The majority of my patients are current STEM employees, spouses of STEM employees, children of STEM employees, or retired STEM employees or spouses. It's true, they really do bring in graphs of their blood pressures, PSA's (prostate specific antigen lab results), blood sugars and cholesterol numbers plotted over time- a phenomenon I experienced oh.... none in Birmingham. But practicing medicine and being responsible for highly educated patients' health is additionally challenging, especially for physicians who are used to being able to tell patients what to do. As medicine shifts to more of a consumer's market, I notice that older trained physicians are being called out by patients for not providing what they really want. Especially here in our community, where our patients are possibly researching genetic diagnosis and treatment in more detail that even mentioned in medical school, we are called to partner with our patient customers in a way that many other physicians in more average communities do not experience. Older physicians and even some newly trained physicians with this attitude, don't understand that patients want a conversation. You don't want to be told what to do. You want to have a conversation about why we come to a particular diagnosis, what your test results mean to us and what your treatment options are. You get to make the decision, it's your body. Our role is to guide you along the way with our expertise to help you in making the best decision for you. This is a very new way to practically practice medicine for many physicians. I graduated from medical school in 2008 and was hardly trained with this approach by most of my physician attendings. But, you deserve to have a partnership with your physician, not a relationship that does not provide you understanding.
Here is the problem with that.... our health care system as it is currently structured where doctors are reimbursed in a fee for service model does not allow for that. Partnering with patients and making decisions together takes a lot of time and conversation with patients. So even if physicians want to do that, generally their schedules just simply can't allow for it. Payment is based on volume of patients seen primarily. It is much simpler for me to use my past 11 years of medical training and experience to review your test results, your exam and treatment options before I walk in the room and have a plan to present to you in the few moments we can actually spend face to face. In fact, the expected time that Medicare and insurance companies have decided all of that should take on average is 15 min. This past Friday, I happened to have 60% of the patients on my schedule here for what I would consider a complicated medical decision making diagnosis and treatment plan. Medicare tells me this should take about 25 min per patient (of which at least 10 min of that is spent rooming the patient and documenting Medicare requirements to bill that office visit) so that leaves 15 min. This. is. not. true. Several of these patients were already frustrated by the health care system in our community dismissing them and not explaining to them what was actually happening to their body. I easily spent over 30 min with each of those patients resulting in longer wait times for subsequent patients, no lunch break for myself or my staff, cancelling the lunch training meeting I was to have with my staff and leaving the office later than anticipated. Some days are like that, you just have to do what the patients need. But, seriously, it would be nice if physicians were paid based on a more realistic expectation of face to face time needed with patients. Sometimes patients tell me "Do whatever you need to do, my insurance will cover everything." I'm sorry to tell you my friend, your insurance does not care to pay for the additional time you need me to spend with you. That is my most valuable service, my time. And now, I will get off my soap box and return to finishing documenting my office visit notes on each of those patients that I did not get to yesterday while my amazing sister has taken my kids to the park so I can finish my work.
Brooke Uptagrafft, MD
Dr. Brooke is a family medicine doctor.