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On my lack of psychic powers

Imagine, if you will, two scenes:

Scene 1

THE SETTING: A BUSY CAR REPAIR FACILITY.  PHONES ARE RINGING.  A CAR IS UP ON A LIFT.  VARIOUS MECHANICAL NOISES IN THE BACKGROUND.

RING, RING! (PHONE RINGING)

MECHANIC: Hi, this is Joe’s Garage.  How can I help you?

MRS. JONES:  This is Mrs. Jones.  I’ve been bringing my car to you for several years for repairs. I last brought it in about a year ago.  Now it’s making a horrible noise whenever I apply the brakes!  And sometimes the steering wheel does this crazy vibrating thing while I’m driving!  It’s so bad sometimes I can barely hold onto it!

MECHANIC:  Wow.  I’m sorry to hear that.  It sounds like it might be serious.  Why don’t you bring the car right over so we can check things out?

MRS. JONES:  No, I don’t want to bring the car in.  Can’t you just tell me how to fix it over the phone?

MECHANIC:  Errrr.  Well.  I’m not really sure what’s wrong.  I have to drive the car and really take a good look at it to figure out the problem.

MRS. JONES:  Well, I really don’t feel like paying to have you look at it.  It’s so expensive!  You just saw the car a year ago, isn’t that good enough?  I really feel like you’re taking advantage of me.

MECHANIC:  I’m sorry, Mrs. Jones.  I’m not sure what to tell you.  I really need to see the car.

MRS. JONES:  This is ridiculous.  You just want my money. I’m just going to keep driving the car.  If it keeps making the funny noise I’ll just turn up the radio volume.

MECHANIC:  Mrs. Jones, this could be serious!  It could be dangerous to drive the car!  You really need to get this checked out!!

MRS. JONES:  Well, you should have thought of that before you got so greedy.

CLICK. DIAL TONE (MECHANIC IS LEFT STARING IN DISBELIEF AT THE PHONE)

Scene 2
THE SETTING: A BUSY PRIMARY CARE OFFICE.  PHONES ARE RINGING IN THE BACKGROUND. 
RING RING! (PHONE RINGING)
NURSE:  Hi, this is Primary Care Associates!  How can I help you?
MRS. JONES:  Hi.  I have a really bad earache.  It’s my left ear.  It’s also really itchy.  Oh, and I can’t hear out of it.
NURSE:  Wow. I’m sorry to hear you’re not feeling well.  I can fit you in with the doctor this afternoon, OK?  Let me just get your name and date of birth.
MRS. JONES:  No, I don’t want to come in.  Can’t she just call something in over the phone? I use Rite Aid.
NURSE:  Well, I’m really sorry, but she’s going to have to take a look at your ear to figure out what the problem is.
MRS. JONES:  I TOLD you what the problem is!  It hurts and it’s itchy.  And I can’t hear!
NURSE:  Right, but there are a lot of different things that can cause those symptoms.  We need to make a diagnosis in order to give the proper treatment.
MRS. JONES:  It’s too expensive.  I have a $20 copay, you know.  I just saw the doctor 3 months ago for my high blood pressure.  Why would she have to see me again?  You know what, just forget it.  I’ll take some ibuprofen.
NURSE:  Mrs. Jones, you should really get checked out!  If it’s an infection it could lead to complications. We can get you in today!  Why don’t you come on over?
MRS. JONES:  Well, you should have thought of that before you got so greedy.  I’m going to find a new doctor, one that cares about her patients more than money.
CLICK.  DIAL TONE.
So, what’s the difference between these two scenarios?  Both are patently absurd, right?
I have no experience as a mechanic, but my guess it that only one is likely to happen in real life.  Scenario number two happens to me frequently.  It doesn’t always get as far as a patient firing me as a doctor, but it has occurred.  
I’m not trying to be greedy.  Really.  But I am trying to practice good medicine, and that includes a good history and physical exam.  The problem is that I attended the University of Rochester, not Hogwarts School of Witchcraft and Wizardry.  Therefore, I didn’t take the class in Divination, which includes crystal ball gazing and predicting the future.  I also didn’t take Occlumency, which involves mind-reading.  So, I’m stuck with the old-fashioned method of actually seeing a patient face-to-face and examining them.  Sorry.

I’ve said it before and I’ll say it again- it’s bad practice to treat someone over the phone.  Even the New Hampshire Board of Medicine agrees with me.    So, I’ll continue to stick to my guns on this one.  If it costs me a few patients, so be it.

5 thoughts on “On my lack of psychic powers”

  1. Now if you were Dr. McCoy on Star Trek you could just use your Tricorder to fix them right up. Or just call Dr. Voldemort..

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  2. There is something missing here. Seriously. The health care industry centers itself around the needs of the business, not the needs of the sick. Let's think about the woman with the earache. The $20 copay may be more than she can afford. She might have to choose between that and food, or medicine, or gasoline. She might not have transportation and have to get a relative to drive her, or a taxi, or the senior citizen bus that is available only a day in advance and has a waiting time of at least an hour. She might have to arrange for child care, or elderly care, or take time off from work, or ask for unpaid leave from work since she has used up her time taking care of a sick child. And so on. Do not criticize her before you know the full story. What is a 10 minute appointment for you might be an hours long problem for the patient.

    The solution is to provide care where and when the patients need it. Suppose your office hired some nurse practitioners or PAs that made house calls for things like this. While it would not solve the $20 copay barrier, it would help with the issues of child care, transport, etc.

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  3. Thanks for your response. I agree, in a perfect utopia, housecalls could be made. Unfortunately, I practice medicine in the real world. Insurance reimbursement for a level 3 visit (such as an earache) is around $60. We actually do have PAs in my office. They are busy every day seeing patients here. If one of them was to go see this patient at home for her earache it would take them out of the office for at least an hour and a half, maybe 2 hours. In that time, she could see 5 or 6 patients at the office, versus 1 patient at her house.

    Since insurance companies won't pay extra for a house call on a patient who is perfectly capable of coming in- we're losing several hundred dollars on that visit.

    I certainly appreciate any financial difficulties my patients have. However, my staff needs money for food, medicine and gasoline, too. I can't pay them in goodwill and happy thoughts.

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  4. Of course, if you had the equivalent of the NHS, the second scenario simply woudln't happen. The patient comes to see the doctor and doesn't worry about finding the cash. But, of course, this would mean going all Communist and Republicans won't allow that.

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