Fear and Loathing in the Doctor’s Office

I was strung out on alcohol and cheap amphetamines yesterday when I arrived at my doctor’s office. Well, of course that’s not entirely true, but I’ll bet I have your attention.

I did visit my Internist yesterday for my annual physical exam. My doctor, Anul Probst, and his partners became employed by Big Medical System, hereinafter referred to as the “BM”, around the time of my last visit, which was in January 2008 (more on that later). I remember talking to him at the time about the reasons for his move to BM. It was the typical stuff; back office efficiency, electronic medical records, help with contracting and so on. He didn’t mention income stability.

I am always interested in practice operations and I made a mental note to pay attention during my next visit. I wanted to see what the BM would do for Dr. Probst. Here we go.

First, I called his office on Monday (my appointment was Friday) to see if I could stop in and let them get my labs so that I didn’t have to fast until after the late morning appointment. I like to eat a little breakfast.

I reached a scheduler with the BM, who informed me that wasn’t possible. She made no effort to help me whatsoever and seemed flustered that I would even ask. Before Dr. Probst joined the BM, his staff encouraged you to “stop in” and have your labs done in advance so that the good doctor would have the results before your visit. They also didn’t want you to get too hungry.

Next, I arrived for my 10:30 appointment at 10:25. I confronted a humorless receptionist. After ignoring me for a good 45-60 seconds, she asked if my insurance coverage had changed. I told her that indeed it had and she asked for my insurance card and picture identification.

I stood there for what seemed like several minutes while she methodically (mechanically?) ran my cards through a what must have been an extremely slow scanner. I was then directed to “have a seat.”

(I would have thought the BM would have confirmed my insurance and would have asked me to have the lab tests before I ever showed up in the office. Seems like I could have completed the paper work through a web portal. And, wouldn’t the BM have coached the receptionist to start with a cheerful, “Hello Mr. Carter, we’ve been expecting you!”)

Now time to sit and wait. Two guys in suits with laptop computers where in and out of the office as I waited. They looked like consultants so I ignored them. All the while Rue McClanahan was busy flaunting her sex life (those gals were the original cougars) during an episode of the Golden Girls playing loudly on the TV.

After what seemed like a very long time (but, was only 15 minutes), the Nurse opened the door and loudly called for Mr. Carter. The fun was just beginning.

The nurse ordered me to remove my shoes and get on the scale. I think she was channeling Lou Gosset, Jr., but I kept that to myself. I dutifully followed her order. Next I followed her into an exam room where she told me to take a seat. She sat at the desk with a massive paper medical record (Dr. Probst has been my doctor since 1992 and I’ve been a healthy fellow) and asked me if I were taking anything daily.

I told her that I take a fiber pill, multi-vitamin, omega 3, baby aspirin and Lipitor. She asked me what dosage of Lipitor. Even though I knew it was 10 mg, I responded that I didn’t know but that Dr. Probst had prescribed it the last time I visited. I wanted to see how long it took her to rummage through the paper to find it. It took a while.

Next she asked if I had ever had a colonoscopy (a review of my record would show that I have had at least 4, all ordered by Dr. Probst). I told her yes and she asked when. Again, I told her I didn’t know (I really didn’t) and she rummaged through the record.

Imagine an electronic medical record tied in with the practice management system and some process improvement. Wouldn’t take much to improve the process to this point.

After taking my blood pressure in both arms and recording my pulse, she opened the door and shouted “5 is ready.” I had been reduced to a number. I took some comfort that I was number 5 and not 992786.

Dr. Probst arrived within a few minutes (I am guessing it was about 5 since I was absorbed in an interesting power point sent to me by Tad Myre) and greeted me warmly. Our kids went to Ballard High School together and we usually spend the first few minutes catching up on how they are doing.

As a side note, I have every confidence in Dr. Probst. He’s board certified, very thorough, respected by his peers and a genuinely nice fellow.

He seemed pleased to see me. After the small talk he asked me if I were still with Jewish. I told him that I left Jewish in April 2008. It was then that I discovered that it had been two years since I my last physical exam. No notice or reminder from the BM.

I asked Dr, Probst if I could go ahead and schedule next years appointment at checkout. No, they don’t schedule that far out. I should just put a note on my calendar to call the office in December to schedule a January appointment.

After a very thorough examination he turned me back over to nurse Ratched who administered an electrocardiogram. I was directed to the lab and for the usual tests with the usual treatment by the lab tech. I took my massive medical record to cashier to check out, the short distance probably made the difference in whether or not I developed a post-exam hernia. I didn’t.

The cashier handed me an envelop and bid me adieu with a curt “that’s it.” The entire interaction usually ends with a letter (yes snail mail) from Dr. Probst summarizing my health status and his advice for maintaining or improving my health.

Now, I don’t mean to be critical of my doctor or his staff. However, you would expect more from BM. Over two years into Dr. Probst’s  “employment” with the BM, the patient experience is worse than it was when he was independent.

Customer service has declined, they still use paper records, and the process changes that BM has implemented have slowed work flow and made the practice less efficient. There is no way of knowing, but I’ll bet you a steak dinner the costs have gone up, not down.

It simply reinforces my belief that physicians need to form independent groups and lead the change in the health care “system.” Simply extending inefficient hospital processes to the doctors office is not going to improve the quality of care or cut costs. As a patient, something I hope to be only annually in his office, the experience is worse not better.

Oh yeah, the envelope. Apparently (no one told me), the BM need a sample from my next BM. I had to add the postage.

Postscript

The names have been changed to protect the innocent. Imagine how my experience could be improved with a process focus enabled by an electronic medical, or better yet, health record and effect use of the internet.