Merigian Studios


Times and Behavior are Changing

Times and Behavior are Changing

Every day goes by quickly now. June has almost ended, giving way to July. July is an extremely busy month, juggling the schedule to meet everyone's demands is becoming a task beyond that of a mortal office staff. Last minute cancellations are creating havoc in the operations of the office. One particular new patient has cancelled three times, less than one day before his initial evaluation. It's odd. I understand urgent or emergent needs to reschedule, or leaving the office because the wait to see me is "too long." However, rescheduling three times is not something I am willing to tolerate. Times they are a changing.

 Why is rescheduling a patient so difficult? Especially a new patient who allegedly has a problem that is complicated, severe and life altering? Well, it's because I typically spend three hours sifting through medical records, history taking, and performing physical examinations when necessary and going over complex physiologic explanations with each patient so that they can get a firm understanding of the multiple disturbances contributing to their symptoms. The human body is not linear, it is fractal, just like tree leaves, insects and all other living creatures that happen to inhabit our planet. Typically, severely ill patients cannot come to our office at a moment's notice when they are suffering and require assistance for travel. Even though we are booking in February 2018 for new patient visits, most of them are very ill and they cannot just hop, skip and jump their way to the Stone without at least a week's notice.

 A patient who desires to be seen at the Stone and at the same time cancels their appointment at the very last minute two or three times is probably someone who really does not need to see me at all. One major downside of their decision to schedule and cancel at the last minute is that they have kept others from being seen in our office who probably need to see us sooner rather than later.

 The niche I fill in our medical community is rather unique, as someone in medical practice once put it, "He sees Mayo Sick patients. I don't want to see those patients. Neither does anyone else." I have an office filled with patients who have rare diseases and medical problems that appear to be undiagnosed by multiple specialists working independent of each other on their cases. These patients have multiple specialists who have no synergy between their evaluations and treatments. They participate in therapeutic adventures leading to nowhere.

 Talking with my medical and administrative staff this week, we have come up with several changes that will be put into effect as soon as we get the kinks ironed out. I am not trying to place barriers to care by any measure, but the idea that patients want to schedule appointments, ask me to see them more frequently than I deem necessary, and then cancel their appointments due to taking some unforeseen vacation to Florida or having an unexpected visit from their grandparents is unacceptable. On the other hand, I am required by the State Medical Board to have an ongoing patient-physician relationship in order to continue to prescribe medications for their illnesses. Some patients conveniently disappear for eighteen to twenty-four months (cancelling appointments or just not showing up), but expect their prescriptions monthly.

 I agree that many of my patients do not need more than a yearly limited routine blood test and a review of the test results, however the Medical Board of Tennessee sets the Standard of Practice, not the patient nor the physician. Although there is this idea that we live in a free country and we can do anything we want, when we want, but it's an illusion. There are hundreds of restrictions that we seldom view as altering our freedom, but they do. We must abide by the State Medical Board's rules whether we agree with them or not. Yearly examinations are State law.

 What's the new paradigm? It's rather simple. I will see new patients three times per week and help them as much as possible over a two or three month period of time. Then I will ask that they choose from two options for their follow-up care over the twelve month period of time. One option will be to pay a physician retainer fee up front, to guarantee that they have access to my expertise and be a priority if scheduling becomes complicated and difficult. The other plan is that they will be given the option to pay as they go, but the fees are going to increase for follow-up care episodes on an individual basis. Some patients require much more follow-up care, some require just a yearly examination. The plans will be customized to meet each patient's needs, as they see their care needs increase or decrease.

 Recently, one of our complicated long term care patient's father decided I was too expensive once I re-lifed his daughter from an extremely ill state; he could no longer pay for his daughter's care. He made arrangements with another healthcare provider on his insurance plan and asked me to guide his daughter's care through that physician. I freely gave of my time and knowledge. However, every time there was a change in his daughter's condition, her father sought my advice, not the counsel of the physician-in-charge paid for by the medical insurance plan. In addition, her father wanted me to call him at the end of my work day to review her care. A simple discussion lasted forty-five minutes. I had to stop answering his requests to speak to him. I hope his daughter is well now.

 There are many variations of the above theme. I recognize that each of us, myself included, must make decisions about the amount of money we are willing to spend for the healthcare of our children, our spouse and our selves. Good health is the single most important confounding variable in living a vibrant, active and purposeful life. I have found that many patients value conforming to their social community's collective vision of what's most important in life (big house, pool, four cars, three family vacations per year, expensive hair salon visits, private school) and just plain ole stuff over good health. As I was solicited by a preacher one time for a donation, he told me that people give money to those charities that are attached to their heart. He was surprised when I told him he and his preaching was not singing to my heart as I exited the church door.

 Paying a fair price for health services is not a God thing, it is a human thing. Caring enough to keep your commitments to yourself first and others second is directly proportional to good health, regardless of your current situation. Making sure you keep your new patient appointment is the first step in maintaining and sometimes saving your health.

 In the future, cancelling your first appointment will probably be your last. Cancelling a follow-up appointments at the last minute will not exit someone from the practice, but they'll have to pay for their next appointment up-front with no refund if they don't show up.

 This information and more will be in the newly revised patient care contract. Human behavior is both interesting and unpredictable at the same time. I guess that's why we have to change our process to meet the demands of our new patients. We have to be fluid and responsive to those who want to be a patient at the Stone Institute.

 Times and behaviors have changed. Now we need to change to meet the demands.






Posted by Amanda Sanders at 11:18 AM
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