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Why Did My Patient Leave Me?

cancer.nautil.us

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Re: Why Did My Patient Leave Me?

#31

Post by ljoshua »

Herodotus38 wrote: post #29
ljoshua wrote: post #22

Earlier quoted context omitted.

Indeed, you're right. It follows a similar model to services that do appointment reminders via text message, which is becoming very common. The permission check becomes vital: it's part of the patient authorization at, for example, a first visit, and is best when also followed by a verbal authorization upon checkout. It's one of the big hurdles we're trying to overcome obviously, but we believe there are proper ways…

I wish you luck. I think your approach is far better than the mailed sheets of paper surveys I inevitably toss in the recycling bin that arrive 1-2 weeks after my children's appointments. Do you guys use any sort of incentive to boost responses?

Thanks! No incentives right now, as we don't want to bias the data. Response rates have been high enough though to blow other mediums away (by a factor of 5x roughly).

Re: Why Did My Patient Leave Me?

#32

Post by ThomPete »

jacquesm wrote: post #26
ThomPete wrote: post #24

Earlier quoted context omitted.

I do question the sustainability of the french system though and that of many other european systems. Its important to remember that in a state economy where healthcare is free or semi free it's operated as a cost center and thus has budgets that are politically mandated not determined by market demand at least not directly. This leads to a number of limitations on what kind of care patients can get what machines the…

Good point. I'm not too worried about France, they seem to have their priorities straight there, other countries are less stable. Especially in former Eastern European countries there are disasters happening right now, and many Western countries will have to come to terms with the cost of health care and attempting to take commerce out of it. NL had a very good system which got replaced by something much less efficie…

My personal suggestion for a good balanced system is that most people pay most of the cost for normal healthcare costs like going to the doctor for a checkup, most of the cost for one of things like a broken leg but that society pays for more serious and longer term situations like cancer, heart surgeries where you are supposed to stay at the hospital for a longer time.

I.e. no one should be bankrupted because they get a serious illness.

With regards to France healthcare system here is an article who seems to think it wont survive though.

https://www.bloomberg.com/news/articles/2013-01-03/frances-h...

Re: Why Did My Patient Leave Me?

#33

Post by josephorjoe »

The primary reason I have left healthcare providers has been the poor quality of their administrative staff.

There are too many qualified doctors in the major metro area I live in to put up with ones where I can't quickly and efficiently make an appointment, can't get an appointment in a timeframe that is useful to me, and where their staff can't seem to successfully process routine insurance claims with major insurance providers.

Also, randomly billing me for stuff weeks or months after an appointment with cryptic explanations thoroughly pisses me off -- even it if is only $15.00 (going to get a new podiatrist over that one...).

As for actual "doctor specific" reasons for leaving a doctor, not explaining the reasoning behind his/her recommendations for me to get certain medical tests or procedures done will get me to look for another doctor. I don't actually need to fully understand the reasoning (I'm not, afterall, a doctor), but I need to know there is a reason beyond "hey, you said your elbow hurt and I think I can get the insurance company to pay for an MRI!".

Re: Why Did My Patient Leave Me?

#34

Post by QSIITurbo »

pbhjpbhj wrote: post #6
jacquesm wrote: post #4

I've done this, without feedback. The reason was that doctors seem to come in several varieties when it comes to bringing their ego to work and my doctor had a serious case of that. I was dehydrated after an operation and when he asked if he could do something for me I asked for some water, the doctor then ordered someone else not in the room to come and get me a glass of water. He couldn't be bothered to walk to the…

>the doctor then ordered someone else not in the room to come and get me a glass of water // It seems possible that was a hygiene issue. For example the doctor knew that he'd need then to wash his hands again (possibly twice, once before going to the cupboard, once after), or change his gloves, before continuing with your consultation?

Another alternative that I've run into. Visiting a doctor friend of mine. She needed to deliver some papers to another room and summoned the nurse for that. I joked that why you can't do that yourself (omg) and she replied that the nurses start to complain if you do stuff that's earmarked to them. It might be that it's because they're in a union or it's a company policy. Who knows, I never asked. But the point was that the nurses wouldn't appreciate it if she did it herself.

Re: Why Did My Patient Leave Me?

#35

Post by csydas »

josephorjoe wrote: post #33

The primary reason I have left healthcare providers has been the poor quality of their administrative staff. There are too many qualified doctors in the major metro area I live in to put up with ones where I can't quickly and efficiently make an appointment, can't get an appointment in a timeframe that is useful to me, and where their staff can't seem to successfully process routine insurance claims with major insura…

> Also, randomly billing me for stuff weeks or months after an appointment with cryptic explanations thoroughly pisses me off -- even it if is only $15.00 (going to get a new podiatrist over that one...).

This part gets me a lot as well, and having experienced other pay-for healthcare systems, it's extremely frustrating remembering just how much I would pay in the US even when I had fair insurance through my employer. Getting a simple biopsy done on my leg resulted in a $250 upfront new patient fee, $2300 for the biopsy, then an additional $400 for lab fees some months later. Aside from the new patient fee, I had no idea or indication about any of the other fees until a bill arrived in the mail, despite asking and persisting about it throughout the visit, and since I had to take time off of work to get an appointment, I was at a loss as to how to "make a stand" to get such information.

Compared to where I've been abroad where it's been an upfront fee for walk-in visits. Appointments were needed, but it was a day or two in advance. And when I got insurance through my workplace, it was equally simple.

Re: Why Did My Patient Leave Me?

#36

Post by XorNot »

ThomPete wrote: post #24
jacquesm wrote: post #18

Earlier quoted context omitted.

France has some of the best healthcare in the world. A family member was involved in a horrific truck/passenger bus accident in France near Metz and I spent the better part of a week in and out of their intensive care department visiting. I've never seen a hospital that I liked better. Everybody was so unbelievably nice and caring it was a huge improvement over what I'd seen elsewhere. http://krant.telegraaf.nl/krant…

I do question the sustainability of the french system though and that of many other european systems. Its important to remember that in a state economy where healthcare is free or semi free it's operated as a cost center and thus has budgets that are politically mandated not determined by market demand at least not directly. This leads to a number of limitations on what kind of care patients can get what machines the…

Ah yes, because the "market" for healthcare operates so well...

Re: Why Did My Patient Leave Me?

#37

Post by DanBC »

tomohawk wrote: post #30

Years ago, I had a truly great primary care doctor. She had her own practice, which was typical at that time. She was caring, but above all, extremely competent. After she retired, I've yet to come across a situation remotely as good. I think she was so good because she was allowed to be directly engaged with her patients and that resulted in some sort of feedback loop where she was always striving to stay on top of…

> Just look at how many doctors no longer will prescribe medicine for pain due to the war on drugs. They're scared of losing their license. The collateral damage is the poor people who need strong pain management but find it increasingly hard to get it.

Doctors haven't stopped prescribing opioids because of the war on drugs. They've changed prescribing because opioid meds are not effective to treat long term pain, and certainly not effective in the way they were being prescribed.

People with long term pain given opioids will quickly develop tolerance to those meds, and need to increase the dose. They quickly reach dangerous levels of opioid use, often with multiple meds, and they're still not getting relief from their pain. So now they're still in pain, and they have an opioid addiction.

People with long term pain need rapid access to specialist pain clinics, with a full range of treatment including physiotherapy and prescribing, and -if needed- carefully prescribed opioids.

Re: Why Did My Patient Leave Me?

#38

Post by rubatuga »

lmns wrote: post #28

So, in this sense, vaccination should be an individual choice? This is something which concerns the individual, but has consequences for society as a whole.

It has and always be the individual's choice, unless they are unconscious or unable to make a reasonable decision on their own. Vaccination has always been opt out, and it's a right to choose whether or not to accept medical treatment.

Re: Why Did My Patient Leave Me?

#39

Post by XorNot »

agumonkey wrote: post #10
danieltillett wrote: post #8

I have luckily been very healthy in my life, but I have always believed that the relationship between a doctor and a patient is a collaboration with the aim being to help the patient make the most appropriate decision for their needs. Too many doctors seem to be of the opinion they know best and the patient should just do as they say - even if they are correct technically it is not their life that is on the line. The…

Well, I've been plunged into this very issue. Even for cancer care, I found no trace of collaboration. It was bureaucratic, sometimes cold, out of sync (no news, contradictory news). No team work possible. Also if you ever try to mention alternate ideas, you get dismissed right away. And for fallacious reasons. Mostly statistical and experience driven, which looked like myopia to me. I'm actually collecting evidence…

People looking for alternatives for cancer care tend to look for things which literally do nothing (high profile example: Steve Jobs), or get fixated on experimental drugs which have a high likelihood of being ineffective or much more immediately fatal.

Re: Why Did My Patient Leave Me?

#40

Post by DanBC »

ljoshua wrote: post #9

This is a growing and very important aspect of value-based care, and really factors into the discussion of quality that will be more a part of reimbursement than it ever has been. The article focused mostly on the provider him or herself, but patients also take into account the entire experience, including office staff, scheduling and billing procedures, etc. Shameless self promotion: this is the exact problem my co-…

People interested in this might also like the "Friends and Family test", which is used extensively in the English NHS.

http://www.nhs.uk/NHSEngland/AboutNHSservices/Pages/nhs-frie...

https://www.england.nhs.uk/ourwork/pe/fft/

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