Re: Another lament about why we need change

[Guest guest]

-

Some risk there-she is technically not your patient.

-i recommend violent 1st person shooters video games.(nothing

like killing a few Nazis to reduce your stress level.

>

> > I agree with sending her a bill; she clearly isn't an established

> > patient with you. You should be paid for the medico-legal risk

you took by

> > giving her advice. She may never pay you, but then she probably

won't call

> > you for free care again.

> >

> >

> >

> > An amazing insurance story: 78 y.o. Cauc. Male with recently dx'ed

> > osteoporosis will pay THREE dollars for 3 months of Forteo if he

gets it

> > from Medco mail pharmacy, but would pay $700 per month if he gets

it from a

> > local pharmacy! I didn't believe it when he told me, so I called

Medco to

> > verify it!

> >

> >

> >

> > Mutt

> >

> >

> >

> >

> >

>

[Guest guest]

And I had just wondered if he got to finish his run..I mean ,charge more if you didn;t Always good the know Spikol is lurking...

-

Some risk there-she is technically not your patient.

-i recommend violent 1st person shooters video games.(nothing

like killing a few Nazis to reduce your stress level.

>

> > I agree with sending her a bill; she clearly isn't an established

> > patient with you. You should be paid for the medico-legal risk

you took by

> > giving her advice. She may never pay you, but then she probably

won't call

> > you for free care again.

> >

> >

> >

> > An amazing insurance story: 78 y.o. Cauc. Male with recently dx'ed

> > osteoporosis will pay THREE dollars for 3 months of Forteo if he

gets it

> > from Medco mail pharmacy, but would pay $700 per month if he gets

it from a

> > local pharmacy! I didn't believe it when he told me, so I called

Medco to

> > verify it!

> >

> >

> >

> > Mutt

> >

> >

> >

> >

> >

>

-- If you are a patient please allow up to 24 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD

ph fax

[Guest guest]

Yes, I

realize there is some risk and I could bill her as she is technically not my

patient, but my lament is not about her. She is someone who is just seeking

good care. My beef is with a system where her insurance encourages her to

change doctors and encourages doctors (through broken reimbursement) to fill

their lists with so many patients they no longer want to be available to answer

questions when needed.

There should not be a need for an Ask-A-Nurse

program—it should be ask your doctor.

Re: Another lament about why we need change

-

Some risk there-she is technically not your patient.

-i recommend violent 1st person shooters video games.(nothing

like killing a few Nazis to reduce your stress level.

>

> > I agree with sending her a bill; she clearly isn't an established

> > patient with you. You should be paid for the medico-legal risk

you took by

> > giving her advice. She may never pay you, but then she probably

won't call

> > you for free care again.

> >

> >

> >

> > An amazing insurance story: 78 y.o. Cauc. Male with recently dx'ed

> > osteoporosis will pay THREE dollars for 3 months of Forteo if he

gets it

> > from Medco mail pharmacy, but would pay $700 per month if he gets

it from a

> > local pharmacy! I didn't believe it when he told me, so I called

Medco to

> > verify it!

> >

> >

> >

> > Mutt

> >

> >

> >

> >

> >

>

[Guest guest]

, I trust your reward will be in heaven.

So I'm on my run today (nine miles) when my cell phone goes off. I don't really ever mind when patients call and this is a patient who is somewhat distraught. She states, "I know I haven't seen you in a while, but we switched insurances and so we started going to another physician. I tried to call the new doc, but was transferred to the Ask-A-Nurse call center. After talking to the nurse, I was told to go to the ER because I am having some atypical chest pain and she was concerned I was having a heart attack and needed to be evaluated. My husband thinks I am not having a heart attack and told me to call you—well, because you are always available."

Some background—patient is 35 years old, has 2 young kids (the last with cleft lip), and has been seen over the past couple of years for dizziness, palpitations, shortness of breath and the work-up has always been normal. She states since she last saw me she has gained 15 pounds and has a constant bloated feeling in her abdomen. Her husband is out of town over the weekend. She complains of a sour taste in the back of her throat for the past week or so and the pain resolves with Mylanta (which she took while I was on the phone with her).

So here is my lament. In a 10 minute phone conversation between mile 6 and 7, I have just saved a patient a $50 co-pay and 6-7 hours in the ER, and I have saved her insurance about $1000 in unnecessary ER testing. Even with the obvious poor access and poor continuity, she will see her doctor (who will know nothing of any of this) early next week ensuring her doc gets paid. The Ask-a-nurse program is funded through the hospital owned physician association to which this doc belongs, so they get paid even for their wrong advice. But I get zero except the satisfaction of a job well done.

Well, at least it gives me something to think about during my long runs….

[Guest guest]

You gave away the milk for free ---

See pt x 1 in office for "consultation" as a "specialist/second opinion."

Good friend of mine said "there will be plenty of takers when you give it away for free."

Matt in Western Pa

Another lament about why we need change

So I’m on my run today (nine miles) when my cell phone goes off. I don’t really ever mind when patients call and this is a patient who is somewhat distraught. She states, “I know I haven’t seen you in a while, but we switched insurances and so we started going to another physician. I tried to call the new doc, but was transferred to the Ask-A-Nurse call center. After talking to the nurse, I was told to go to the ER because I am having some atypical chest pain and she was concerned I was having a heart attack and needed to be evaluated. My husband thinks I am not having a heart attack and told me to call you—well, because you are always available.”

Some background—patient is 35 years old, has 2 young kids (the last with cleft lip), and has been seen over the past couple of years for dizziness, palpitations, shortness of breath and the work-up has always been normal. She states since she last saw me she has gained 15 pounds and has a constant bloated feeling in her abdomen. Her husband is out of town over the weekend. She complains of a sour taste in the back of her throat for the past week or so and the pain resolves with Mylanta (which she took while I was on the phone with her).

So here is my lament. In a 10 minute phone conversation between mile 6 and 7, I have just saved a patient a $50 co-pay and 6-7 hours in the ER, and I have saved her insurance about $1000 in unnecessary ER testing. Even with the obvious poor access and poor continuity, she will see her doctor (who will know nothing of any of this) early next week ensuring her doc gets paid. The Ask-a-nurse program is funded through the hospital owned physician association to which this doc belongs, so they get paid even for their wrong advice. But I get zero except the satisfaction of a job well done.

Well, at least it gives me something to think about during my long runs….

[Guest guest]

May I have your phone number to give to all my patients when I am unavailable?

I will be telling them that you don't charge.

On Sun, Dec 14, 2008 at 7:11 AM, Brady, MD

wrote:

> So I'm on my run today (nine miles) when my cell phone goes off. I don't

> really ever mind when patients call and this is a patient who is somewhat

--

Graham Chiu

http://www.synapsedirect.com

Synapse - the use from anywhere EMR.

[Guest guest]

You already know / knew system is broken. Charge pt significant amount. You will feel better.

Mike S.

Yes, I realize there is some risk and I could bill her as she is

technically not my patient, but my lament is not about her. She is

someone who is just seeking good care. My beef is with a system where

her insurance encourages her to change doctors and encourages doctors

(through broken reimbursement) to fill their lists with so many patients

they no longer want to be available to answer questions when needed.

There should not be a need for an Ask-A-Nurse program-it should be ask

your doctor.

The weather's getting colder, but the movies are getting hotter. Get the Moviefone Toolbar and see Moviefone's holiday movie guide today.

[Guest guest]

You already know / knew system is broken. Charge pt significant amount. You will feel better.

Mike S.

Yes, I realize there is some risk and I could bill her as she is

technically not my patient, but my lament is not about her. She is

someone who is just seeking good care. My beef is with a system where

her insurance encourages her to change doctors and encourages doctors

(through broken reimbursement) to fill their lists with so many patients

they no longer want to be available to answer questions when needed.

There should not be a need for an Ask-A-Nurse program-it should be ask

your doctor.

The weather's getting colder, but the movies are getting hotter. Get the Moviefone Toolbar and see Moviefone's holiday movie guide today.

[Guest guest]

Graham,

I certainly don’t mind you

forwarding your patients my phone number to talk to them when you are

unavailable. After all, given the great access and care your patients receive,

they will have little need to call me at all. It is the broken practices which

bother me, not the IMP ones.

Re:

Another lament about why we need change

May I have your phone number to give to all my

patients when I am unavailable?

I will be telling them that you don't charge.

On Sun, Dec 14, 2008 at 7:11 AM, Brady, MD

<drbradythevillagedoctor (DOT) hrcoxmail.com>

wrote:

> So I'm on my run today (nine miles) when my cell phone goes off. I don't

> really ever mind when patients call and this is a patient who is somewhat

--

Graham Chiu

http://www.synapsedirect.com

Synapse - the use from anywhere EMR.

[Guest guest]

I can't run 9 miles anymore, but I carry my cell-phone on bike rides, and on cross-country ski outings, which can take a long time away from regular phones ... I often tell people: medical advice over the phone is worth every penny you pay for it (meaning maybe like zero, but that is a joke... sometimes, it is worth a whole lot, of course ...). I will tell a patient who calls me, when I am in a situation that makes it impossible to just invite them to come see me right now, that it might be a good idea to go straight to the E.R., but if I really don't think it is likely to be a life/limb-threatening situation, I will discuss the different kinds of Aluminum/Magnesium Hydroxide preparations, and tell them I wish they could call me back tomorrow morning, when I am at the office, to let me know how they come through that crisis. Then, if they do call me again, I tell them it would be a good idea if they could come to see me, to confirm with exam what I hear them telling me ... or, to contravert that conclusion, if I find them in new-onset of atrial fibrillation, or horribly-pale, or hypoxemic. I have very few instruments in my office, but I have eyes to see skin / mucosal color, and a stethoscope to hear heart sounds, and a pulse-oximeter (I love my Onyx). Then, if they say, well, "I can't " (because of that insurance company switch), or if they don't feel like they really need to see a doctor after all, I pause a moment, and tell them I hope they can get to see their new doctor promptly, or that I am glad to hear they are feeling better ... That little pause says, don't abuse me like this too often. If I have a few more minutes of "free time", I will put a note about those phone calls in that patient's chart, and the pause gets longer, if those telephone messages recur ... I have not yet told a patient to not call me again, but I have told more than one: "you need to call your new doctor about this pain", or this dyspnea, or whatever ... My typing is slow and tedious, but my memory is imperfect ... I hate to think what would happen, if somebody suffered a bad result because of my telephone advice, and I didn't even have a chart note to remind me about that phone call ... Rian Mintek, M.D. -- Allegan, Michigan (a fine place for Toko Violet, at this time of year) ... You gave away the milk for free --- See pt x 1 in office for "consultation" as a "specialist/second opinion." Good friend of mine said "there will be plenty of takers when you give it away for free." Matt in Western Pa Another lament about why we need changeSo I’m on my run today (nine miles) when my cell phone goes off. I don’t really ever mind when patients call and this is a patient who is somewhat distraught. She states, “I know I haven’t seen you in a while, but we switched insurances and so we started going to another physician. I tried to call the new doc, but was transferred to the Ask-A-Nurse call center. After talking to the nurse, I was told to go to the ER because I am having some atypical chest pain and she was concerned I was having a heart attack and needed to be evaluated. My husband thinks I am not having a heart attack and told me to call you—well, because you are always available.”Some background—patient is 35 years old, has 2 young kids (the last with cleft lip), and has been seen over the past couple of years for dizziness, palpitations, shortness of breath and the work-up has always been normal. She states since she last saw me she has gained 15 pounds and has a constant bloated feeling in her abdomen. Her husband is out of town over the weekend. She complains of a sour taste in the back of her throat for the past week or so and the pain resolves with Mylanta (which she took while I was on the phone with her).So here is my lament. In a 10 minute phone conversation between mile 6 and 7, I have just saved a patient a $50 co-pay and 6-7 hours in the ER, and I have saved her insurance about $1000 in unnecessary ER testing. Even with the obvious poor access and poor continuity, she will see her doctor (who will know nothing of any of this) early next week ensuring her doc gets paid. The Ask-a-nurse program is funded through the hospital owned physician association to which this doc belongs, so they get paid even for their wrong advice. But I get zero except the satisfaction of a job well done.Well, at least it gives me something to think about during my long runs….

[Guest guest]

I can't run 9 miles anymore, but I carry my cell-phone on bike rides, and on cross-country ski outings, which can take a long time away from regular phones ... I often tell people: medical advice over the phone is worth every penny you pay for it (meaning maybe like zero, but that is a joke... sometimes, it is worth a whole lot, of course ...). I will tell a patient who calls me, when I am in a situation that makes it impossible to just invite them to come see me right now, that it might be a good idea to go straight to the E.R., but if I really don't think it is likely to be a life/limb-threatening situation, I will discuss the different kinds of Aluminum/Magnesium Hydroxide preparations, and tell them I wish they could call me back tomorrow morning, when I am at the office, to let me know how they come through that crisis. Then, if they do call me again, I tell them it would be a good idea if they could come to see me, to confirm with exam what I hear them telling me ... or, to contravert that conclusion, if I find them in new-onset of atrial fibrillation, or horribly-pale, or hypoxemic. I have very few instruments in my office, but I have eyes to see skin / mucosal color, and a stethoscope to hear heart sounds, and a pulse-oximeter (I love my Onyx). Then, if they say, well, "I can't " (because of that insurance company switch), or if they don't feel like they really need to see a doctor after all, I pause a moment, and tell them I hope they can get to see their new doctor promptly, or that I am glad to hear they are feeling better ... That little pause says, don't abuse me like this too often. If I have a few more minutes of "free time", I will put a note about those phone calls in that patient's chart, and the pause gets longer, if those telephone messages recur ... I have not yet told a patient to not call me again, but I have told more than one: "you need to call your new doctor about this pain", or this dyspnea, or whatever ... My typing is slow and tedious, but my memory is imperfect ... I hate to think what would happen, if somebody suffered a bad result because of my telephone advice, and I didn't even have a chart note to remind me about that phone call ... Rian Mintek, M.D. -- Allegan, Michigan (a fine place for Toko Violet, at this time of year) ... You gave away the milk for free --- See pt x 1 in office for "consultation" as a "specialist/second opinion." Good friend of mine said "there will be plenty of takers when you give it away for free." Matt in Western Pa Another lament about why we need changeSo I’m on my run today (nine miles) when my cell phone goes off. I don’t really ever mind when patients call and this is a patient who is somewhat distraught. She states, “I know I haven’t seen you in a while, but we switched insurances and so we started going to another physician. I tried to call the new doc, but was transferred to the Ask-A-Nurse call center. After talking to the nurse, I was told to go to the ER because I am having some atypical chest pain and she was concerned I was having a heart attack and needed to be evaluated. My husband thinks I am not having a heart attack and told me to call you—well, because you are always available.”Some background—patient is 35 years old, has 2 young kids (the last with cleft lip), and has been seen over the past couple of years for dizziness, palpitations, shortness of breath and the work-up has always been normal. She states since she last saw me she has gained 15 pounds and has a constant bloated feeling in her abdomen. Her husband is out of town over the weekend. She complains of a sour taste in the back of her throat for the past week or so and the pain resolves with Mylanta (which she took while I was on the phone with her).So here is my lament. In a 10 minute phone conversation between mile 6 and 7, I have just saved a patient a $50 co-pay and 6-7 hours in the ER, and I have saved her insurance about $1000 in unnecessary ER testing. Even with the obvious poor access and poor continuity, she will see her doctor (who will know nothing of any of this) early next week ensuring her doc gets paid. The Ask-a-nurse program is funded through the hospital owned physician association to which this doc belongs, so they get paid even for their wrong advice. But I get zero except the satisfaction of a job well done.Well, at least it gives me something to think about during my long runs….