I have a confession, I have been purposely mean to my patients in hopes that some of them would leave my panel. It's been too busy and I can't keep up with the volume. Being bombarded with a constant barrage of patients I have turned into a young tired doctor. Maybe by being a dick some of these folks will leave. I choose who to be mean. They're the folks who abuse the system. The normal folks I'm still nice.
A quick rant
Screw you Medi-Cal/Medic-Aid. You pay me 10% of the bill and expect me to keep quality of care.
Screw you demanding patients with the crappy insurance medi-cal/medic-aid. Your insurance pays crap and fewer and fewer doctors take your insurance. I'm doing community service by seeing you. Stop demanding all kinds of meds and equipment. It's not covered. Finally stop asking for Ensure because it's a ton of paperwork and it will get denied in the end.
Screw you patients who come in without an appointment and demand to be seen. Have you heard of a telephone! Damn, call ahead.
Screw you patients who demand antibiotics at the first sign of a flu. Antibiotics dont help a flu. You have to get over it the old fashioned way with fluids, rest, and time. It's normal to get sick 4-6 times a year. The flu has been with mankind for eternity. The H1N1 flu aka swine flu is still a flu. Most of us get better. Wait 48hrs before you freak out and come in. See also rant above.
____________________________
I've been busy, maybe too busy. I need to vent somewhere and this anonymous place was as good place as any.
1. I am at my peak mental capacity in the morning between 9-11. My second wind is from 200-330PM. If you come late or walk in right before lunch or at 5pm, I'm tiring out and am at lower efficiency.
2. I hate you if you come right before lunch or 5pm. I'll only do what's needed at that point.
3. I am a healthy guy and expect other guys to do the same. If a guy were to come for simple colds, I'd think he's a pussy. Man, suck it up!!
4. I'm more lenient on females for some reason. I won't think you're a wimp to see me for colds.
5. If you come in looking nice and clean, I'm nicer to you.
6. If you stink, I'm going to get you out fast. You know who you are!
7. Primary care docs like myself don't make as much as the specialists. You're not doing me a favor by seeing me a lot, you're just clogging up my schedule.
8. I have a lot of Medic-Aid patients (Medi-CAL for those in California). I call that insurance pseudo-insurance. It's shitty pay and I break even by seeing you. I consider it charity work.
9. I'm a bit nicer to folks with good insurance. A smidgen only, not a lot.
10. Double standard? You betcha. I want to keep the patients that will pay my bills and overhead. Charity doesn't pay my bills. A lot of doctor's don't even accept that insurance FYI.
11. If you play by the rules, I'm super nice to you. That means you listen to me, do what's expected, and keep yourself healthy. I love patients like you even if you have shitty insurance.
12. Don't call me by my first name. Call me Dr. There are a handful of patients who call me by my first name and most of them are family. The rest needs to get with the program.
13. Sometimes I want to write "stupid idiot" or "fucking crazy" for the diagnoses. However, they are no diagnoses codes for them so I can't bill.
14. I think "crazy parents" should be a billable diagnoses. I remember the crazy parents more than the normal parents. The crazy parents bring their kids in ALL the time for minor stuff.
15. Pharmaceutical representatives are a necessary evil. I hate seeing them but I need some of their free meds to give out. If I were to rate their usefulness in 1-10, I'd give them a 5. I'm not nicer to the hot female reps either. They're all the same to me.
This was inspired by some random confessions I read elsewhere. I've been too busy in life to blog anymore. Even with the recession, my office retains the volume. Regardless of money, people are coming to the doctor for health issues. Life moves so fast, I have to keep reminding myself to relax and enjoy life.
I was watching the Miss Universe yesterday.I only wanted to watch the introductions and
the swimsuit competition.After that,
the show takes a dive in my opinion.Honestly, who wants to watch the evening dress competition or the interview?B-O-R-I-N-G!Ms. Venezuela
deserved her title, she was hot.After
the swimsuit part, I flipped channels.
During the show, I saw a familiar face as one of the
judges.It was Taryn Rose.She was my exgf’s sister a long time ago.She has struck quite a name for herself in
the fashion business selling expensive shoes.
It was a flashback to the past.Seeing people succeed is pretty cool.It almost makes me want to go to my upcoming high
school reunion.I doubt I’ll attend my
reunion because I wasn’t very active or particularly popular in high
school.Attending the reunion would be
meaningless unless I wanted to show off... which I don't.
I have a lot of patients that are new immigrants to the US.They come from third world Asian countries
like Thailand, Vietnam,
China, and Philippines.These patients will often come to my office
right after immigrating to the US.
At their first visit, I can see the smiles and excitement in
their faces mixed with a little fear.To
them they escaped poverty in their homeland and are now in the American
Dream.They have a lot of beliefs and
expectations about living here.There is
money to be made if you work hard and these people want to work hard.
I know that with time reality will come down hard.Living in the US
is hard.Making money is hard and working
hard doesn’t always translate into success.As their optimism diminishes, these folks will come see me often for
mixed complaints.Stress manifesting as
aches and pains.Worry causing insomnia
and fatigue. They will obsess about
their health.
I try to be patient during the obsessive stage.They are going through the grim reality that life
in the US is
tough.I try to assure them that their
aches and pains are just aches and pains. I explain western medicine still has a lot of
limitations and that sometimes you just have to wait things out.
Finally, these immigrants will adjust to their new life in
the US.Some will regret moving to the US.Some will succeed.Many will put their hopes and dreams in their
kids and hope that the next generation will succeed.
Here is an example:
Mr. P emigrated from Thailand
at 55yrs old.He has a wife and 2
kids.I suspect he was wealthy in Thailand
because his whole family was hefty.In a
land of thin undernourished people, a chunky family sticks out.In the US
he had difficulty finding work and ultimately worked for an Asian grocery store
as a loader.The stressful job and the
uncertainty of their economics lead him to develop back pain and chronic
fatigue.Later he quit his job and
started work in a car wash.He told me
on a good day he made $50 dollars.I saw
him again recently and he broke down about his life and his regret about
bringing the family to the US.He cried briefly and then regained his
composure.He apologized and left.
Mr. P was a walking time bomb.He is a fifty something year old male with
poorly controlled diabetes, hypertension, and high cholesterol.However, his worst problem was his denial.He wouldn’t take his medications nor follow
my advice.He was one of those
non-compliant patients who visited their doctor but didn’t follow orders.
He visited me sporadically for minor aches and pains.At each visit, I’d notice he hasn’t been
taking his medicines and I would urge him to comply.He would say the right things so he can get
out the door and disappear.At first I
tried to be nice to get him to comply but to no avail.Next I tried scare tactics and told him he
was going to “expire early.”When that
didn’t work, I tried using his wife and daughter as a means of leverage.That didn’t work either and then I tried
being mean.I yelled and even threatened
to fire him as a patient. Of course that
didn’t work either yet he still visited me in the office. Finally, I just resigned myself to wait for
the impending train wreck.
It didn’t take long.A year later he was admitted to the hospital with multiple organ
failures.He recovered from that
prolonged hospitalization and returned to my office.Now he comes to the office almost
biweekly.His life is now seeing several
doctors each week:a nephrologist, a
cardiologist, a neurologist, an ophthalmologist, an endocrinologist, and I.
I look at him and I think all this could be avoided if he followed
the regimen.I don’t understand why he
would ignore all the advice.Was it a
deathwish?Did he think he was
invincible?Why destroy your body?I have so many questions to ask him
especially, “What the hell are you thinking?”
I was right but saying “I told you so” is meaningless.He is a broken man now physically and
mentally.
This was one of those moments when being right means nothing.
