Sometimes this board runs the gamut of responses? from the ridiculous (that was mine) to the sublime (David and Jimmie).
The draw of the ?dark side? is ever present and can be insidious. I don't think people generally go into medicine to be greedy bastards; sometimes it just gradually happens. I know David is not picking on gastroenterologists, but the precariousness of our situation is easy to understand. The lopsided reimbursement system is part of the issue. My wife (an internist) spends 40 minutes sorting out the patient?s various medical issues; I spend 5 doing an upper endoscopy and I get paid several times what she gets. Throw in the fact that the anxious patient may feel better after having had the procedure, and is it any wonder that some people make the choice to inappropriately scope rather than to talk? David, you probably spent more time talking that patient out of having an upper endoscopy than it would have taken to do one; and you are left with the uncomfortable worry that he thinks you aren?t ?careful enough?. So much of what we need to do involves education of the patient. Sadly, that is not part of the reimbursement scheme; unless you bill for ?counseling?. You certainly can?t do that with a 2.5 minute visit!
David, your example of irritable bowel syndrome treatment is well taken. Really, though, take that quote (?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?) and isn?t it nearly equally true of managing diabetes, anxiety, obesity, and maybe even hypertension?
tvo, I think you know the answer to your questions. You are doing it right; what you describe IS "standard"...for a crappy doctor providing lousy care.
