and am wondering if others are finding similar encounters at the dr's office?

[Corie]

I have never heard of such a thing!!!

When I go to ANY doctor, I bring my list of questions with me. I may
end up asking the doctor 4-5 various questions about a range of issues.

I would be seriously pissed if I had to go back for each & every issue.

[crl]

I had that happen with military medicine, but haven't encountered it since. I do usually list everything I want when I make the appointment so maybe they are booking double for me when I have multiple issues?

I can see that doctor's offices have to schedule time so the doctor isn't always running behind, but I think the solution is for the receptionist to book extra time when making the appointments if needed (and to ask enough questions to figure that out). Because coming back multiple times is seriously inconvenient.

I don't think it can be a billing issue, because a million years ago when I briefly worked in a doctor's office there were different billing codes for different lengths of appointments. . . .

Catherine

[slworld]

I recall seeing a notice in the Dr office maybe 2yrs ago about limiting to 3 issues.

[codex57]

It's an insurance thing. Many insurance companies will only pay for one issue per visit. So, if a doc looks at two in the same visit, he'll only get paid for one thing. I can't remember for sure, but I think it was in an article talking about wasted $ and the debate on the universal healthcare issue.

[Nooknookmom]

Wow, that's weird. I usually bring a list as other posters mentioned. I have so many issues with my back and arthritis that I WILL forget. For the Dr. to limit my questions to one body part would mean my returning for an appt. each day of the week.

I wouldn't feel comfy with that Dr.'s office.

[SnuggleBuggles]

That happened to me at the dermatologist's office- and they have a frickin' 6 *month* wait for appointments!

Beth

[NancyJ_redo]

It's very much a time-management thing. Imagine if you're waiting for your appointment and the guy in front of you has 10 things addressed instead of the 1 issue for which he was scheduled. The dr would then be very late in seeing you, and by the last patient of the day the dr would be hour(s) late.

That being said, I totally understand your frustration and have been equally frustrated myself. Nonetheless, I'd still rather the dr limit appts to the issues for which people were scheduled, vs addressing a whole litany of issues.

As a PP mentioned, the scheduler is at fault - he/she should be asking you when you first make your appt what you're coming in for so that enough time can be allocated to properly address all of it.

And actually, one more thought - I believe with HMO plans, there may be some billing issues as a PP mentioned. I don't believe that's true with PPO plans since the dr's are paid differently, but I could be wrong.

[ha98ed14]

Yes, I've had it happen, but not since being on an HMO with salaried physicians. It is one benefit.

PP is right; it's about getting paid by the insurance companies, but it's downright insulting to the working stiff who has to get time off work to go to the doctor. Personally, I'd be looking for another doctor. There must be some doctors left on the planet who actually put the patient before his co-pay.

[pinkmomagain]

I wouldn't feel comfy with that Dr.'s office.

Yeah, I won't. Especially since he told me he didn't know what was wrong with my hand, but could make something up like he did with another woman this week. Waste of a $30 copay.

[cheri]

The reason doctors do this is to provide better care in a timely manner.

You went to a new doctor with two completely separate issues. Addressing each of these issues will take roughly the same amount of time, as there isn't much crossover between hand and back issues (unless they're symptoms of a systemic problem).

You were scheduled for "x" amount of time, which is the time that the physician allots to address one new issue. If he were to take the history and examine you for both issues at that visit, it would take about "2x" amount of time.

Since he only has "x" time scheduled for you that puts him in the position of making a choice. He can:
1) Give each problem half as much time as it deserves, or
2) Spend "2x" time on your two problems, which means he is behind schedule for his next patient.

People complain incessantly about waiting for their doctor, but get mad when doctors try to keep on schedule. You can't have it both ways.

[SnuggleBuggles]

The reason doctors do this is to provide better care in a timely manner.

You went to a new doctor with two completely separate issues. Addressing each of these issues will take roughly the same amount of time, as there isn't much crossover between hand and back issues (unless they're symptoms of a systemic problem).

You were scheduled for "x" amount of time, which is the time that the physician allots to address one new issue. If he were to take the history and examine you for both issues at that visit, it would take about "2x" amount of time.

Since he only has "x" time scheduled for you that puts him in the position of making a choice. He can:
1) Give each problem half as much time as it deserves, or
2) Spend "2x" time on your two problems, which means he is behind schedule for his next patient.

People complain incessantly about waiting for their doctor, but get mad when doctors try to keep on schedule. You can't have it both ways.

But, if they could find out when you are making the appointment how many things need to be covered then couldn't they allot more time and not overbook the time slots?

When I tried to do that with my derm. they cut me off while I was making the appointment and didn't give me the option of making a 2nd appointment. I'd have had to wait 6 more months for the next one. That is 100% unacceptable to me (and it ticks me off that there are not more derm. practices around and all the ones around here have a ridiculously long wait).

When I had my 1st midwives' appointment they blocked off an hour. For most of the following ones they blocked off 20 minutes. There were 2 other 1 hour long ones during the pregnancy. Certainly the schedulers have the ability to block new patient/ longer appointments without it causing a big problem. If they can't then they need to make changes.

With those 20 minute appts. I had I often was only there 10 minutes because I had no questions and all was well. Things balance out so I don't think we should really feel guilty about trying to get our needs met at the appointment on the times that we might need more time than normal.

I don't mean to put you on the spot. I'm just kind of airing this out there to the general world.

Beth

[wellyes]

I remember an episode of House where they talked about the "doornob moment"..... a patient goes in to talk about something mild, and as the doctor goes to leave and is almost out the door, the patient digs up the courage to mention her embarrassing but more serious issue (in the episode, it was bloody stool). I know it's just a TV show but it makes total sense to me.

I guess I could understand doctors limiting the appointment to an issue for certain non-critical specialties, like podiatrists or dermatologist (though as SnuggleBuggles said, it'd be nice if you could book time based on your # of issues). But I think it'd be irresponsible of an internist or family doctor or ped to only agree to one issue per visit.

FWIW my internist and pediatrician appointments are all generally on time, give or take 5 minutes, and they don't limit the number of inquiries. So there must be others effective time management methods - perhaps fewer patients each day?

[maestramommy]

That's crazy! I always have a list of questions and concerns. When my ped walks in he always asks if I have any questions or concerns/worries, and deals with those first if it's a WC. If it's an urgent care appt, he deals with the current issue, then asks if I have any other questions or issues.

[sste]

I am getting my 8-12 minutes of fame or they are going to have to try to drag me out clinging to the exam table! If its a specialist, I understand that they don't generally have much more than 12 minutes or 15 at the outside (based on the way most offices book) but I expect to be able to cover as many problems as we reasonably can in that time frame. I do understand that they can't address two major, complicated problems but two little things or one primary issue and one quick question I expect answered.

[DrSally]

That's crazy! I always have a list of questions and concerns. When my ped walks in he always asks if I have any questions or concerns/worries, and deals with those first if it's a WC. If it's an urgent care appt, he deals with the current issue, then asks if I have any other questions or issues.

I've never experienced this the op's issue. Although I have had one doc that tried to rush me out (a derm, and it doesn't matter how long I've been there, could be 4 min, could be 15 min, she's always trying to cut me off and get me out the door). Anyway, Melinda, I wonder if ped's offices are different b/c they view it as their chance to screen the child for any problems (many kids don't get into the doctor often) that can be dealt with now (better for the child, easier to get tx started earlier, and more cost effective).

[sste]

Actually, specialists are different from primary care doctors (pedis, internists, family practice doctors). As a generalization but most often a true one, the primary care people view their goal broadly wellness and prevention. Specialists view themselves as consultants addressing discrete problems. Specialists also have to buy more expensive equipment and, again generalizing, tend to be more financially-motivated.

This is why I usually stick up for pedis on this board . . . compared to other types of doctors, they are very accomodating and well-intentioned!

[cheri]

compared to other types of doctors, they are very accomodating and well-intentioned!

Just one of those non-accomodating, evil-intentioned specialists over here...trying to take good care of my patients. (sigh)

[♥ms.pacman♥]

It's very much a time-management thing. Imagine if you're waiting for your appointment and the guy in front of you has 10 things addressed instead of the 1 issue for which he was scheduled. The dr would then be very late in seeing you, and by the last patient of the day the dr would be hour(s) late.

That being said, I totally understand your frustration and have been equally frustrated myself. Nonetheless, I'd still rather the dr limit appts to the issues for which people were scheduled, vs addressing a whole litany of issues.

As a PP mentioned, the scheduler is at fault - he/she should be asking you when you first make your appt what you're coming in for so that enough time can be allocated to properly address all of it.

.

:yeahthat: i agree. i remember this issue was actually addressed in the "BABY 411" book...the question was, "why are doctors always running late (making patients wait in the waiting room, sometimes for up to an hour?)?" And the answer was that a lot of times people come in for their appointment for a specific thing and then ask the doctor to check out other things or even additional patients (e.g. a patient with an ear infection also has some other infection; a parent bringing in one sick child happens to have another sibling who is also sick, etc). If the doctor attempts to try to address these extra issues, they fall behind in the schedule, making everyone else wait.

I agree it's frustrating though, and yes the person who schedules the appointments should do their best to allot the appropriate amount of time for all the issues needing to be seen by the doctor.

[sste]

Cheri, my DH is a specialist as well :) He also gives the pedis and internists props for doing so much for their patients and not being compensated the same way as most specialists.

ETA: Not trying to say that specialists are mal-intentioned as a group . . . more that I very, very rarely meet a pedi who doesn't like kids but I have on multiple occasions met certain specialists who don't really like people, they like problems. Or in a few cases they seemed to like the higher reimbursements. But, I have been the patient of many excellent and caring specialists too - - none of whom adopted a hard and fast "one problem" rule but rather took it case by case according to the amount of time the problem took and how packed or not so packed their schedule was that day.

[cheri]

Cheri, my DH is a specialist as well :) He also gives the pedis and internists props for doing so much for their patients and not being compensated the same way as most specialists.

ETA: Not trying to say that specialists are mal-intentioned as a group . . . more that I very, very rarely meet a pedi who doesn't like kids but I have on multiple occasions met certain specialists who don't really like people, they like problems. Or in a few cases they seemed to like the higher reimbursements. But, I have been the patient of many excellent and caring specialists too - - none of whom adopted a hard and fast "one problem" rule but rather took it case by case according to the amount of time the problem took and how packed or not so packed their schedule was that day.

Thanks for the explanation. I don't mean to be so touchy--I think I'm just burned out. :(

[sste]

No worries, I am burned out on medicine merely being MARRIED to DH. It is a tough lifestyle. Especially when you feel like you are giving up a lot personally and patients don't see that or appreciate it . . .

[jent]

ITA with Cheri. I don't think it's a "new" trend, per se, but that the particular doctor's office is dealing with it in a particularly upfront way that comes off as a little harsh. There are other, more subtle ways to ask a patient to come back and discuss that at another visit, such as saying "try X for few weeks and see me if it doesn't get better" or "please keep track of your symptoms for a few weeks and then we'll get together and talk about it then."

And it's not just as easy as fewer patients per day. Fewer patients = less reimbursement, and that money is not just lining your doctor's pockets but mostly going to the overhead of running the office.

Though with dermatologists... well, maybe I'd better just not get started on them. It's late.

[billysmommy]

Another issue could be if they are working for a hospital or in private practice. We have many friends who are Drs, both PCP's and specialists. And in the past few years, many of them have left their hospital-based clinics and gone into private practice because the hospital gave them a quota of patients to see every day. They were seeing patients in the office and then would have to go to the hospital during their lunch and after office hours to see patients to get their numbers in. Once in private practice they had more say over their schedules.


I would be totally frustrated and be looking for a new Dr if that happened to me also unless I absolutely loved the one I was seeing.

[crl]

I'm confused by the billing thing. Admittedly I only worked briefly for a doctor and it was a very long time ago. But I remember quite distinctly different codes related to the length of the visit. (It wasn't in exact minutes, but it was something like "short" or "complex" or something like that.) Is billing not done this way anymore?

Catherine

[Piglet]

It has been this way around here for ages! I am not sure if it is the same across the whole country but every doctor I have been to has had a notice about "only one issue per visit". The thing that annoys me is that sometimes the 2 issues are connected (like the neck and back would seem to be the same problem manifesting in different ways, yk?). Worse than that, my friend has lupus and it comes with a huge number of symptoms - it would have been very hard to diagnose if she were limited to one symptom at a time!

[Nooknookmom]

Yeah, I won't. Especially since he told me he didn't know what was wrong with my hand, but could make something up like he did with another woman this week. Waste of a $30 copay.

Sounds a little fishy, like they are looking for an excuse to rack up some more co-pay's. Yikes! I hope you find a place to go, that WILL listen to your aches and pains and not rush you out the door :)

[o_mom]

I'm confused by the billing thing. Admittedly I only worked briefly for a doctor and it was a very long time ago. But I remember quite distinctly different codes related to the length of the visit. (It wasn't in exact minutes, but it was something like "short" or "complex" or something like that.) Is billing not done this way anymore?

Catherine

Yes, but I'm willing to bet that the payment for two 15 min visits is more than for one 30 min visit. Additionally, the copay is collected up front and the rest of the cost is paid a the insurance negotiated rate.

[JBaxter]

No Ive never heard of anyone doing that. The orthopedist we go to (teenage football player) ASKED if there were any other problems while we were there. I had Logan in for a broken wrist last year and they asked us how his shoulder was doing. This year when were were in for his foot they asked if his wrist and shoulder were holding up ok.

I was to a plastic surgeon for a mole removal and I was asked if there was anything else while I was there.

[mommy111]

I'm confused by the billing thing. Admittedly I only worked briefly for a doctor and it was a very long time ago. But I remember quite distinctly different codes related to the length of the visit. (It wasn't in exact minutes, but it was something like "short" or "complex" or something like that.) Is billing not done this way anymore?

Catherine

Reimbursement has changed a lot over the past few years. So MDs can't charge on time and many small issues don't justify a 'complex' code, as far as I know, the code is related to the complexity of the most complex problem.
Which is bad patient care and customer service but is what most offices have to do to be able to see enough patients to make ends meet financially.

[sste]

OK, I asked DH about this last night who is a specialist doctor - - DH works in academic medicine so salaried, is a member of doctors for universal health care, the whole nine yards . . . so take this with a grain of salt.

DH said he would be concerned that he was missing a systemic problem because the patient was obeying the "rule" and only mentioning one complaint. He feels like his job as a specialist is to apply his knowledge to figure out what might be related or part of a syndrome. He says if he is running out of time and he can tell the issues are completely distinct he will ask the patient to prioritize the top couple of problems - - he has had patients come in with 4-6 different issues they wanted to cover and in those cases he tries to focus on the top 2. So, his view was as others have mentioned that the business/insurance pressures push policies like this . . . but he thinks it goes against what medicine is about.

[DrSally]

OK, I asked DH about this last night who is a specialist doctor - - DH works in academic medicine so salaried, is a member of doctors for universal health care, the whole nine yards . . . so take this with a grain of salt.

DH said he would be concerned that he was missing a systemic problem because the patient was obeying the "rule" and only mentioning one complaint. He feels like his job as a specialist is to apply his knowledge to figure out what might be related or part of a syndrome. He says if he is running out of time and he can tell the issues are completely distinct he will ask the patient to prioritize the top couple of problems - - he has had patients come in with 4-6 different issues they wanted to cover and in those cases he tries to focus on the top 2. So, his view was as others have mentioned that the business/insurance pressures push policies like this . . . but he thinks it goes against what medicine is about.

ITA with your husband. There are times when an important dx would be missed wo/the whole sx picture, and how is the pt. supposed to know they're related.

[1964pandora]

Yes, this is an insurance issue, not a time management issue. My doctor actually explained it to me.

[maestramommy]

I've never experienced this the op's issue. Although I have had one doc that tried to rush me out (a derm, and it doesn't matter how long I've been there, could be 4 min, could be 15 min, she's always trying to cut me off and get me out the door). Anyway, Melinda, I wonder if ped's offices are different b/c they view it as their chance to screen the child for any problems (many kids don't get into the doctor often) that can be dealt with now (better for the child, easier to get tx started earlier, and more cost effective).

Maybe, I don't know. This is my third ped, and the first two were somewhat similar. At least they never tried to rush me out the door, and always took time to answer questions. My current ped, though is a kind of geek and I think he just likes to chat about these things. He used to be a schoolteacher before he went to med school, and I think childhood development still fascinates him, whether it's a medical or other issue.