As a child, I knew our family physician as a kindly guy who came to the house with his small medical bag, checked my temperature, wrote a script and left. You didn't have to go to his office, he came to you. Times have changed in many things and in medicine it has been a huge change, but one thing is coming back; docs are making house calls. Of course, it's not your friendly doc you've known for years, but a new doc each time because they work for a service that makes house calls.
Our doc met an untimely death due to a few thugs hanging around
until he had seen all the patients in his packed waiting room (he only charged $5 for an office visit) left. Then, they brazenly marched into his office, pistol-whipped him into unconsciousness and stole all the drugs they could find. His nurse had left for the day, so Ronnie, wasn't around to yell for help.
Lost eyesight, poor balance and, eventually, death from multiple injuries resulted in a community in desperate need of a physician, who wasn't in it for the money, having no one. The loss was significant. The poor people "down the hill" had to go to the ER, if they could get there, or make their way to the friendly family-owned pharmacy where help might be available. I got my cuts ministered to there as a child and I will never forget to be grateful to Mr. Himmelfarb, who we called "doc."
Today, I find I've had more experience than I care to in terms of interacting with medical staff, especially physicians. Now, physicians work in group practices where they go from office to office in three towns and perform procedures that hospitals won't like expensive MRIs or injections in the spine for pain.
The business is quite lucrative and there is no provision made for any emergencies, even for those in the waiting room. The local EMTs or ER services aren't exactly an extension of their practices so much as a nice, free addition to their practices.
Signs in the physician offices indicate that late arrivals for appointments will be charged $50 and anyone who doesn't give 24-hours notice of cancellation of an appointment, will be bill for $150. And if you can't pay it or your insurance company won't pay for it, what do they do? Sue you. Yes, that's another lucrative business; medical lawsuits against patients. Bills from physicians' offices now state that your bill will be submitted to a collection agency if you are delinquent in your payment.
Where, oh, where is Dr. Shapkin when you need him now?
In the USA, 100 million people suffer from a pain syndrome, so it's a very, very lucrative field to enter. Recently, I was attempting to help a friend find someone to help her with intractable pain. No pain meds worked and she was experiencing intolerable pain with each heel strike.
Barely able to get into my car, after a short and truly traumatic, unprofessional and unhelpful hospital stay (the neurologist had all of four years experience post-residency), we made the trek to a female physiatrist who was described as the maven. We went to this woman based on reputation and the fact that the other maven couldn't give an appointment for three months. Imagine being in pain for three months?
Of course, his office said that people who want appointments, CALL EVERY DAY to see if there's been a cancellation. The office does not call patients on a waiting list. It's all up to the patient in pain.
A graduate of an ivy league college and an outstanding medical school, this woman was all professional, but the only time my friend saw her was just prior to the epidural injection to ease her pain. Before that, my friend had to have an appointment with an associate, a DO who is not board certified in his specialty and has no privileges at any hospital. That should have signaled something to us, but it didn't. Examining my friend, he intensified her pain in another area as he manipulated her leg. Again, not good.
The procedure went well but there was some confusion about any medication she should take afterward and the degree of pain or relief she would experience and when. Nurse said weeks, doc said days.
She asked to have the physiatrist call her to clarify the differing opinions. No, the woman never speaks to patients afterward and doesn't make any appointments with them after the procedure; everyone goes to that DO associate. Is this arrogance or a woman acting like a medical mechanic? Why didn't she just go into anesthesiology? There you never see the patient again and you collect a hefty fee for your one-time service.
How do you not tell a patient that they'll be seen only for the procedure and then the physiatrist will wash her hands of them? Is this unethical and not in compliance with complete disclosure? I think it is. The woman isn't just someone with a candy store office. She works in several offices and is chief at the hospital where she performs epidurals only on an outpatient basis; insurance won't pay for inpatient was their explanation.
All of this isn't to grouse about how dismal medicine has become in the US. It is an effort to make you a more informed medical consumer. Some question may not occur to you because you assume that you don't have to ask them; you know who your doc will be. Oh, no you don't as I've just illustrated.
To be continued in this ongoing saga.