Why do so many physicians offer such poor patient care?

• By MaggotLady
• Posted February 19, 2009 at 10:29 am
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Your info is right on. I too, tell patients the same thing exactly. I believe physicians have to take more and more patients to recoup their money since reimbursements are so low. They too are so busy learning new techniques, drugs all the time(or should be) BUT I find that being your own patient advocate is the MOST important thing. You know your own body and know if somethinge is wrong. Go with your instinct. Most of all know all your options. Doctors are not always right, they do not know everything and sometimes they make mistakes. It is not like the old days. Too many specialists and not enough good primaries who keep up with all your info anymore. You sound like you know what is going on to me. Keep up the good work!!!

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• By enlightened
• Posted February 19, 2009 at 10:42 am
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That you for the nice reply. You sound like a very well informed lady as well. I am happy that you are on the site. I agree with you, we need to learn how to be our own patient advocate.

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• By alinfun
• Posted February 19, 2009 at 2:43 pm
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WHAT MUST BE UNDERSTOOD ABOUT PHYSICIANS
THEY ARE A FRANCHISE FOR PHARMACEUTICAL COMPANIES, AND ARE LISTED AS PHARMACOPOEIA TO THE COMPANIES I.E. THEY ARE IN BUSINESS FOR THEMSELVES AND THE PATIENTS ARE THEIR COMMODITIES..SO THEY LOSE COMMODITIES AT TIME'S... COMMODITIES ARE ABUNDANT AND BELIEVEABLE. SO WHAT'S A FEW !!!!!!
PHYSICIANS ARE LIKE OWNING A MAC DONALD'S FRANCHISE YOUR MENU IS ALREADY LISTED.

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• By Globalwoundcare
• Posted March 1, 2009 at 4:58 pm
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I once was told that to assume was making an ass of u and me. I can kind of understand when a pediatrician has seen twenty sore throats already that day, he is already assuming what the next sore throat is. But even though a rose is a rose... a red throat may be scarlet fever of some off the wall histimine reaction or even some wierd bacteria.

Can doctors get in a rut, sure everyone can . When I see any wound infection right now, I am prescribing doxycycline, because it is likely MRSA or CA-MRSA and the cultures I am getting back are frequently sensitive to Tetracycline. Am I always right-I wish, but I right most of the time-it is a good guess based on results I am seeing on other patients. Some times you are pushed into making an assumption. On the other hand, with the anticipated cut in Medicare and the increase in insured patients, you are going to see most all your doctors making assumptions and spending less time with patients. God help us all. As far as pharmacutical companies bribing doctors, I am not really sure, my drug reps treat me nice, feed me and keep me upto date on what is being sold or developed, but everyone seems to recognize the patient comes first. If I can use your drug , great, if no, sorry.

I am a practicing physican. I feel that I have earned a certain style of living, as my friends who did not get a college education have had years to put away earned income. At the same time, I went in to medicine because I love getting wounds well. I have a lot of ideas on how this could be worked out, but nobody is asking me. ....

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• By missmatic
• Posted March 1, 2009 at 7:10 pm
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I'm asking.

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• By enlightened
• Posted March 1, 2009 at 9:00 pm
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Hello GlobalWoundCare,

I'm asking. You stated, "I have a lot of ideas on how this could be worked out, but nobody is asking me. ...."

If you would like to share your ideas about how to encourage physicians to take the time to record accurate patient histories, leave bias out of it and make a sincere effort to diagnose the patient correctly the first time, I am certain we would all love to hear your ideas.

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• By Globalwoundcare
• Posted March 4, 2009 at 12:16 pm
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I am in a private practice. I own it. I have one more full time doctor and one part time doctor working for me. I also have close to a million dollars in equipment. Including the physicians, I have ten people working for me. I practice in rural north Georgia. And if you are paying attention to what I have been saying, you will realize I have gone from being a person who went into health care to help the ill and has become a business man who has bills to pay, staff to manage. Somewhere my priorities changed.

I love getting people well and I tend to forget those I have helped heal. Many a night I have gone to bed with those I failed. This is not true for just me, but also for million of healthcare workers, throughout time and throughout the world.

I remember when I first started, every morning was Christmas. What kind of wounds was God going to send to my office today? I would jump out of bed, eager to get work, eager to see the first patient that came in the door. Then I became popular, I was good at what I did. I got many people well, that would have had amputations. So, I hired another young doctor and taught him how I was doing Medicine. I would still see his patients and mine routinely to maintain the quality of medicine I wanted. I was becoming both professionally and financially successful.

It was easy to get caught up in the money I was making, but I felt I had earned it. I had working hard to go through school, and to save money, so I could buy the expensive equipment I needed to get my patients well. Sure I bought a nice car, as nice house..But, I had never forgotten why I went to work everyday. I still cared for my patients, still loved what I did. I still tried to be the best and provide my patients with the best care they could receive anywhere. Heal wounds that others had given up on. Then one day, Medicare decided they did not like the way I practiced. No I had not done anything wrong. I had not lied or cheated the system. Medicare went through my charts looking for ways to avoid paying me. I am a doctor. trained in treating people. I have spent my life learning better ways to prevent amputations. I had not spent my life learning how to play the insurance company game.

Now, I when I get up, It is hard to get out of bed. It is hard to see patients, because I can not afford to stock supplies I need to treat them. It is hard to look a patient in the eyes and say, I don't have what you need, because I can't afford to buy it. Medicare won't pay me and I am broke. I can't put you in the expensive hyperbaric oxgyen chambers, because of Medicares not paying, I can not afford to purchase the necessary oxygen.

I still see a patient has a patient, but I.... I am not sure how to say it. I love getting wounds well, but now everynight I go to bed, worrying about paying my bills. I feel cheated and wronged by the very people I have spent my life trying to save. My goverment (and I am a veteran) is persecuting me and I know it is not just me. And now many private insurances are doing the same. It is not uncommon for blue cross/blue shield to take 8 months to pay me for prior approved patient care.

I have been open and honest, if I have a bad attitude, well let me know what ya'll think.

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• By enlightened
• Posted March 4, 2009 at 1:53 pm
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Globalwoundcare,

Thank you for sharing this information.

You have stated a number of times now that you have paid the price in order to earn a good income and that you deserve to earn this income. I do not think anyone here disagrees with you. That is not our issue. Our issue is the lack of quality health care primarily due to physicians failing to do the minimum to provide it, and that is taking an accurate and unbiased patient history. Could you please elaborate on why that is not done? That is one of the primary issues here and one of great concern to millions of patients. Thus far, we have not received an answer to that question.

Now the government is failing to live up to your expectations and doing everything they can not to compensate you for your time and materials. Welcome to my world! I am a business owner. I did not inherit anything. My family was very poor. I created my business from conception. If it helps, there are millions of people who have the same problems that you have with different labels attached to them. Many of us are very well educated. We have high IQs. We simply decided to choose a different occupation than you did. I am a nationally recognized expert in my field. Do I think I should be compensated better? Yes. I think most of us would enjoy better compensation during these very difficult times.

Are you familiar with the popular TV program, "House?" I love the show. I love the humor and the troubled character that "House" portrays. This character thinks ALL patients lie. His redeeming quality is that he goes to any and all lengths to get a correct diagnosis and then he treats the patient. Unfortunately, out here in the real world, patients find that they are not believed either by physicians. While I realize that all patients are not always truthful, I believe most of us are and we really want to give accurate information to physicians so that we can receive an accurate diagnosis and the correct treatment. Far too often, what we say is never even considered. What is documented is the conclusion that some physician jumped to based on nothing more than their own personal bias, another physician's bias and/or limited experience so the facts simply are not documented. This is not only "unfair and insulting" it is potentially life-threatening. This should never happen.

You stated: "I still see a patient has a patient, but I.... I am not sure how to say it. I love getting wounds well, but now everynight I go to bed, worrying about paying my bills. I feel cheated and wronged by the very people I have spent my life trying to save."

That statement appears to be directed at the patients. Do you resent your patients? Do your colleagues share this resentment? Perhaps that is why patients are often met with hostility rather than caring and compassion. Do you really blame patients for what insurance companies do? Do you feel that you do not owe them an adequate level of care because the government is reducing your income?

Your patients go to bed every night worrying about how they will feed their families, keep a roof over their heads and pay their bills, including all those medical bills. Patients have absolutely no control over insurance companies and their desire not to pay your fees. Patients have to fight with insurance companies continuously to get them to pay the contracted amounts so that physicians and medical facilities will not go after them for debts that the insurance company owes to the medical provider. We pay very high premiums for this coverage, plus extra fees for visits, medications, etc. This is not some joy ride for the patients either.

Perhaps if physicians showed respect for patients, rather than disdain, their jobs would be easier, and we would all benefit.

Do you have any thoughts about this? Please share them with us.

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• By Amyrosenberg
• Posted March 5, 2009 at 8:05 am
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I think we are expecting too much of MDs. I think we need to expect more of patients and insurance companies and hospitals.
MDs are not their own bosses any longer. It is now the plans that decide what they will pay for and yet the MDs cost remain the same. The patients often do not take medical advice and expect good results. The want to eat at Mcdonalds and smoke and drink and when their body starts to go, they expect the MD to fix it. A patient needs to take care of him or herself and use the MD sparingly.

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• By littlechill
• Posted March 5, 2009 at 9:10 am
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Dear enlightened,

I think your anger towards Globalwoundcare is misplaced. There are many Doctors that are unable to practice medicine in the best interest of their patients because the pharmaceutical and insurance companies have taken over their medical practices. I also think that our whole medical system is a business geared towards making money for the drug companies, therefore diet, exercise, stress reduction are just not profitable enough and too time consuming to be utilized by doctors. I also agree that we need more "General or Family" Doctors (these could be Nurse Practitioners or Physician Assistants) that could develop a "whole" lifestyle health plan with patients to correct diseases that are being caused by their lifestyle. This Plan should cost less for patients because the Health Care Provider does not need to invest in expensive equipment or give out expensive prescriptions. When a patient has something more severe or technically wrong then they can see a specialist. I have had very bad luck even with caring Doctors. They just do not know how to help me unless they prescribe medication that ends up causing another problem for me. I spent 18 months in India on a Humanitarian Mission and found out what it is like to get great medical care. The Hospital had the newest equipment. The set up was different though. Most of the Doctors had small offices with one examining table in them with a curtain to pull. You could usually get an appointment the same day or at least in the same week. My heart Dr. for instance listened to my heart with his Stethoscope and could tell me more about my heart than my Heart Surgeon here at home in N.C. This Dr. comes to the U.S. once a month to train Dr.s here. I asked him how he knew all this. He said you have to train your ears and mind to listen. He still used the fancy equipment like an echo machine but it only confirmed what he already knew. I still only saw him for 10 or 15 min. so the time with him was not different, he was extremely busy. But I felt he listened and understood, he did not just brush me off. Also the medical care cost a few dollars but the best part was that I kept all of my tests, x-rays and files. I was just to bring them with me for my office visits. This gave me a great since of control. I could call and go see any Dr. I wished without having to go through a long line of Dr.s. My husband had a hernia operation while we were there and our accomodations were fantastic. He was in the hospital for 5 days with a private nurse, our room had a flat screen t.v., I had a bed and a small kitchen. I was not allowed to see him for 36 hours after the operation except on a monitor in the surgeon's office, because patients are kept in the ICU. Both my husband and I will go to India once a year for medical checkups and if surgery is needed then we will get it there. We changed our $1,300/month insurance policy (highest deductible) to a $500/month Health Savings Account in case of an accident.

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• By enlightened
• Posted March 5, 2009 at 11:25 am
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Littlechill,

Thank you for responding. You have written some interesting information. However, I am not angry with Globalwoundcare. This physician indicated he had some information to share that would answer our questions about why many physicians are providing inadequate care. Though several of us stated that we were listening and interested in knowing, and asked this person for the answer, the reply was a non-answer. This person wrote an essay about his/her dissatisfaction with the healthcare system, but never addressed the question that continues to be asked. No answer was given about why many physicians here do not take the time to take a proper patient history or even examine a patient. That is where good health care begins.

You stated: "There are many Doctors that are unable to practice medicine in the best interest of their patients because the pharmaceutical and insurance companies have taken over their medical practices."

As someone who has actually worked many years in the healthcare industry and am very well acquainted with how physicians are trained, how pharmaceutical companies and insurance companies do business, I find it amazing that some people think that the availability of medication for patient treatment and insurance company re-imbursement has something, ANYTHING, to do with why some physicians do not take careful patient histories or examine patients. There is absolutely no connection between these various parts of the medical industry and the proper taking of a medical history and a medical examination. Physicians have always been in the business of making money. This is not new. It is a business and of course, they should be allowed to make money. Pharmaceutical companies make it possible for the physicians to make even more money, not less. I spent many years working within the industry and in no way does the pharmaceutical company keep a physician from doing his/her job. Medications are used to treat patients AFTER a diagnosis is made. The physicians have numerous options for writing prescriptions after they take the time to accurately diagnose the patient. Getting reimbursed by an insurance company happens later, not at the time of the visit.

When you made this statement, whether you realize it or not, you have made my point and that is the most important thing that a physician can do and a basic physician job requirement at that, is to take the time and effort to take a patient history correctly. A careful exam is also part of the basic job requirement for a physician. Here's what you wrote emphasizing what happens when a physician actually takes the time to take a history and examine the patient. Here's your statement:

"My heart Dr. for instance listened to my heart with his Stethoscope and could tell me more about my heart than my Heart Surgeon here at home in N.C. This Dr. comes to the U.S. once a month to train Dr.s here. I asked him how he knew all this. He said you have to train your ears and mind to listen. He still used the fancy equipment like an echo machine but it only confirmed what he already knew. I still only saw him for 10 or 15 min. so the time with him was not different, he was extremely busy. But I felt he listened and understood, he did not just brush me off."

The kind of care you described is exactly what I and others on this site have stated, in various ways, that we do not always receive. That is our issue.

Thank you for sharing this information with us, and for the patient care information provided about your experience with Indian physician and their medical healthcare system. It really does make a difference when a physician cares enough to speak with the patient and perform an actual patient exam in a professional manner. As your physician stated, the tests usually simply confirm what the physician already suspects the diagnosis will be from the thorough history and exam. That is what the good physicians who perform well at their jobs actually do. That is why we seek them out for our health care. We are not anti-physician or anti-medical establishment. We are thankful for the good physicians who care enough to do their jobs and do it well.

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• By enlightened
• Posted March 5, 2009 at 11:59 am
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Hello Amyrosenburg,

Thank you sharing your opinion. I believe it is helpful to all of us to see input from various people with different ideas. You stated, "I think we are expecting too much of MDs. I think we need to expect more of patients and insurance companies and hospitals."

I absolutely agree that patients are totally responsible for doing their part to take care of themselves, living a healthy lifestyle, and doing what they should to stay healthy. I also agree that the insurance companies need to be revamped and more emphasis should be placed on the patient's welfare and hospitals need to continue to use quality assurance and quality control to improve patient care, but I also understand that there is a need to prevent unnecessary expenses or exorbitant expenses because the system must make the best use of the funds available.

Can you explain why you believe that we should not expect physicians to perform the basic requirements of their job and that is taking a proper patient history and giving the patient a thorough exam? I am curious about why you do not appear to think it is necessary that they perform the basic duties associated with their jobs.

You stated, "MDs are not their own bosses any longer. It is now the plans that decide what they will pay for and yet the MDs cost remain the same. The patients often do not take medical advice and expect good results. The want to eat at Mcdonalds and smoke and drink and when their body starts to go, they expect the MD to fix it. A patient needs to take care of him or herself and use the MD sparingly."

Please explain what your statement has to do with the fact that some physicians perform poorly at their chosen occupation? Do you believe that the highly trained physicians are not responsible for performing basic job requirements just because they have on the job pressure? Everyone has on the job pressure. Ask any person you know or even strangers whether they have on the job pressure to deal with. Then ask them if they still have to perform adequately at their jobs or risk losing their jobs. Whenever anyone has an employer or is self-employed, certain job requirements go along with that job. If someone does not do their job, then they will probably be fired. If a self-employed person does not perform well at their job, then their competition will take away their business. We all have responsibilities when we make commitments. A physician's chosen occupation requires a strong commitment and a major responsibility, but they know that. They chose to take on the responsibility. That is why I recommend that patients write reviews of physicians, both good and bad, so that other patients can make informed decisions about who will provide them with the best health care.

Once again, I agree the patients must do their part to live a healthy lifestyle and many of us do, just as many of us carefully follow our physicians advice because that is why we go to see our physicians and pay the high price to see them. We want to get the correct diagnosis and treatment so that we can either be cured of our disease or have a better quality of life. Many people have diseases which are genetic or age-related and even a healthy lifestyle does not prevent these diseases. The patients are not at fault when they acquire TB or have breast cancer, or Type I Diabetes, a malfunctioning thyroid gland, etc. When a patient takes hours of their time, and spends sometimes hundreds of dollars to see a physician for an examination to determine what is causing their illness, I simply do not think it is too much to ask that the physician makes a sincere effort to properly diagnose and treat the patients. This is not suppose to be an adversarial process. It is suppose to be a mutually beneficial one.

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• By Globalwoundcare
• Posted March 5, 2009 at 1:11 pm
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This conversation has really developed. Reminds me of the sixties when I was in my teens and we all sat around and talked about how the world needs changing and how it should "be".

First off, let me say this; we are all born as equals. Now some may be born to money and some not, and some of us are born with disabilities, but in essense we are equals. Then you look at the really disabled and you say to yourself, are they my equal? In importance, yes. Will they be able to out run you, maybe not them but some body can out run you too. So let me get by, by saying we all are equal in importance.

Now the person who spends their life doing minimal wage work and never goes beyond that, they are still equal in importance, but are they any less valuable than the man spent his entire life studying to gain more knowledge? I don't know the answer.

But, I imagine that the person who works for minimal wage feels he is owed more, but is limited by what he can do to optain more. I know when I was working my way through nursing school (I don't come from money and I was a nurse before I was a doctor) I would work nights as a waiter, weekends as a janitor and had additional income from the GI Bill. And I still had to borrow money to finish my education. My friends from nursing school, who did not go on to be doctors, had $30-40,000 put in savings when I finished Podiatry school. Some of my friends who were carpenters or brick layers, already owned their own homes when I finished school. Did I go into medicine for money-Hmm? I don't think so. I was an old hippie and I wanted to change the world. I remember the day I decided to go back to school to be a doctor. I was working 7p-7a in an intensive care unit in south Florida. I was complaining to another nurse how the patient I was taking care had an idiot as a doctor. The nurse turned to me and said, "if you can do so much better, why are you not a doctor?" Next day I started looking in to medical schools.

I (and I hope I am right) really feel most people go into medicine to help people and relieve suffering. Having money is nice. We all want to live in a nice house and have a good car to drive. I think the good brick layer should be successful and make more than a crummy brick layer, and the same should be true for professional white collars.

Across the street from my office is a beautiful home with a large inground pool, three car garage... My patients always ask me if that is my house. I laugh and tell them the truth, my house is not nearly as nice and that house is owned by the local barber.

I am talking in circles and I am sorry. In my last note, I mentioned I felt I deserved a good income and I still feel that way. I spent 12 years, after high school studying hard. In stead of investing in a house, I invested in an education. I borrowed $165,000 for my last 4 years of college. Tuition was closed to $20,000 per year, books over a thousand per semester...But after school, I borrowed over $500,000 to properly equip my first wound care center. I feel that I am very good at what I do, I have spent a lot of money and gambled building a business that happens to be a medical practice. If people like me who take a chance are not rewarded, will someone else take a chance. Thomas Edison like to invent, but he also enjoyed the financial reward he got from inventing.

Next note, I will try to explain how I feel medicine can be improved, but let me finish with this. There are good brick layers and there are good doctors, and the opposite is also true.

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• By Globalwoundcare
• Posted March 5, 2009 at 2:17 pm
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First let us start my defining the problem.
1.) doctor not emotionally involved.
2.) doctor not careful or doing poor workup (exam and history taking)
3.) doctor not spending sufficient time with patients.

got any more complaints with doctors?
Send your complaints and let's get our complaints organized. My feelings may not be the same as yours.
This may evolve and include the entire medical system, but let us start with what we would want our doctors like in an ideal world.

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• By missmatic
• Posted March 5, 2009 at 4:42 pm
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I think amyrosenburg's comment belongs to some other conversation. "Enlightened"s comments were clearly not about the kinds of "standard issue" characters she describes. Unfortunately, I think her pre-judiced point of view is typical of many doctors.

I was and am none of those things and have experienced everything "enlightened" has described and worse. I did everything she recommended and more and was treated well by a few doctors and like dirt by many more for doing so.

The most recent PCP refused to test me for the chronic form of an infection that I had had exposure to and symptoms of because "there's no treatment for it anyway." Never mind that it's a devastating and disabling condition that has a higher rate of certain kinds of cancers associated with it and numerous other complications, not to mention the peace of mind a patient needs that a true diagnosis represents. And what about the information that diagnosis brings to the other specialists involved in my care? There are serious ramifications to deliberately ignoring a chronic degenerative disease and all the complications that accumulate, and pretending it and symptoms don't exist. How would anyone like to have undiagnosed, untreated diabetes? For years? How would they like the complications of that to be called "normal"? Do some of you get the picture or is that reality too unbelievable to contemplate?

This same doctor claimed I only had one damaged heart valve because it fit his preferred diagnosis. ("Damaged" of course, is not an allowable word.) He claimed it wasn't in the record of my most recent echocardiogram. When I said "It had better be there because I discussed it with the cardiologist as we were looking at the pictures," he still hesitated. I said "Then let's call the doctor right now and ask him why it's not in my record anymore," and he suddenly found it! Amazing. It's business as usual.

One of my specialists ordered the tests for the chronic form of the infectious disease and they were positive by CDC definition standards. Yet going from bad to worse almost, the specialist told me the test was normal when in fact it clearly wasn't, something that took me at least 4 precious months to verify. It was not the first time that had happened and it's been more common than not. Among other things that have shown up on recent tests and that I'm being denied a diagnosis and treatment for are anemia, possibly associated with an amino acid insufficiency, and both called normal.

When is a low count of RBCs considered normal? When it doesn't fit the easy definition of common causes and requires believing the patient as well as doing a little research and maybe making a referral to a specialist or figuring out what other tests need to be ordered. It's "normal" when the record shows no diagnosis. Ignoring a destructive process such as anemia and it's consequences is unethical, but since most everyone does it, it's the new ethic. The new ethic is that if one doctor fails to do the job they were licensed to do, it gives a free pass to the next to do the same without consequences.

Not believing the patient and treating them like a hostile witness to the reality of their illness means that a correct diagnosis will not be possible unless they happen to order the right tests. But in reality, not wanting to hear or believe the patient is building a foundation for ordering no tests or the wrong ones and getting misleading results. It's a staging ground for expensive, time-consuming failure and further misunderstanding and pain.

Do I leave these doctors? Am I accused of "doctor-shopping" if I do? Is that what my record will show instead of the symptoms I described and the timeline of their development and association with other symptoms that I described to doctors? Many of my medical records make no mention of major symptoms or any logical sequence, as I had related them to doctors. Even printed timelines didn't help. Minor symptoms were exaggerated out of all proportion and symptoms I never complained of mysteriously found their way into the records of some doctors. Personal comments about me, but not about the doctor's behaviors are considered medical information, but not my symptoms or even signs.

Doctors don't have to accept even objective test results if they don't add up to a McDonalds type diagnosis out of the box and pre-packaged. If it requires them to interpret the results in terms of a patient's symptoms and medical history, it's easier to not believe the patient, play dumb about the meaning of the tests and what further tests might be useful, and to just flat-out deny the meaning of them or the existance of reported symptoms that clearly correspond to test results and vice versa.

I believe the doctors I'm working with now, for all their faults, are basically caring people, certainly compared to some that I've seen. And believe it or not, I actually think about their lack of compensation every time I ask them for more time, tests, consideration. In spite of having to act like a guilty defendant in a losing battle with them, they have reluctantly responded and I've received some useful referrals and tests, for which I'm greatly appreciative. But I've had to fight and be aggressive and assertive and better educated than they to stand up to their walls of denial and neglect. It's exhausting, time-consuming and demoralizing. It's stressful. Stress causes illness.

I'm sorry if some readers here don't understand what's going on with doctors, and I sympathize with their plight via insurance. I write to my congressmen in support of doctors' rights to be adequately compensated, but a correct diagnosis is essential and in the long run, simpler and more humane and ethical than what my experience has been far too often, but not always. "enlightened" has expressed very well what is happening and I share her opinion entirely.

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• By enlightened
• Posted March 5, 2009 at 8:22 pm
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Missmatic,

I am so sorry that you have gone through what no patient should ever have to go through. The terrible ordeal that you have endured simply trying to get adequate health care is absolutely shameful. From my own personal experience and that of the many people who have shared their medical stories with me, my impression is that inadequate care usually goes hand in hand with the totally insensitive, biased and quite often arrogant, physician. This physician offers inferior patient care and then cannot understand when patients become upset about the lack of care. It never appears to occur to them that the suffering patient actually feels the pain and has to live with the limitations of their disease and the consequences of that inaccurate or delayed diagnosis.

It is so nice to hear that you have persevered and have found someone who will take care of you. You should never feel guilty about asking to receive what you are paying for. When you pay the physician to provide a service, then the service should be performed.

Clearly, it takes a special kind of person to be a good physician because it takes much more than the great education and specialized training. It also takes a caring, compassionate person who really likes people to provide good care or one whose standard of excellence will not allow him/her to do anything less than their best. I am thankful that I have known more of the very good ones than I have of the bad ones. The reason the bad ones made such an impression is because they do so much harm, not only to the patients, but to the professional image of physicians.

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• By enlightened
• Posted March 5, 2009 at 9:02 pm
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Globalwoundcare,

Thank you for taking the time to respond. Now we are getting somewhere. The question that I and so many others want answered is very simple and it is one for here in the real world, not in an ideal world. That question is:

"Why should a board certified physician ever fail to provide adequate and proper treatment to a patient?"

I think most of us realize that you are all human so you can and do make mistakes. We do not expect absolute perfection. It is when there is a pattern of "mistakes" because the physician is not concerned enough to do what he/she knows how to do to evaluate the patient properly that we have an issue because it affects the quality and sometimes the length of our lives.

We realize, because it is very obvious, that this failure to provide adequate and proper treatment is usually the result of either a poor history taking session, or no history taking and sometimes no physical exam whatsoever. I think most of us have at least a passing knowledge of what you went through to become a physician. We know that anyone, who has passed all the training, endurance tests and comprehensive medical knowledge tests that all of you have, certainly should be smart enough to provide adequate care. That is why patients resent it so much when it is obvious that the physician clearly has no intention of providing the service he is being paid to provide. No one expects any of you to be saints, but expecting you to do your job is totally reasonable.

That's it! It is not about emotional involvement. If you become too emotionally involved you might lose your objectivity and that would be detrimental to the patient. It is not even about the amount of time you take, because if you do your job properly then you have taken sufficient time to assess the patient's condition.

We do not believe that this is too much to ask. If we can simply focus on the problem and not other issues, I believe we might get somewhere. This "cloud" over physicians has been caused by some, but not most of the physicians. Surely you can see how this is harmful to your profession and to patients? If we can all make a serious effort to do our part, then that will make a difference on both sides of the exam room. That requires mutual respect. Is that possible?

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• By Globalwoundcare
• Posted March 6, 2009 at 11:51 am
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As I read your comments I feel I am seeing the concern is not based so much on knowledge base of your doctors, but more about caring and wanting them to be more concerned about the patients "feelings". With the remark made about the doctors being hesitant to have certain test performed, I agree with you. I had a friend, physician come back from missionary work in Africa. This physician stated they did not tell patients when they had AIDS or were HIV positive. I was thunder struck to hear that. She went on to say, there was nothing that could be done, and the family would kick them out of the house. I also remember hearing stories of doctors breaking the necks of babies when they were born with gross deformities back in the 1800's. Urban rumor? I don't know, but the thought was that the doctor knew best.

Today, most patients in our country want to be up to date and involved in their care. How is the doctor to know who he should protect and who he should be open with. Frankly I feel that lawyers have already resolved that issue. I know in my office, when lab or radiology results come in, we review them with the patient and offer a copy for them to take with them.

I had an instructor in Podiatry School who said that if you listen, 80% of your patients will tell you what is wrong with them and just as frequently tell you how they should be treated.
Now, the realism. I don't get paid to care about someones feelings. A psychologist does. I am paid by diagnosis codes and treatment codes. Just like the doctor I go to is. Please don't think I am being a jerk, I really don't mean to be. But if I see 30 patients in an 8 hour day, removing 30 minutes for lunch, leaves 450 minutes, or 15 minutes per patient. This does not include the additional time needed to make chart notes, review labs in the morning for emergence responses, call in prescriptions, answer patient and sometime personal phone calls, and the list goes on. Then many of us still have hospital rounds and some even house calls.

For the doctor to spend more time with patient, we need to make it worth the doctors time. Don't misunderstand me, it does not mean the doctor is in it just for the money. I have ten employees, including doctors. Payroll, and I am cheap and live in rural Georgia, is about $36,000 per month. Rent (two offices) about $11,000, equipment overhead is about $17,000, utilities for both offices roughly $1800. Taxes, insurance, mileage, supplies, anyway the overhead per month is already $ 100,000. If I see (and I am not alone) 30 patients a day, it usually does not pay that much. Check with your doctor, but I think a simple brief visit only pays about $17.00. 17 x30=$ 510. That comes to $10,200 per month. Do you see a pattern and a problem here. By the way, the $17 is not my charge, it is what Medicare allows. I would charge $35. Gotta go. I will come back to finish this later.

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• By Kristin_F
• Posted March 7, 2009 at 6:48 pm
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I have had really bad Drs., really good Drs., and Drs. that do what they need to but no more. I worked in the medical field for 6yrs. I learned a lot about Drs., their families, and how stressful their life really is. I'm not supporting Drs. for bad care, but there are reasons why sometimes Drs. don't seem very good. I live about an hour outside of Chicago. Rockford, IL is the main community in our area supporting areas such as Belvidere, Winnebago, Seward, Pecatonica, and a few more. For the medical profession this makes for A LOT of patients!! Esp. when talking about specialists, our area doesn't have very many. Rockford only has 3 adult endocrinologist, and 1 pediatric endocrinologist. These 4 Drs. are expected to treat all diabetic and thyroid pts. in our area. Then when you add in ins. companies dictating who you can and can't see, that can put a even heavier load on one Dr. vs. another. These Drs. are under the gun to provide "perfect" care, and not get sued in the process. It's tough, very tough!
At the surgeons ofc. I worked for, I saw Drs. leave because they saw too many pts. in a day to provide the care each pt. deserved, and somedays their call rotation would make them too tired to correctly perform their job. For example they'd have to go into an emergency surgery in the middle of night, operate all night, be late to ofc. because the surgery took too long, then go to the ofc. to see pts. that are angry that the Dr. was late, then try to cram all the pts. in before their first scheduled surgery in the afternoon. By that time the Drs. would be exhausted and testy. Can you blame them? Not only does the overload effect their ability as Drs., but it also effects their home lives. The best Drs. I have, have limited their practice. They are independent (not directly tied to any hospital), and only see the number of pts. they are comfortable seeing. This way when they come in to see you, they have time to sit down and talk, and listen. They aren't in a rush. But this isn't an easy way for a physician to start out. Physicians that have ofcs. like this usually started out in a bigger practice dictating their hrs., etc. and as they aged were able to seperate themselves from that practice and open their own.
There is a big shortage of Drs. in comparison to the number of pts. that require care, and more and more people are straying away from the profession because of high malpractice insurance prices.
There are really bad Drs. out there, but in my opinion most of the Drs. we classify as "poor" probably aren't. They are physically and emotionally stretched beyond their means. Most Drs. go into the profession to "help people", but in the rush of life they accidently forget the "person" part.
Like I stated at the beginning, I have had what I would classify as bad Drs., and I will encourage anyone not happy with their physician to look for a new one. Most often when I've changed Drs. I'm glad I have, but if I sit back and look at what they do in a day, I can see where they are coming from, and am very glad I am not a Dr.

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• By Globalwoundcare
• Posted March 18, 2009 at 10:13 am
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Kristin F

Great letter. There are many reasons to be a bad doctor, none of them acceptable. And you are especially correct in saying, if you don't like your doctor or the medical care you are receiving, find another doctor.

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