Lack of Customer Service in the USA

[dmccarty]

I am curious about one thing. If you have a patient that has been to you with a disease and you have prescribed antibiotics. Two weeks later this patient comes back uncured and with symptoms of the same disease but the patients symptoms of the disease are of less intensity. If you prescribe another round of the same antibiotics do you charge them for this second office call ?

Of course he does.

Just like the mechanic charges me to everytime they see a car with a mystery problem. Mechanics and Doctors don't work with perfect information. Sometimes they just have to make a decision with the info at hand and see if it solves the problem.

My daughter had chronic strep almost every 6 weeks for about a year. Antibiotics only knocked it down but it would then come back. Only until she had an operation has the problem been solved. Taking the antibiotics was the correct approach to see if it would solve the problem. The DR should be paid for her time. Certainly the lab should be paid for their expenses. Many times we would take the kid to the doc thinking she had Strep and needed antibiotics. Often she did not have Strep and giving her antibiotics would have been a waste of money. Antibiotic can make you sick. They are not candy.

I know two people with Terminal illnesses. They still go to the doctor for treatment. They will not be cured. One will be dead in less than a year or so. The other one might hang on for 2-3 more years.

Later,
Dan

 

[N80]

I have lived in other countries where that is done and the cost of health care is lower. If George is correct that it will increase his buisness then good for him he will be able to recoup the investment that his education cost him that much more quickly.

The cost of healthcare there isn't lower because of access to antibiotics, its lower because medicine is socialized! If you want to go down that road then fine, then we'll have a real conversation about customer service. I did much of my training in a VA hospital, if you ever think socialized medicine sounds good to you...just visit a VA clinic on a Monday afternoon.

I had a patient in our office the other day who went to see his VA internist to get his prescriptions filled. He also had an ear that was plugged with wax. He asked the doctor to flush it out for him (a 2 minute procedure). The internist told him that he did not work on ears and that he'd need to see an ear, nose and throat surgeon in another city. He set the appointment up for him and it was 3 months away.

So you want to talk about low healthcare costs, well, its all bull. It costs just as much over in Shangri La or wherever it is you think it so great. Its just that the citizens are taxed extraordinarily and the care is 'paid for by the government' and you get what you pay for. Dream about socialized medicine all you want, but be careful, you just might get what you ask for in another 6 months or so.

And then you also mentioned Mexico as a shining example of good drug policies. Great healthcare system they got down there isn't it?

 

[N80]

1. If professionals screw it up it must be too complex for non professionals to handle. Good arguement basically people without medical degrees are too stupid to read about drugs and make intelligent decisions.

You said it, not me. But you're partly correct, it really isn't possible for non medical people to get their heads around this stuff. Where you're wrong is the stupid part. Many of my patients are far smarter than I am, but they still don't have a clue about the complexities of drug interactions, pharmacology, etc etc. The problem is that people like yourself think they can Google a medication and know enough to prescribe it for themselves. I can read about how to fly an airliner, run a nuclear reactor, fight an insurgency or build a suspension bridge. I might even be able to grasp and understand the principles. But that hardly qualifies me to fly the 747 on my next vacation, run the local power station, be a Navy SEAL or engineer a bridge.

So don't try to twist my words. There actually IS a reason that a doctor has to finish 4 years of college, 4 years of med school, 3-7 years of residency, pass two major licensing exams, take repeating board certifications, have to apply for and be approved for hospital privileges and hold no less than two state licenses AND meet the criteria for every insurer he contracts with. I'm not beating my own drum, I'm just telling you that there IS more to medicine than a Google search or reading Dr. Gott is going to provide.

2. Most people get their medications from multiple pharmacies, the va, online etc. Last time I looked the VA kept records of what they give you.

Again, you're confirming, repeatedly that you don't understand how things work. I'm not saying you're stupid, I'm just saying that you're talking about things you don't fully understand. Of course VA pharmacies keep records. But most VA patients see non VA doctors and get acute care meds at non VA pharmacies. I have patients who see me as their doctor but go to the VA to get their expensive meds for free. Because that is an enormous hassle, sometimes requiring travel, they get everything else locally. Multiple pharmacies. Just like I said.

I would imagine online pharacies do also but I dont know that for a fact.

Yes, they do, but again, people use both. Now that Walmart
has $4 generics though, people get the high dollar stuff through the mail and the cheaper stuff at Walmart. And you even if you can get a Z pack for your cold at an online pharmacy, just try and get a pharmacist on the phone!

I think a lot of people have a pharmacy they use for whatever reason ( usually customer service comes into play here)

They used to. More and more drug plans dictate where you have to buy your meds. A great many of them dictate that you get your meds through the mail and not at a local pharmacy at all in which case you have NO pharmacist to ask questions of when you diagnose yourself and want to make some toxic cocktail out of your medications.

I do not know many people that just walk into the first pharmacy they see and say fill my prescription. Most people I know use one pharacy and stay without until they have a reason to change

The reason you don't know that is that you're not in the business. Tons of people go into whichever pharmacy they pass by first. That is THE reason all the pharmacies moved out of strip malls and shopping centers onto corner lots. I'm not saying its a great practice, but people do it all day, every day. Especially people who aren't on other meds and just need a medicine for an acute problem. When that happens, that particular pharmacist doesn't know you from Adam's house cat.

3. I am ignorant of various drugs other than the ones I have been prescribed which I try to find out as much as I can about. So if all valium does is make you sleepy then all heroin does is make you feel better so why should either one of those not be available at walmart available without a prescription.

Since the basis for your argument is equating valium with heroin, I don't feel like that is even worth my time to try to explain.

I believe I was trying to point out that we might want to limit addictive drugs to having a doctor prescribe them.

I'd rather be addicted to valium than swollen up, blue and dead from taking the wrong antibiotic or a stroked out vegetable because some antibiotic made my coumadin ineffective.

When I lived in the middle east where I could get antibiotics and similar items without a prescription it seemed like drugs with addictive properties were still controlled through a doctor.

Ah, the middle east. Now there is a healthcare system worth emulating!

Interesting enough my asthma medicine at the time METROTERENOL (sp) was one of the controlled drugs. I am sure that is because of its chemical makeup.

All drugs are 'controlled' because of their 'chemical makeup.' I think that's the point I've been trying to make this whole time. Metaproterenol can cause serious problems if used improperly or with the wrong combination of medications. Just like antibiotics.

The bottom line is that you would rather see the hundreds of thousands of people in the United States that have very limited health care suffer than to have them able to get medications without

No. The bottom line is that I would rather see drugs properly controlled than see hundreds of thousands hurt or killed by using drugs improperly.

Sounds a little different when I say it that way, doesn't it.

Other countries allow people to get certain drugs without prescriptions

So does this country.

and the news has not reported the huge epidemics of drug resistant diseases that are running rampage in these countries.

And if it isn't in the news then it must not be a problem. The news is always your best source for medical information.

And how about sparing us this 'other country' generalization. If you think some 'other country' does it better than us, then say which country it is and quit hiding behind some fantasy land.

I am curious about one thing. If you have a patient that has been to you with a disease and you have prescribed antibiotics. Two weeks later this patient comes back uncured and with symptoms of the same disease but the patients symptoms of the disease are of less intensity. If you prescribe another round of the same antibiotics do you charge them for this second office call ?

You are not curious about it at all. You already know the answer and you're just trying to be insulting. I think I've been pretty forthright in all this. There are lots of other doctors on this board who haven't said a word, probably because they are smarter than me and know that someone like you is going to start taking cheap shots when they get backed into a corner. But I'm not so much saying any of this for your benefit but for the others who are so board that they've kept reading this far.

But hey, that's fine. I'm not embarrassed or ashamed of how I practice medicine. Yes, I charge for the second visit. Humans are not machines. You don't replace a bolt and go on your way. People get sick, some get well, some get sicker, some die. Most of the time I am only a part of that process. I cannot account for the other factors such as did the patient keep smoking? Did they take their medicine right? Did they follow my instructions. Did they catch something else. Did something stress then out, etc etc ad infinitum. Those things are beyond my control. So yes, when you don't get better and you come back in, you get charged. If you can find a doctor that doesn't practice that way... go see him. See how things go.

And since we're taking little stabs at each other's profession, lets say as a realtor you're showing a house that you just can't sell. Then, one day someone from out of town calls the owner because a mutual friend told them the house was for sale. This someone talks with the owner and they strike up a deal. You had no role in selling the house because this buyer never saw an add and never saw a for-sale-sign. The owner calls you and tells him about the sale. Do you collect a commission?

Never mind. I don't care what you do. I know that any realtor would. As a realtor, or an ex-realtor, does that embarrass you?

And if I'm totally wrong about this, why would that be? Because I don't know enough about the realty business to have an informed opinion!

 

[dooleysm]

Fascinating stuff George, I've learned a lot from this topic. You've taken a bunch of your time to answer a variety of questions very honestly, thank you.

Here's my only comment...I ruptured my achilles tendon in January and picked the first orthopedic surgeon I found in my town that was in my network. He patched me up and I have been seeing him since then for followups. I have learned that the later in the day I schedule my appointment the longer I'll have to wait, upwards of 2 hours. I now make my appointments on days when I can be the first appointment of the day and never have to wait. I am fortunate that I have the luxury of an accomodating employer.

 

[N80]

I'm sure it varies from office to office and doctor to doctor, but your best appointment times will be the first one in the morning and the first one after lunch. In addition, with me the last one of the day is a good one. I rarely get behind and I usually want to get home as much as you do.

(I'll repeat this: a lot of my patients like the way I do things, but plenty don't. I'm not trying to sell myself as perfect when it comes to appointments and being on time. There are tradeoffs you have to make and that doesn't suit plenty of people and they might complian about my 'customer service' for other reasons.)

 

[MikePA]

There are lots of other doctors on this board who haven't said a word, probably because they are smarter than me and know that someone like you is going to start taking cheap shots when they get backed into a corner.

It's the same reason why a number of professional people don't respond any more. Too many cheap shots from amateurs who think they know more. It ain't worth the trouble. Lots of good advice happens in PMs or emails.

 

[N80]

It's the same reason why a number of professional people don't respond any more. Too many cheap shots from amateurs who think they know more. It ain't worth the trouble. Lots of good advice happens in PMs or emails.

Agreed. But I'm secure in what I do and how I do it, so the cheap shots don't bother me at all. And I understand that for most folks its just not worth the trouble, but I don't mind talking about this stuff. I think the more that people know and understand about the healthcare system the better we will be. I think there is a lot of good in the system and a lot of bad. I think there are good ways to solve the problems and bad ways. Like you say, just like any other business or profession.

And you are right about good advice here. I've gotten tons, both in the public forums and PMs. Fortunately there are lots of people who know what they are talking about here and are willing to share it with others.

 

[LMTC]

It's the same reason why a number of professional people don't respond any more. Too many cheap shots from amateurs who think they know more. It ain't worth the trouble. Lots of good advice happens in PMs or emails.

Triple double quintuple dittoes to that! I can deal with reasonable questions, but it does so often seem to quickly become demeanment.

I have a lot more pharmacology knowledge than the average joe, probably match my own PCP in some areas (note the caveat..."in some areas"). And that is enough to tell me without question that the old adage is true..."A little learning is a dangerous thing; drink deep, or taste not the Pierian spring: there shallow draughts intoxicate the brain, and drinking largely sobers us again." Alexander Pope, Essays in Criticism

 

[N80]

And many of my patients, especially those with chronic or unusual conditions often know as much as I do about their problems and treatments. But as you say, that knowledge is often narrow.

As a primary care type physician my medical knowledge is broader than it is deep. And subspecialists have far more knowledge than I do within their specialty. So its never an issue of who is stupid or ignorant, its an issue of what you've been trained to do.

I did all of the plumbing in my 3 room, one bath cabin and I did a pretty good job (well there was this one mistake.... ...which only goes to prove the point being made). But I would never presume to tell a plumber that I have any insight into all that he knows and does. I can tell him that I know how to plumb a simple log cabin and make only one significant mistake...but that's it. And that aint much even though it took me a lot of research to figure out that little bit.

 

[gemini5362]

You said it, not me. But you're partly correct, it really isn't possible for non medical people to get their heads around this stuff. Where you're wrong is the stupid part. Many of my patients are far smarter than I am, but they still don't have a clue about the complexities of drug interactions, pharmacology, etc etc. The problem is that people like yourself think they can Google a medication and know enough to prescribe it for themselves. I can read about how to fly an airliner, run a nuclear reactor, fight an insurgency or build a suspension bridge. I might even be able to grasp and understand the principles. But that hardly qualifies me to fly the 747 on my next vacation, run the local power station, be a Navy SEAL or engineer a bridge.

So don't try to twist my words. There actually IS a reason that a doctor has to finish 4 years of college, 4 years of med school, 3-7 years of residency, pass two major licensing exams, take repeating board certifications, have to apply for and be approved for hospital privileges and hold no less than two state licenses AND meet the criteria for every insurer he contracts with. I'm not beating my own drum, I'm just telling you that there IS more to medicine than a Google search or reading Dr. Gott is going to provide.



Again, you're confirming, repeatedly that you don't understand how things work. I'm not saying you're stupid, I'm just saying that you're talking about things you don't fully understand. Of course VA pharmacies keep records. But most VA patients see non VA doctors and get acute care meds at non VA pharmacies. I have patients who see me as their doctor but go to the VA to get their expensive meds for free. Because that is an enormous hassle, sometimes requiring travel, they get everything else locally. Multiple pharmacies. Just like I said.



Yes, they do, but again, people use both. Now that Walmart
has $4 generics though, people get the high dollar stuff through the mail and the cheaper stuff at Walmart. And you even if you can get a Z pack for your cold at an online pharmacy, just try and get a pharmacist on the phone!



They used to. More and more drug plans dictate where you have to buy your meds. A great many of them dictate that you get your meds through the mail and not at a local pharmacy at all in which case you have NO pharmacist to ask questions of when you diagnose yourself and want to make some toxic cocktail out of your medications.



The reason you don't know that is that you're not in the business. Tons of people go into whichever pharmacy they pass by first. That is THE reason all the pharmacies moved out of strip malls and shopping centers onto corner lots. I'm not saying its a great practice, but people do it all day, every day. Especially people who aren't on other meds and just need a medicine for an acute problem. When that happens, that particular pharmacist doesn't know you from Adam's house cat.



Since the basis for your argument is equating valium with heroin, I don't feel like that is even worth my time to try to explain.



I'd rather be addicted to valium than swollen up, blue and dead from taking the wrong antibiotic or a stroked out vegetable because some antibiotic made my coumadin ineffective.



Ah, the middle east. Now there is a healthcare system worth emulating!



All drugs are 'controlled' because of their 'chemical makeup.' I think that's the point I've been trying to make this whole time. Metaproterenol can cause serious problems if used improperly or with the wrong combination of medications. Just like antibiotics.



No. The bottom line is that I would rather see drugs properly controlled than see hundreds of thousands hurt or killed by using drugs improperly.

Sounds a little different when I say it that way, doesn't it.




So does this country.



And if it isn't in the news then it must not be a problem. The news is always your best source for medical information.

And how about sparing us this 'other country' generalization. If you think some 'other country' does it better than us, then say which country it is and quit hiding behind some fantasy land.




You are not curious about it at all. You already know the answer and you're just trying to be insulting. I think I've been pretty forthright in all this. There are lots of other doctors on this board who haven't said a word, probably because they are smarter than me and know that someone like you is going to start taking cheap shots when they get backed into a corner. But I'm not so much saying any of this for your benefit but for the others who are so board that they've kept reading this far.

But hey, that's fine. I'm not embarrassed or ashamed of how I practice medicine. Yes, I charge for the second visit. Humans are not machines. You don't replace a bolt and go on your way. People get sick, some get well, some get sicker, some die. Most of the time I am only a part of that process. I cannot account for the other factors such as did the patient keep smoking? Did they take their medicine right? Did they follow my instructions. Did they catch something else. Did something stress then out, etc etc ad infinitum. Those things are beyond my control. So yes, when you don't get better and you come back in, you get charged. If you can find a doctor that doesn't practice that way... go see him. See how things go.

And since we're taking little stabs at each other's profession, lets say as a realtor you're showing a house that you just can't sell. Then, one day someone from out of town calls the owner because a mutual friend told them the house was for sale. This someone talks with the owner and they strike up a deal. You had no role in selling the house because this buyer never saw an add and never saw a for-sale-sign. The owner calls you and tells him about the sale. Do you collect a commission?

Never mind. I don't care what you do. I know that any realtor would. As a realtor, or an ex-realtor, does that embarrass you?

And if I'm totally wrong about this, why would that be? Because I don't know enough about the realty business to have an informed opinion!

Actually I think you deserve to be paid for every visit someone makes to your office. You have provided the office space and your time so you should be paid for that. The difference is in the care after your office visit. As a person with asthma I have to take prescription medications every day. I have had doctors in the past who give me a 3 month prescription and then demand I come see them for refils. They dont change my prescription they just want to see how I am doing. But back to the point I was trying to make. If I see my physician and they prescribe anti biotics for me then a couple of weeks later I am better but not well yet. I would love to be able to go back to the pharmacy and just pick up another z pack for instance. There are numerous people in this country who have had recurring illness that there doctor prescribes the same anti biotic who could go to the pharmacy and buy that anti biotic on their own.


I did not think the health care my family got when we lived in Saudi Arabia was that bad. It was not socialized my insurance paid for every doctors visit or hospitalization. I dont know about the quality of doctors there but I know I have one heck of a time seeing a doctor locally who does not have a middle east accent and a name to match.


I am not trying to take pot shots are your profession. I have said that I feel you should be making the kind of money you are making and that you should be paid for every visit a patient makes to your office. I have an opinion one that is based on my travels around this planet and times I have lived other places. You have an opinion based on your professional education and your professional experience. We are both entitled to our opinion and air our views to support the reasoning for our opinion. I am not going to change your view. I am sure that you realize you are not going to change mine. That does not mean that I dont respect you or your profession. It just means that I disagree with you. At one time all the professionals knew beyond any shadow of doubt that the earth was flat and if you sailed far enough you would fall off. A ships caption disagreed with them. Just because you disagree with professionals does not autmatically make you wrong. I suspect that we wont find out about buying antibiotics over the counter in the USA because I am a minority in my opinion about that. So you will probably win this difference of opinion by default.


You are actually wrong about the realtor issue. First of all that is not my profession you should have read my post a bit closer. I said I have a realtor license but I use it only to invest. Second to do what you mentioned in your post a buyer would have to have a seller agree to that in the listing contract. I have never asked anyone to agree to that because I think it is an insult to the intelligence of the buyer to ask for that. Most listing contracts I have seen have a clause that if the realtor shows the house to someone and they buy it either while the house is under the listing contract or for a period of 6 months after the listing contract is over the realtor recieves their commission because they have done their job by marketing the house to a buyer. But that is limited to a buyer the realtor has had direct contact with and marketed the house to. ( keep in mind here that when I say realtor in this context I am talking about all the realtors that have access to a multlisting even though one realtor lists the house and another company sells it the two realtors split the commission)