It's Good to be the King!
|American Tim O'Donnell|
In Your Doctor's Office
The pressures physicians feel these days have never been more intense. The gradual switch to electronic medical records, decreased reimbursements, major alterations to resident education, etc. have many docs changing the style of practice they manage. The use of physician extenders like nurse practitioners, PA's, and Athletic Trainers has never been higher. In many instances this can be a good thing. These bright, motivated medical care givers often have a great deal of knowledge and experience, plus the time to answer questions possibly omitted by the physician or surgeon. They frequently choose this line of work because they enjoy teaching, and your thirsty triathlon loving brain is just what they like.
Let me begin with two stories. First is about a woman with shoulder pain I saw a while back. She complained to her care giver of this problem and it was felt a shoulder MRI was in order. Normal. Once back in the care giver's office, there was consideration that this was potentially of neck origin so an MRI of the neck was ordered. Normal. In short, perhaps choosing a course where an exam by someone who knew a little more about shoulder pain, maybe even some plain x-rays, might have been a more cost saving approach.
That said, I know of two docs in my community who take advantage of this situation. The physician extender not only does the initial work up, orders and interprets tests like MRI's or CT-myelograms, they make the decision for surgery and do the work up, all before the patient has ever even met the surgeon. In fact, it's so bad, rumor has it that one our docs meets the patient for the first time in the OR! 4 years of med school, 5 or more years of surgical training, and the first time they ever lay eyes on the patient is in the OR! Maybe not the best way to practice the profession.
Short of listing some kind of patient bill of rights, in my opinion, this just really short changes the patient, YOU. When you give your history to the doc, your story of the problem, he/she may glean something completely different from your story than the extender. Sometimes, what may seem to you like the smallest detail, can completely change the way the data is interpreted. This then may significantly alter the tests that are ordered and your ultimate treatment. And, in some settings, whether you've seen the physician or not, your charges reflect that you have. Remember to check.
So, think about this next time you need medical care, ask initially what the standard is for this particular medical team or office. Don't be afraid to state your expectations. If things don't seem right, they probably aren't, for you as an individual anyway. And, you can always vote with your feet.