doctors and groceries and rules

When I see my doctor for a routine check-up, he wants an updated history.  The paperwork he gives to patients for writing that history includes the question, “What concerns would you most like to have addressed today?” and allows space for three short answers.

Sometimes, based on my answers to this question, he has billed for both a physical plus a mid-level appointment.  I’d had no idea that writing something on those little lines turned the appointment into a routine physical plus an extra appointment.  I’m not complaining; my doctor listens to me and always addresses my concerns, so I’m happy to pay whatever is owed.

It was with a bit of surprise, then, that I discovered that this might be a problem.  It doesn’t take much time in the blogosphere to discover that there are doctors who want to limit the number of issues they’ll deal with at one time.  Some doctors say one complaint per visit.  Some say keep it to two or three.

That seems crazy.  When I buy groceries, I go to the store and purchase everything that I need.  I don’t go today for bananas, then tomorrow for tomatoes, and the next day for olives.  I make a list of everything I need, then go to the store one time.  Only when the cupboards are looking bare do I scrape together enough energy to go to the store again.

Like going to the store, I thought it was reasonable to go to the doctor as seldom as possible.  Once it couldn’t be put off any longer, I’d make a list for the doctor and assume that he’d bill based on the complexity of the appointment.

My doctor never indicated frustration with my approach.  Had I known, I could have found a way to make separate appointments for separate issues.  Or at least requested two time-slots when I phoned to schedule an appointment.

The last time I was in my doctor’s office, however, I noticed a new sign on the wall:  Important Information Concerning Multiple Problem Exams.  All concerns will be addressed, however insurance might determine that a second copayment is due based on the complexity of some issues.

It turns out that there are rules to seeking medical care, but patients aren’t allowed to see the rule book.  Everything we know about doctor/patient interactions was picked up from parents and friends, and those people might have been (probably were) wrong.  It’s a case of the blind leading the blind.

Those who know the rules – the doctors themselves – are in the perfect position to teach patients what the rules really are.  That’s one reason I like reading medblogs – and have changed my approach to my doctors based on the things I’ve learned.

Dr. Synonymous  has an interesting post pondering how doctors and patients can protect their relationship.  None of that Patient Centered Medical Home nonsense, where a zillion people come between the doctor and the patient.  I really like DrS’s concept of the Human Centered Health Home, with patients and doctors respecting one another’s time.

I want a rule book!