Tvo,
I have been chewing on this for a day, and it deserves a whole lot more than a one-liner. Since I have a break, I'm going to try.
The real issue is, of course, not that you envy his ability to spend only 5 minutes with a patient; you envy the fact that he is rewarded for doing so. And that really is the crux of the problem.
There is a physician in town who, like me, comes from an age and program where we were trained and credentialled in GI endoscopy. Like me, he continues to do so. Unlike me, however, every patient coming under his care, for whatever reason, gets both an upper and lower endoscopy. Every one. And, likely more than once. I once had a patient move to my practice and ask if he really needed a third gastroscopy that year for his heartburn. How do you tell that person that they never needed one at all? Yet, this doctor has a number of patients that give him high marks because he is so "thorough."
I try to follow guidelines pretty strictly, not just because it is good medicine, but because I recognize the terrible conflict of interest it sets up in me when I am self-referring for a procedure. Still, I cannot totally help wondering what my income and lifestyle would be like if I emulated my colleague.
Irritable bowel syndrome is a really pretty common condition that we all see. This is what UpToDate says about the appropriate care:
Therapeutic relationship ? The most important component of treatment lies in the establishment of a therapeutic physician-patient relationship. The doctor should be non-judgmental, establish realistic expectations with consistent limits, and involve the patient in treatment decisions [1]. Patients with established, positive physician interactions have fewer IBS-related follow-up visits
How effective would you, I, or Jon be if we tried to do this in 5 minutes?
The reimbursement system in which we find ourselves has been set up by accountants and lawyers. They have never been part of a profession or priesthood where honor and trust are everything. I do not think that those among our profession who follow the black-light arrow around the corner and join them are efficient. I do not think they are "moving with the times". I do not even think they are lost and misguided. I think they are Evil. I feel of them the same as when I turn over a wet rock and see some slimy, crawling thing wriggle away out of the light. I feel revulsion.
Yes, I envy my colleague when he brags about his villa in Spain. But I have no wish to follow him. I hope you don't either.
