These are the thoughts of a cantankerous ol' gynecologist who remembers when things were a little different. I try to find a little humor in my life and the people I meet along the way. Come meet the characters in my world.

Thursday, September 29, 2011

Customer “Service”

Or Not

I just got off the phone with the cable company.  I probably don’t need to say any more for most of you. 

The first call I made was “before the office was open”. 

The second time I called, I got hung up on. 

The third time I called, I pressed 4 for “service” and got “billing”.  This was the same extension that had hung up on me the last time.  It wasn’t the proper department.  I got transferred three different times. 

Supposedly they fixed the e-mail problem with the bill I have had for over two years.  I will wait and see about that. 

They don’t care and didn’t apologize that I didn’t get the last bill.  They don’t care and didn’t apologize about having shut off my service in the middle of the night.  Mr. Impatient gets up at 4:30 AM to play on the internet.  It wasn’t working.  Neither was the TV.  Moooommmmmmm…….   

I apologized that I am a little cranky from having to find my credit card and pay a bill at 5 AM. 

Now can they please explain why the bill is going up by $30 per month?  Oh, I see.  We had a special rate, and now we don’t.  And something about cable boxes that weren’t available in my area until last week.  I can exchange them at the billing office and save $9.95 per month. 

I’ll get back to them on that.

I’m proud of myself for not slamming down the phone or swearing.  I’ll let Mr. Lasermed decide about the boxes.  I don’t do electronics. 

Wednesday, September 28, 2011

Confidentiality and Medical Records

HIPAA – Health Insurance Portability and Accountability Act
Are you frustrated because you called the doctor’s office about your Mom’s medications and nobody would talk to you?  Are you angry because you called to check on your husband’s prescription and the pharmacy couldn’t tell you anything?  Did you want to get a copy of your latest lab results, and they said you needed to come sign a form?  These are all things you can thank your federal government for. 
Several years ago, the government decided that there was too much sharing of information in the medical profession.  So they set to work making rules and regulations about it.  As usual, everything got more complicated. 
Now there is that form that you have to sign at every doctor’s office.  You see it at the dentist and the pharmacy, too.  We have to protect your privacy and tell you what your rights are.  The only “entity” who can invade your privacy without asking is – are you ready? – the government!  If they want something, we have to give it to them, without asking YOU.
It used to be that I could just call radiology or the lab and ask for your results.  Not anymore.  Now I need a records release all signed and witnessed.  Can I send your Pap smear results to your medical doctor?  Not without your signed consent.  If I send you to another doctor for surgery, then you come back to see me, I need to get a records release to get the operative record if s/he forgot to send it to me. 
Those sign in sheets everyone used to have?  Those aren’t really legal anymore, either.  You can see who else has an appointment etc.  That’s a VIOLATION!!!!!! (Insert Mr. Impatient giggling here – he thinks that’s funny).  We’re even supposed to keep our screens turned away from patients so you can’t see what we’re typing.  What???
Basically, this law has created more paper work.  It makes most of us in medicine much more paranoid about what we can and can’t say or send.  It also makes us very, very careful about whom we talk to about what.  There are disclaimers everywhere about changing identifying details unless we get permission. 
When the law first started, we even had major discussions about whether or not a fax signature was a “legal” signature, or whether we had to have the “original” signature.  Somehow, as fax machines have become more common, that has worked itself out.  It’s OK to fax your signature now. 
The law was intended to maintain your privacy.  I think, as usual, bureaucracy has made things more complicated without necessarily doing what was intended.  It came from the government.  So is anyone surprised?

Tuesday, September 27, 2011

Good News about Coffee!

This is a link to a study that was just published.  For those of you that can’t live without your daily coffee, it found that, in women, the more coffee you drink, the lower your risk of depression.  Men were not studied.  Sorry guys. 

Health Insurance 101-2 “Participating Provider”

There are two parts to this one.  The first is “participating”.  This means that the insurance company has a contract with someone or something.  The insurance company has agreed to pay directly to this “provider” in a “prompt” fashion.  In return, the “provider” agrees to give the insurance company a significant discount on the charges.

Basically, the insurance company threatens otherwise to wait forever and/ or pay the patient for the service.  Then the “provider” has to try to get the money from the patient.  However, many patients think that the check from the insurance company is money for them to spend.  This is especially true if it is a large amount of money.  The “provider” may be taking payments for years.  The “provider” benefits by getting the check directly from the insurance company. 

We all know that it is corporate blackmail, but nobody can actually prove it.  The insurance company will say that they trust their clients to bring the check directly to the “provider”, and the “provider” must take that risk if they don’t want to “participate”. 

The second part of the statement is “Provider”.  What is a “Provider”?  In health care talk, this can be a pharmacy, a hospital, a home health agency, a chiropractor, an optometrist, a physical therapist, a nurse practitioner, a physician’s assistant, a nursing home……. and maybe a physician.  I didn’t spend eight years in training after college to be lumped with all of these other “entities”. 

Health Insurance 101 - 1 "Usual and Customary"

I find there are a lot of terms that insurance companies use that are confusing to consumers.  As someone who has been dealing with them for many years, let me give you the doctor’s version of some of them.  I look forward to your comments.

“Usual and Customary Rate” is what the insurance company decides it wants to pay.  It has nothing to do with what the doctors in the area charge or expect to get paid.  Of course they represent to the patient that the doctor is charging more than s/he should.  Insurance companies also tell patients that they are not responsible for any more than what the insurance company determines is the UCR.  This may be true if the doctor participates with the insurance.  If the doctor is not a “participating provider” (Health Insurance 101-2) you are responsible for whatever the insurance doesn’t pay.   

Insurance companies are not allowed to set a doctor’s charges.  They can tell us how much they are willing to pay.  We can decide whether or not we are willing to work for that amount of money.  If not, we don’t participate. 

Monday, September 26, 2011

Telephone Diagnosis

Why Your Doctor Needs to See You
There are many times when patients call the doctor’s office about a problem that they want to have treated over the phone.  This leaves the office “in a pickle” for several reasons. 
If this is a new problem, we have no idea whether or not your diagnosis is correct.  I have had patients call with “a yeast infection”.  When I start questioning them, the symptoms are indeed “down there”, but do not sound like yeast.  When they come in for an exam, they may have a bacterial infection, a bladder infection, herpes, a sexually transmitted disease, a chemical reaction or a number of other things. 
If I treated the “yeast” over the phone, the patient would not get better, she would waste her money, and she would be miserable for a longer period of time.  Besides, she can give some of those things to people that she is very close to.  Nope, better to have her come to the office. 
What about a patient who calls and says “my asthma is acting up and I need my inhaler called in”?  Is it asthma, pneumonia or even heart failure?  Sir, can you put the phone next to your lungs and breathe deeply?  Yeah, right.  Better come in so your doctor can listen to your heart and lungs, check for swelling, check if you have oxygen in your tissues and all that stuff that internists do. 
We are all concerned about the cost of medical care.  Most doctors work hard at keeping costs down.  We are aware of the costs of testing, medications and hospitalizations.  However, if you catch something early, you can avoid significant expense later.  I even keep the local pharmacy $4 and $5 medication lists on my desk so I can pick the least expensive medications that will work for your problem.
A doctor’s office visit with EKG, Chest X ray and some lab work is cheaper than a week or two on a ventilator in the ICU for severe pneumonia, right?  Treating that infection with the right medication the first time saves time and discomfort over multiple treatments with the wrong medication.  It also prevents possible spread.
I don’t want my patients to get sicker because I missed something by treating a diagnosis made over the phone.  Medical care is available 24 hours a day somewhere if you really need it.  Don’t take the risk of a wrong self diagnosis.  See a doctor.  We went to school for that.

Sunday, September 25, 2011


Where has It Gone?

We were driving in the car the other day, when Three Speed made the comment that most people don’t use their turn signal any more.  We watched for a little while, and he was right.  It got me to thinking.  Where has common courtesy gone?

I had an argument on line with some friends about manners.  As a parent, I spend lots of time trying to instill them in my children.  I also try to live what I teach.  I say please and thank you, even at the drive thru.  I hold doors for people and try to teach my kids to do the same thing.  You know all the stuff you hated that your Momma taught you when you were little. 

We seem to have lost courtesy in the world today.  Instead we have “individual rights”.  These include things like the right to protest at a ceremony for special education students because you don’t approve of the governor’s recent policy statements.  Do these people care about the rights of those children?  I don’t think they even thought about it.  They were being selfish about whatever their own agenda was.  I see examples of this in the news all the time.  It’s time to think about how our actions impact others.

What I find really amusing is people’s reaction to when I do something courteous but not expected or necessary.  Something little like letting someone go ahead of me in line in the grocery store.  Or letting someone into a long line of traffic.  I love to see the look on their faces.  I get that same look when someone does the same thing for me. 

I would love to see everyone do at least one “random act of kindness” and see what happens.  It’s funny how it gets a little warm fuzzy inside you going.  Try it.

Friday, September 23, 2011


What we want to charge patients for:
Rescheduling referrals and tests: $25

Princess spent a lot of time scheduling those tests.  Sometimes I had to call to get a doctor to see you before their front office wanted to fit you in.  If you need to reschedule, call the office or hospital and take it up with them.  Please don’t put us in the middle.  You will then find out how hard it is to manipulate someone else’s schedule.
*This is a recurring feature. Princess and I get certain patterns of phone calls that we find annoying. We would like to present them to you, with what we would like to charge for them. Unfortunately, we can’t. Charge that is. The phone calls will remain annoying. Princess says she could get rich if she could charge for all this stuff.


Mr. Impatient has an anger issue
Last night we had a major problem at my house:  we ran out of AA batteries. 
Mr. Impatient needed new batteries for the headphones for his game system.  He could only find one AA battery.  He needed two.  For some reason, this really upset him.  He has rechargeable batteries, but nobody knew where they were.  Of course, they were not in the charger.
Nobody told me that we were low on batteries last week when we made the run to the big box store.  I don’t mind buying them, but I have to know that we need them.  It turns out we are out of AAA batteries also.  I checked the drawer in the refrigerator where we keep them.  All we had were 9 V and D.  (Someone told me that batteries last longer if you store them in the refrigerator.  My children always thought you needed cold batteries to replace a used up one when they were little!)
Mr. Impatient isn’t very good at problem solving when he is busy having one of his “anger issues”.  I suggested that we take the battery out of his computer mouse and use that one until Dad could get one on the way home from his meeting.  So he had two, and headed back upstairs.  Next thing I hear is a loud swear word (!!!) and something being thrown down the hall. 
Mommy mode kicked in.  “All three names” get down here!  We had time out on the steps, a long discussion about “anger issues”, not using bad words, and we don’t throw things when we are having anger issues.  We did some breathing and calming down. 
Dad came home with batteries, and I promise to buy a bunch today. 
Being a Mom can be such fun.

Thursday, September 22, 2011

testing, testing, testing

This is a test of the Amazon widget.  I have my friend who knows stuff about computers.

Remember I am a dinosaur.  I "kidnapped" him from school after band practice - he's not in the band, but was doing chemistry.  

We'll see if this works.

Menopause Info Web Site

ACOG (the professional organization for all us OB / GYN docs) sent me this link yesterday.  This web site is FREE.  You have access to their magazine PAUSE, which is filled with information about menopause, and can sign up for a newsletter.

Check it out!

Wednesday, September 21, 2011

Is It a Side Effect or an Allergy?

Let me help you figure it out!

Every place you go to get health care, you are asked, and “Do you have any allergies?”

I love to see the responses to that question.  Now, folks, we are really serious about this.  We need to know if a medication caused a reaction severe enough that you should not take it again, because the next time it just might kill you.  Most doctors get mighty upset about that!  There is a difference between a reaction and an allergy.

A reaction is anything that happened when you took a medication.  We do need to know about those.  If you had a headache, diarrhea, muscle cramps etc., you might not want to take the medication again.  If it is the only medication that will work for your problem, your doctor can help you prevent or treat the side effects.  These are generally only “nuisances”. 

An allergy is a reaction that involves your immune system.  These cause symptoms like: itchy or watery eyes, runny nose, wheezing, itching, shortness of breath, heart irregularity and (dum-da-da-dum) death.  These are important to know about.  Each time you are exposed to something you are allergic to, the reaction is generally more severe.  Enough exposure can be fatal. 

Did you see “death” up there after the “music”?  A doctor does not want to give you this medication again if possible.  It is very important to tell your doctor about these.

If you’re not sure, describe what happened.  Some helpful medical person will help you decide.  Make sure to write down the medication somewhere.  Carry a card or something with you so you can tell the next doctor or nurse what the name of the medication was and what happened.  It will make taking care of you much easier.  Really.  Honest.  Would I be taking my time to write this if it didn’t?

We don’t want to hear:

“My Mom said I can’t take Penicillin.  I don’t know why.”  Please find out.

“I had a reaction to the white blood pressure pill.” Many generics are white.

“I’m allergic to xyz - it made me sleepy.”  That may be what it’s supposed to do.

We do want to know:

“When I took Gorillacillin, I developed a rash, itching and trouble breathing.”  Now, that’s what I’m talking about.

“After they gave me Superdrug, I had to have a shot and steroids for a week for my allergic reaction.”  OK, I believe you’ve got a problem.

See the difference?  I hope this helps you be ready the next time you talk to your doctor or go to the emergency room.

Did You Read the Package Insert?

Why Create Extra Trouble?

All medications come with information from the manufacturer.  This is called a “package insert”.  It includes information about the medication, what it is used for, when you should not take it, dosages, what medicines it might interact with and an extremely long list of side effects.  They are usually divided into the severe and the common ones.

I usually advise people NOT to read the side effect list unless they are having a problem with the medication.  Some people tend to get worried when they read the possible problems.  If you are this type of person, please don’t read the insert. 

I have had patients who absolutely refused to take a medication after they read the papers that came with the medication.  They got scared by the list of possible side effects.  That list is required if even a small percentage of people got a particular symptom.  The symptom didn’t even need to be caused by the medication.  It could have been caused by what the medication was supposed to be treating, or by some food that the person ate, or any number of other things.  If it was reported during the trial for the medication, it goes on the list. 

Some medications cause you either to be sleepy or to have insomnia.  I’m still trying to figure that out.  Others cause either depression or anxiety.  Some cause either weight gain or weight loss.  I can do that without medication!

I just looked up my new heart medicine.  It can cause: heart failure, heart block, low heart rate, chest pain, painful breathing…..  The common reactions are: headache, fatigue, dizziness, diarrhea, nausea, insomnia, rash, and swollen feet and ankles.  I told you this is not a good idea. 

When I went for a consultation to the cardiologist, I told him about a reaction I had to a previous medication.  I took the medication for two weeks.  I had a nagging headache the whole time.  It stopped when some of my doctor friends convinced me to stop taking the pills.  He told me that he had never had a patient with that reaction to that particular medication.  I wanted to say “well, you have now, Buddy!”  He suggested that I retry the same pill at a lower dose.  I declined, because I really don’t like headaches.  I’m on a bunch of medications to help prevent them.  Why should I take one that causes one?

I didn’t read the insert until I had the headache.  For a week.  As it should be. 

Tuesday, September 20, 2011

Electronic Medical Record Rant 3

Barriers to Care

Doctors are speaking out more and more about electronic
medical records.  As a general rule, we’re not really fond of them.  There are lots of different reasons:

·        Some of us don’t type all that well.  It’s just a fact of life that your average 60 year old doesn’t touch type at 70 to 80 words per minute.  This is one time I’m glad I’m “above average”.

·        Many of the EMRs have a touch screen that you have to pick various places and go from screen to screen to enter data.  They were not designed by the people who are actually using them.

·        I feel that it puts a barrier between me and my patient.  Before, when I was talking to my patient, I would lean on the chart, making small notes if needed, and fleshing them out later.  Now I sit behind a laptop and type off and on the whole time I am talking to the patient.  It feels impersonal.

·        My EMR won’t print out the bill until the note is complete.  So, I have to have the note finished before the patient leaves if she wants a receipt.

·        Perhaps we are mistaken about this process.  There are NO written instructions, just a very confusing web site.  We get referred there with questions.  Tech support isn’t very helpful with the little things. 

·        Remember, I’m a dinosaur.  Chat rooms just don’t cut it for me.  My 17 year old kids have given up on helping me with this, too.  Princess knows less than I do about computers. 

·        I have paper charts that go back literally 27 years.  There is NO way I can enter all that data into the computer.  Nor do I want to.  I usually start with: “This patient has been seen since 1987.  She has an extensive paper chart that will NOT be summarized here….”

·        I started a medication flow sheet in 1995.  When someone asks for “that medicine that you gave me that worked for….” I just flip through the sheets until I find it.  Not going to enter these, either.  I think they have fixed the program so it will enter from now on.  I’m not sure.  The update was just last week. 


Kangaroo care

Something I learned today

I read an interesting article today while doing “continuing medical education” (CME).  I just wanted to share this one.  They studied kangaroo care and whether it helped reduce pain for procedures in premature infants.  Evidently they already know it works for term infants.  They also studied whether Moms or Dads worked better.

For those of you who don’t know, kangaroo care is a method of caring for infants involving skin to skin contact between the baby and the care giver.  The baby has a diaper on and is placed against Mom or Dad’s skin.  It is supposed to help with bonding, breast feeding, growth and development.

There were a lot of technical details in the article I read.  I won’t bore you with them.  If you want, you can refer to the article. The study was done by Johnston and colleagues and is reported in the September issue of the Archives of Pediatric and Adolescent Medicine. 

The results were interesting.  All the babies were comforted by being with their parents during the procedure.  The procedure was having their blood drawn from their foot – a “heel stick”.  They cried less, their heart rates went up less, and the heart rate returned to normal faster.  FYI, Moms did just a little bit better than Dads. 

I was impressed that we are studying ways to make painful procedures more comfortable for the little ones.  Aww….

You learn something new every day.

Monday, September 19, 2011

Refilling Other Doctor’s Prescriptions

A Physician’s Dilemma

I sometimes have patients ask me if I will refill a prescription that was written by another doctor.  This is a really difficult thing for any doctor to do.  Some doctors want to see the prescription first.  Most will just flat out refuse.

Here’s why. 

Often, the medication is something I am not familiar with.  I had one patient look at me in amazement and exclaim, “But you went to medical school, didn’t you?” Yes, but that was back in the stone ages.  A lot of today’s medicines weren’t available then.  That goes for medications in and out of my specialty.  I have tried to keep up with those in my specialty.  I have not been able to keep up with those out of my specialty.

Not only do I not know how to spell the medication, I don’t know what it is used for (indications), whether or not it will interact with any medication I might be giving you, what the doses are, when you shouldn’t take it (contraindications), what the side effects are or anything else about the medication.  I admit there are fancy computer gadgets that let me look that stuff up.  However, there is not enough time in an average appointment to look up every medication.

The other issue is WHY ARE YOU OUT OF THE MEDICATION?  Are you late to see your other doctor?  When did you have your last screening testing done?  Do you need an appointment to get your cholesterol or sugar or kidneys checked? How am I supposed to know if you are taking the right amount?   What if I refill it and it isn’t the right amount?  Your condition could get worse or you could DIE.  I would feel pretty danged awful about that. 

Nope, I’m not going to take the risk.  I will call the doctor who wrote the prescription and see if you can get an appointment.

And don’t even think about calling after hours or on the weekend.  I’ll need extra blood pressure medication for that!

Hot flashes? Irritability? Night Sweats?

You’re Not Crazy, It’s Just Menopause!

Menopause is a natural time in a woman’s life when she stops having periods.  Most women stop between 45 and 55, with the average being about age 51.  It is normal to have some symptoms for a few years before and after this time.  Some women have no symptoms, while others have symptoms that are quite bothersome. 

Guys, you should pay attention, too.  This may help you understand your mother, your sister, your wife or your daughter.  You might apply this to the cranky teacher who is always opening the window, or the lady next door who sits on the porch in the winter.  We are everywhere!

Menopause is considered early if you quit having periods before age 40.  You should see your doctor if you are having problems with irregular periods before this time. 

Symptoms of menopause include hot flashes, night sweats, vaginal dryness, fatigue, irritability and changes in your period.  The irritability and fatigue may be from not sleeping well because of the hot flashes.  This may lead to depression.  Vaginal dryness can cause irritation of the bladder with more frequent bladder infections.  It may cause difficulty determining if you have a vaginal infection.  It can also cause difficulty with intercourse.

The period changes may be heavier periods, lighter periods, more frequent or farther apart periods.  It may be time to start keeping a record, like when you were a teenager.  Heavy bleeding can be treated by a variety of methods, and should be discussed with your physician.  Too much bleeding can cause anemia with other health problems. 

If you haven’t already thought about it, now is the time to get educated about hormone replacement.  You should discuss this with your doctor.  Menopause is the time when your estrogen drops.  Without hormones, your risk of heart disease starts to climb.  It eventually catches up to a man.  Not a thing you want to do. 

You also start to lose calcium from your bones when the estrogen drops.  Calcium replacement (with Vitamin D) helps a little, but this process continues after menopause.  The risk of breaking a bone gets worse as a woman gets older.  The hip, spine and wrist are the most common bones.  A large number of people die within 6 months of hip fracture.  Many never are as mobile as they were before.  You cannot reverse this by starting estrogen later. 

Many women are also concerned about the hair thinning, skin thinning and wrinkling that also occur as a woman ages.  These things seem to accelerate at the time of menopause.  They may also be somewhat hormone related. 

Some of these symptoms may be caused by other problems.  Remember that this is general advice.  You should consult your physician for specifics about your problems.  Don’t forget your mammograms and pap smears. 

September is menopause awareness month.  I hope this has given you some basic information.  Please use these thoughts to start a discussion with your doctor before you actually go through menopause.  This should help you stay healthy longer into your golden years. 

Sunday, September 18, 2011

Medication refills

Please check before you run out

I read a lot of other medical blogs.  This was posted on theangrypharmicist: http://www.theangrypharmacist.com/archives/2011/09/careastatin-0-refills-remaining.html.  She is on the receiving end of people who forget to refill their routine medications until they are out.  Often they are out for days.

Folks, we all know when the bottle is almost empty.  The bottle has the pharmacy number on it.  It has the name of the doctor that prescribed it on it.  If you need to call the doc, call when there is about a weeks worth left so that the process can be done.  If you haven’t been seen for a year, call when the bottle says NO REFILLS.  The doctor is going to need to see you. 

In some offices they will schedule your appointment, then call you in enough medicine to get through until you run out of medicine.  Other offices will want to see the whites of your eyes before you get another prescription.  Most doctors are no longer giving prescriptions after hours or on weekends, because they don’t have access to your records.  We no longer know our patients like your family doctor did 50 years ago.  We also don’t trust people.

I have had patients call for antibiotics and “a few pain pills”.  Then they only get the pain pills.  I have one patient who only calls on the weekend because she has a bladder infection.  I don’t know if she sees anyone else, but she never calls me when she could come to the office.  I finally stopped calling her in medications when I went to chart her weekend call and realized she hadn’t been in for almost two years, and had called me on the weekend about 4 times.

We have an expression: lack of preparation on your part does not constitute an emergency on my part.  Believe it. 

Friday, September 16, 2011

He Said What?

Work Exploration Subversion

I absolutely love to try and understand what goes on inside the head of my autistic son.  He is very intelligent, but sometimes doesn’t quite understand things.

There is a wonderful program in our school system for the high school students who have learning difficulties.  It’s called Work Exploration.  Those who participate spend a portion of their time at a local business learning to do the jobs that you would do if you worked there.  My son has worked at an animal clinic, a local farmer’s market, and a national fast food chain. 

Right now Mr. Impatient is working at a Gym.  He seems to be quite happy.  I try to ask him what he does every week after he goes to the business.  Sometimes his answers are interesting.  This week he was “sabotaging the machines”.

I asked for an explanation.   He said “you know, Mom, wiping them down with the cleaning stuff.” Oh, sterilizing them.  Got it. 

You gotta love them. 

Thursday, September 15, 2011




What we want to charge patients for:

Inquiring about your appointment time after the first $5.00

Please keep those little appointment cards we give you.  Or write the appointment down somewhere. 

*I’d like to make this a recurring feature. Princess and I get certain patterns of phone calls that we find annoying. We would like to present them to you, with what we would like to charge for them. Unfortunately, we can’t. Charge that is. The phone calls will remain annoying. Princess says she could get rich if she could charge for all this stuff.

Waiting Room Dynamics

Is the system broken?

I went to my doctor’s office the other day.  I sat in the “waiting room” for over an hour and a half.  This is a medical group consisting of 6 different “providers” – 4 doctors, a PA and a NP.  When I got there, the room was full.  I have no idea how many of the docs were seeing patients that day.  It was mid afternoon. 

I watched patients come in to the window, sign in and sit down.  I could tell they had the routine down. 

One man came in complaining about the cost of his wife’s medication.  She had been on several different medications.  This one seems to be working better, but cost $136 per month.  After some conversation in the back, there were no samples, but they were going to call him later to see if they could either authorize it with his insurance company or find a less expensive medication.  This entire conversation took place in front of everyone in the “waiting room”.  He was not taken back to a more private area where this could be discussed.  The only things I don’t know are his wife’s name and the name of the medication.

Then one of MY patients came in with her significant other.  She wasn’t feeling well.  I guess she hadn’t called ahead.  She went to the window and said she needed to be seen.  She described her symptoms.  A staff member came out from the back.  At first she was scolded for driving herself.  When they found out she had a ride, they told her that she needed to go to the emergency room and loaded her back in the car.  She was there less than 5 minutes.  I hear she spent 6 hours in the ER. 

A pharmaceutical rep came in, took one look, and offered to come back another day.   The woman at the window did manage to get a signature so he could leave samples. 

There wasn’t a lot of conversation in the waiting room, even though it was packed.   There was complaining about how long people had waited.  One person had been there over an hour when I got there.  I settled in for a long wait.

 I did talk with a lovely woman who works for home health about some of the problems with “the system”.  She had waited 4 months for an appointment.  She ran out of medication, then had an issue with the office staff because she needed a refill.  I think the system is broken.  At least in that office.

Wednesday, September 14, 2011

Medical Test Results

How will the office notify you?

When you went for your recent doctor’s visit, did you have some lab work?  Were you scheduled for some X-rays or other testing?  Did they send off a biopsy, a urine test or a pap smear?

You now have the dreaded dilemma: HOW ARE YOU GOING TO GET THE RESULTS?????  Secondary question:  WHEN WILL THE RESULTS BE BACK?

Every medical office is different.  It is IMPORTANT to know the answer to this question BEFORE you leave the office.  If you are the forgetful type, get the answer in writing.

There are several options.

1.     If everything is OK, you won’t hear anything.  This is not my favorite, as you can miss a phone call, and the bad results will be sitting around somewhere.

2.     Call us in a certain amount of time.  This leaves YOU with the responsibility of following up and calling the office for results. 

3.     Office will send you a letter in a certain amount of time.  If the results are not normal, the letter is not the best way in my opinion.  However, if you are hard to reach, I have resorted to this.

4.     Office will call for results.  This is what I do in my office.  We don’t have a huge amount of lab work, so this is not labor intensive for us.  We agree ahead of time where to call the patient and what message to leave.  Our two not very specific messages are: “Lab work was normal” or “please call the office”.  Please call does not mean you have cancer, it just means we need to speak with you.

5.     E-mail or text- this is new fangled stuff, and I am still adjusting.  We leave the same messages as #4.  Remember, I am a self professed dinosaur. 

I always discuss with my patients how they want to be notified and when I expect results to be returned.  I think it keeps everyone from worrying about lab results. 

I hope this helps.  Don’t forget to ask.

Tuesday, September 13, 2011



What we want to charge patients for:
Changing your appointment time:
First time: $5
Second time: $10
Each additional: $15
*I’d like to make this a recurring feature.  Princess and I get certain patterns of phone calls that we find annoying.  We would like to present them to you, with what we would like to charge for them.  Unfortunately, we can’t.  Charge that is.  The phone calls will remain annoying.  Princess says she could get rich if she could charge for all this stuff.

Prior Authorizations 1

You Need Permission for This Medication Why?

Prior authorizations are one of my least favorite things to do.  Most other physicians will agree with me.  When I first started in medicine – back when dinosaurs roamed the earth – we didn’t have to do this.  Now, almost any time I write a prescription or order a test, it seems like someone is second guessing my clinical judgment.  Actually, they are.  And I, as a board certified physician, resent it.  It also takes an immense amount of time.  Patients and insurance companies do not feel the need to pay me or any other doctors for our time.

From personal experience, here are a few of what I consider to be wasteful or ridiculous prior authorizations.  OK, I will break my rule and use the “S” word.  Most of these are just plain STUPID.  You be the judge.  I’ll be anticipating your comments.

I have one insurance company that requires a prior authorization for birth control pills for EVERY patient under the age of 18.  They must NOT be prescribed for birth control.  Of course we in GYN use them for many other things, but isn’t it a nice side effect that your 16 year old isn’t getting pregnant?  I have to call once a year to authorize these.  Sometimes even if the woman is over 18.

I have another patient who is in her 30s.  She is autistic.  She is on Depo-provera to control her periods.  Since she has NEVER been sexually active, this is NOT for birth control.  The insurance company requires that I call them yearly.

Imitrex is a medication that is used for migraines.  It comes in pills, nasal spray and injections.  I have one patient who can ONLY get relief with the injections.  Her insurance company has this on the approved list, but I have to call them to authorize it and tell them that she HAS tried other medications.

I have another patient with fibromyalgia who is having difficulty adjusting the dose of a particular medication.  Every time I change the dose, I have to call Medicaid.  EVERY TIME.

My favorite story is a lovely patient I have who is in her 80s.  Sometime in the mid 1990s I put her on a particular estrogen vaginal treatment.  We tried several cheaper methods, but she had allergic reactions.  She has been on this medicine since that time.  About 5 years ago, her insurance decided they would no longer pay for the little estrogen tablet.  I spoke with the pharmacist.  I had to fax the entire chart.  For the last 15 years.  We finally got things approved.

Two years later, she switched pharmacy benefits plans again.  This time the pharmacy decided that we should try an estrogen patch.  We fought back and forth for FIVE DAYS.  I finally had to threaten the pharmacy benefits plan with “practicing medicine without a license”.  I also told them that her cardiologist and I were not willing to take the risk of giving her systemic estrogen.  If they wanted to assume the medico-legal risk of doing so, and do it in writing, I would be happy to let them. 

We got our approval.