Roy:
Some other thoughts:
1. Non-compliance seems to me to be equal-opportunity. Some of my best insured and best educated patients think they know too much to take my advice.
2. Non-compliance due to financial constraints can be propagated by physicians. I freely admit that I don't have a comprehensive grasp of which meds are expensive vs affordable, generic vs non-generic. I am also sometimes unconscious of the financial status of my patient and I don't find out that they didn't fill my Rx because of expense until months later. I can tell you from experience that this is not a problem in a cash-only clinic; NOBODY is insured, and so you do get attuned to cost.
3. As far as the sample closet goes, mine is perpetually stocked with dust-covered bottles (with a few exceptions), much to the chagrin of the drug reps. I only use the samples to make sure someone can tolerate a medicine they can afford to buy. Otherwise, what's the point? I've tried to keep patients afloat in Lipitor for months at a time. One day, they come in and you don't have any. Better to start someone on a generic from the very first (thank you WalMart four dollar list).
4. Again, phone abusers and no-shows, in my experience, are equal-opportunity.
My phone policy is to let my nurse screen all calls first. If there is an issue that really needs to be addressed BY ME, I make a judgment about whether the issue is one that I should have addressed in the context of our last visit (in which case I call), or if this is a new problem (in which case they need to make an appointment). This would be my policy regardless. I would say that there might be less attempts at free phone advice if we weren't forced to run from room to room so much.
I don't have a lot of patience with no-show patients in my practice. However, again to be fair, I think the cash-only no-show patients might be (in part) a problem we create by policies that are hostile to patients who don't have insurance.
I will tell you who I find to be the biggest misusers and abusers of medical resources: Medicaid patients. Who is more likely to view medical care more lightly: the guy who pays $45 cash, or the guy who pays *nothing*?
BC
