More than one problem? Make another appointment

So I’m currently rotating through an outpatient medical clinic, and despite all the hand-holding, kumbaya-ing, and “the patient is a person” mentality, beneath the surface an insidious beast lurks. This “beast” is the closely held belief that the patient is only allowed one complaint for each scheduled appointment. You made your appointment to get your blood-pressure meds refilled but you also have seasonal allergy concerns? Too bad, make another appointment so we can discuss the issue on a separate occasion.

Just recently I was (politely) scolded by my resident because I presented a 7-week-old baby whose mother had 3 concerns – the child had been throwing up his milk at each feeding for the past few weeks, he had a rash across his entire body for the same amount of time, and she was concerned that he might also have an umbilical hernia. “Try to keep them to one complaint” my resident told me. But the rash and difficulty feeding were likely related (milk-allergy), and the hernia concern arose because she was a new mother and didn’t realize kids usually outgrow those things – it took 2 seconds to say “oh, that’s normal and he’ll probably outgrow it. don’t worry.”

I have difficultly understanding where this idea, that we can only allow the patient one problem per visit, comes from. I understand that the appointments are booked closely together, generally with 15-20 minutes per patient (which includes the time it takes to fill out any necessary paperwork), but have these doctors lost their minds? Do they not realize that people who come into their clinics must take off work to get there, rearrange child-care schedules, etc? Even if they are retired or stay at home to take care of their children, they still have lives and would prefer not to spend most of it at the doctors office waiting in boring stimulus-free rooms.

I have to believe that if we actually had a free-market health care system many of these problems wouldn’t exist. Our society is accustomed to getting it all done at once – this is why stores such as WalMart or Target have achieved their level of success – you can get your grocery shopping done and stock up on anything else you need in one trip. People expect the same thing from their doctors, and I’m siding with the patients on this one. There is no reason why our system couldn’t adjust to accommodate the person who has a couple different medical problems going on. A more market-based approach would simply charge a bit more for the larger amount of doctor’s time the visit uses. As it sits right now the system is too rigid to adjust to these demands – everything must fit neatly into a 4-5 digit “code” for what the visit accomplished, and the doctor is paid according to that code. I understand doctors don’t like it when a visit they thought would take 15 minutes all of a sudden takes 45 because the patient has a lot of issues to bring up, but if you took your car to the mechanic to get the oil changed and they found a problem with your engine, wouldn’t they offer to fix it on the spot while you waited? Wouldn’t you be pissed if the mechanic told you to make another appointment (which would be at least 2-4 weeks from now) to get your engine fixed, and that in the meantime you would just need to deal with it and keep your fingers crossed while hoping that your car doesn’t break down? I would be pissed. No wonder people don’t like going to the doctor.

~ Lily

3rd year medical student extraordinaire (at least in my mind)

Advertisements

Why you should avoid hospitals during the month of July

I haven’t posted in awhile, mostly because I’ve been so busy studying for (and hopefully passing) Step 1 of the US medical licensing exam. But I thought this would be a good time to write a post – for one, I have the day and weekend entirely free, and two, I start rotations in the various clinical specialties next week and am not sure how much free time I will actually have at that point.

So, why should you avoid hospitals during the month of July? To avoid run-ins with new interns and 3rd year medical students like me! No, I’m not trying to be self-deprecating…just realistic. Interns started at the beginning of this week – these are students who just graduated medical school and are starting the first year of their residency. Many of them are at new hospitals in a new part of the country, and have not had to assume a whole lot of responsibility up to this point. They’re nervous and still learning the ropes, and it will take time for them to feel comfortable with the situation.

Then there are 3rd year medical students like myself – we’ve had limited patient contact up to this point, but now we are thrust into the hospital and assigned patients to follow as we rotate between specialties like surgery, medicine, pediatrics, etc. We have limited clinical skills, but are expected to hone them as we complete the year (this includes things involving needles and patients – such as inserting IV’s and drawing blood…scary thought). We may not have much say (read: almost none) in what happens to the patients, but since we are new to the hospital we inevitably don’t know much about what’s going on and will slow the well-oiled machine down.

These factors contribute to longer stays and higher rates of mortality during the month of July (http://www.nber.org/papers/w11182). Just another reason to be careful this July 4 holiday.

~ Lily