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The Business of Healthcare

I'm telling you, you are not on the schedule today!

A recent, less than satisfactory experience with a local medical practice left me frustrated at their basic lack of awareness and compassion. Is there anyone out there who believes the current state of healthcare in America is not a mess? I doubt it, but to be fair let’s look at two perspectives.

The Patient

I recently read a post from an old friend who talked about his most recent visit to the doctor,whom he had been going to for nearly 30 years. His first impression was that he saw a lot of new faces in the office staff. He was coming in for an annual physical, which included labs. Upon checking in, he was told the lab technician was not in that day, so they could not run the blood tests. No big deal, my friend simply rescheduled the appointment, even though he had been fasting all day. (The office didn’t bother to call) When he checked in for his rescheduled appointment, the receptionist got into a debate with him about whether or not he was really scheduled for that day, but finally told him she would “squeeze him in.” He overhears this lady tell patients that there is no room to wait back at the lab, and there is no room left to sit back there. He also observes her giving the wrong records to a patient, who had to go back and tell her she had the wrong records. After an hour of waiting, my friend reschedules once again, knowing he will have to fast for a third time.

I see a lot of different doctors, and I have had similar experiences. Upon checking in for a scheduled appointment, I was told the doctor was not coming that day, but if I wanted to drive to her office (30 miles away in downtown Dallas) they could “fit me in.” The appointment was to refill the intrathecal baclofen pump surgically implanted inside my chest, and 6 months earlier the doctor felt comfortable scheduling this appointment within two days of the “alarm day” for the pump. The doctors office however didn’t seem to share my sense of urgency, until I went into my “enraged patient” mode. I don’t like to pull that tool out of the bag, but I do when I must. While the vast majority of encounters with doctors and their staffs are pleasant and productive, there are still too many arrogant and dismissive doctors, and too many staff members who treat their patients as a pariah. Unfortunately, in the court of public opinion, most people don’t hear about the vast majority of positive experiences. According to the White House office Of Consumer Affairs, news of bad customer service reaches more than twice as many ears as praise for a good service experience.

The Doctor

I recently read an article by Dr. Marc Siegel, a professor of medicine at the New York University School of Medicine. The article was entitled, “Healthcare Is a Mess.” In the article, he said over the past decade, healthcare delivery has deteriorated to the point where it can no longer be managed effectively or efficiently without enormous staffs. In the meantime he says, insurance premiums have skyrocketed while reimbursements to doctors have decreased. Health insurance he claims, is falsely promoted and sold to you as though it is actual healthcare, yet it still relies on a business model which makes a greater profit by turning down your requests rather than approving them. He says doctors struggle to remain healers beneath a pile of mounting insurance regulations, while doing their best to live up to their Hippocratic oath. In spite of the current chaos, he urges all doctors to remember that it is an honor and privilege to gain entrance into the private health world of their patients.

I have seen this frustration from a growing number of doctors that I visit. It usually manifests itself in the doctor trying to get out of the appointment room as quickly as possible, which is why I bring a printed list of questions with me on every visit. Despite the sometimes look of consternation on the doctors’ face, I make sure we discuss every question on the list to the point of my understanding. I have yet another doctor who openly tells us of his frustration, particularly after having merged his private practice in with a local consortium. The current situation in the medical field is such that patients have to take more responsibility for their own health care, and that includes learning about their situation so as to be able to have an intelligent discussion with their doctor. At the same time, it is more important than ever for doctors to realize that while they are in the business of healthcare, they are in the practice of medicine.

Noticeably absent when we all left rehab was the instruction manual for dealing with the myriad of situations we would find ourselves in.Ask This Old Quad articles serve to fill in that vacuum, because we have all developed tricks of the trade that we believe would be valuable for others.Share your ideas and experience with us at

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