Excuses, excuses

I love it when a non-compliant patient (a teen) does not show up to appointments and does not follow any of the prescribed regimens, which are reached to via consensus, and then oh, 9 months later, when said teen is away at college, everybody wonders why his acne is out of control. I actually received his mothers' rebuke TO ME for not "feeling" the stress he's under and not renewing his meds, sight unseen. I set her straight, no compliance from you, no more renewals from me, this crosses over into medico-legal land. I also urged them to find a different dermatologist who would suit their needs. I was already the third one he had seen in a year, "because nobody is helping him". Well, most of the time, you have to put in some effort, and help yourself. I am only a guide, not a magician with Merlins' wand to wave over the acne and have it disappear.

You can't always get what you want

Along the same lines as my previous post, a patient no-showed yesterday and called today to chew us out for not calling to remind him of his appointment. No nanny works here. My policy is, and has always been, that you are an adult and if you have an appointment, you keep it. I will not hold your hold and remind you like an alarm clock. There are a bevy of items in the marketplace--beepers, smartphones, calendars, etc. to do such a thing. It clearly said to me that he's not ready for the cosmetic things he wants done. He had no concept despite all the education, flyers, and information I gave him at the consultation 10 days ago. I advised him to seek treatment from a different doctor. Unmotivated, rude, diffident patients are not welcome here.

Rating Websites=Jerry Springer's forums for the disgruntled patient

A doctor friend recently shared her frustration with Yelp!, one of the many doctor-ratings websites in existence, where patients can anonymously post whatever they want about a doctor. The disgruntled patient railed against the doctor and called her competence into question because his insurance didn't cover certain things (quel surprise!) and the patient gave her a one-star rating out of five.

Here's the thing: you aren't a success until you have people who love you as well as the people who don't. With this in mind, this is how people conduct themselves with respect to insurance fraud. 

KA-CHING. The attitude is, "hey! it's not my money, let the insurance figure it out. I've already paid enough and I'm not paying any more". Think of all the people who have boasted of a generous payout on their auto accident claim, or flood claim, etc. In America today, insurance fraud is a way of life, and one of the biggest reasons why the cost borne by the consumer keeps increasing.

Third party medicine makes the exam room too crowded--doctor, patient and insurance company. You not only have to be a superb physician and have a warm bedside manner delivered with a painted-on smile, you also have to know every copay, code, modifier and deductible in advance. And these change weekly, sometimes entirely cancelled and replaced by new bureaucratic codes. The situation is not sustainable and is doomed to fail. It will only get worse with increasing regulation and bureaucratic red tape--hello, HIPAA 5010 updates? PPACA? 

Many physicians have gone cash-only, opting out of insurance/Medicare/Medicaid completely and I can only see the trend increasing.  BCBS and UHC have online real-time plan look-ups where you can see at registration what the patients' copayment or responsibility will be, and if they have a $5000 deductible, we tell them so, and collect payment on the day of the visit. You forgot your wallet? Reschedule. Everything else? Cash/Visa/MC/Discover accepted.  "Here is your superbill so you can send it to your own plan. "

I will also say that sometimes it makes more sense to limit the scope and volume of a practice. You can't be everything to everybody. I briefly contemplated interviewing patients before deciding to accept them into my practice. Pragmatically, it didn't work. But I am mindful of the patient interaction from the beginning, from the phone conversation in booking an appointment to their behavior in filling out a new patient registration sheet. My staff tells me everything, as bad behavior with front-desk staff predicts inappropriate behavior, nearly always. I've had patients refuse to sign the financial responsibility sheet and then I've refused to see them. The doctor-patient relationship is a two-way street, we are not technicians repairing a flat tire. This is a personal service involving vulnerability, for both the patient as well as the physician. 

Doctor review websites are a reality. Physicians have zero legal recourse in addressing those defamatory statements, I think HIPAA even makes it illegal to respond. Some physicians have patients sign contracts that are basically gag-clauses, where the patient must consent to NOT post on these websites. Frankly, I think our core mission is being diluted in all of this crap. Let's just be doctors. Reject third party medicine. Attacking the doctor because insurance didn't pay will only reduce access to doctors in the future. 

Penn State Horror Show

I'm not going to add to the copious analysis about the Penn State child sex abuse horror. My gut feeling is that the entire administration, athletic dept. staff and athletic donors need to be subpoened and prosecuted, then summarily fire those involved and prosecute. The NCAA needs to shutter the football program, or at least close it for a year to re-evaluate the whole institution. They've done it for far less, Ohio state players selling autographs and shirts, and they won't do it for this?
If the football program goes down, it goes down and ends. It's OK. There are bigger things than this, people. Our societal mores and the core of what constitutes ethical action are both at stake.

My current loves

Here are my favorite things right now:

1. Books
Alan Cohen, I Had It All The Time. A self-exploratory aid to reconnect with your inner spirit.

2. Music
Gipsy Kings, Bamboleo. An oldie but a goodie. Such great energy.

3. Jewelry
The large lapis and bronze cuff from Paige Novick. Bold, colorful and cheery.

http://www.paperdolls-style.com/wp-content/uploads/2011/07/Paige-Novick-Lapis-Medallion-Cuff-565.jpg


4. Makeup
Laura Mercier Shimmer Bloc and Bobbi Brown (new larger-sized) Lipgloss.

Kinda dangerous bikram yoga

When visiting my sister recently, she persuaded me to take a bikram yoga class with her. I had no idea it was as challenging as it turned out. They're all 90 mins. long, with a set sequence of yoga poses conducted in a heated room--min 105F. Needless to say, after about 30 mins. I was sweating profusely as well as others,  dripping sweat all around. I didn't do the poses I simply could not do, I attempted my own modifications just to try them out. Afterward I felt really stretched and oddly relaxed. I din't feel any problems during the class, I saw some folks in there just sitting on their mats at own point, clearly overwhelmed but exhorted to "not leave" the room. This is such bullshit.

However, I decided to look into this when I got back home, and I tried a bikram class locally. The room had a low ceiling and it was quite crowded, about 30+ people were in the class. Unfortunately I didn't hydrate properly beforehand and towards the end of the class I was nauseous and had palpitations, which scared me. I got up to leave, and the instructor follows me out, "where are you going?" I murmured with as much decorum as I could muster before vomiting right there on the carpet, "I feel like I'm going to vomit". She then asks, into the microphone, with the best of the Seattle-granola-earth-mother intonation as you can imagine, "Are you going to vomit?" I ignored her and scurried out to the coolness of the locker room. I splashed cold water all over me, changed out of my shirt, had some dry heaves and then calmed down, and drank some cool water. After 10 mins. she comes into the bathroom to check on me, and exhorts me to come back to class. I say no no no. Forget it lady. I'm done for the day. She left me alone, mercy be to God. I was able to drink more water and checked my pulse, back down to around 80. When the class let out 10 mins. later, I crept into the stinky room and gathered my mat and towels and went home.
I started to recall that incident in the "sweat hut" in Arizona, I think, a few months ago, where some people died of heat stroke, and that led to me hightailing out of there. These instructors can't be following people around or insisting that they stay in the room. I should have said, lady you're not equipped to handle any kind of heat stroke here, do you want me to have a seizure? I was in no shape to think clearly. I followed my instinct to leave a dangerous room and stuck to it. I don't think I'll do this again. These devotees are sometimes cult-like to their own detriment, that's a huge turn-off to me.