By Rob Lamberts, MD

While hard at work at building a new practice and (in the eyes of some) on my insanely misguided effort to build a medical record, I’ve been thinking.  Dangerous thing to do, you know.  It can lead to scary things like ideas, creativity, and change.  I know, I should be satisfied with the usual mental vacuum state, but I’ve found it a very hard habit to kick.  Perhaps there’s a 12-step group for folks with ideas they can’t suppress.

Anyway, my thoughts have centered around explaining what I am doing with all of the my time and energy, and, more importantly, why I am doing all that stuff that keeps me from writing about important things like body odor, accordions, and toddlers with flame-throwers.  I’ve really strayed from the good ol’ days, haven’t I?  The problem is, I’ve grown so accustomed to my nerd persona that I end up giving explanations that are harder to understand.  To combat this, I’ve decided to employ a technique I learned from my formative years: stories with pictures.  My hope is that, through the use of my incredible drawing talent I will not only explain things faster (saving 1000 words per picture), but prevent my readers from falling, as they often do, into a confused slumber.

So, here goes.

Adventures in Health Care: Part 1 – The Participants

This is a patient.  Let’s call him “Chuck.”  Chuck is not really a “patient,” he’s a person.  Many doctors believe that people like Chuck don’t exist outside of their role as “patients,” but this has been proven false (thanks to the tireless work of Oprah and ePatient Dave). But since this story is about Chuck’s wacky adventures in health care, we will mainly think of Chuck in his role of “patient.”

Why are people like Chuck called “patients?”  Some people think it’s to put them in their necessary subservient place in the system.  I think it’s just to be ironic.

Chuck is a generally healthy guy, but occasionally he does get sick.  He also worries about getting sick in the future, and want’s to keep himself as healthy as possible.  This is when he uses the health care system, and when he is forced to be “patient.”

This is Chuck’s Family.  It’s the main reason he wants to stay healthy and avoid being a “patient.”  He has a lovely wife, two adorable children, and a cat that likes to ride around the house on a Roomba.  I suspect you’ve heard about the cat; he’s gotten pretty famous.  Chuck’s family wants him to stay around for a long time so he can pay bills, share his expert opinion on whether an outfit makes his wife’s butt look fat, lecture the kids about the dangers of drugs and Cartoon Network, and answer his cat’s voluminous fan mail.  He would also like to live to be able to see his grandchildren (although he’s not sure his kids will survive that long).

This is Chuck’s doctor, Dr. Ron.  Dr. Ron is a “primary care provider,” or PCP.  Ron never particularly liked being called a “provider,” but the peer pressure from the insurance companies and the other “cooler” doctors (specialists) have made Ron accept this name without thinking any more.  Primary care doctors are also called “generalists,” but are known to hospital administrators, insurance company barons, and the “cool” specialists as:

1. Referral sources
2. The ones to blame
3. Cannon fodder for insurance contracts
4. The guys who can’t afford the cars we drive.

Like most primary care doctors, Ron is very, very busy.  He doesn’t feel like he’s got much of a choice, as it’s the only way he can make enough to pay his student loans and still have enough for his loan on his Kia. This causes the following deadly consequences:

• Spending all day seeing patients in the office gives him little time for anything else.
• He doesn’t answer questions over the phone, instead making patients come in for anything that takes more than three words to answer.
• This makes his office visit workload even heavier, and makes the average visit be about less “exciting” problems.
• Ron then wonders why his patients come to him for such small problems.

Last week, Chuck hurt his back (while trying to avoid his cat) and wasn’t sure what to do about it.  He didn’t initially go to the doctor, but did what most people do when they have a question: checked the Internet.  He doesn’t like doing this, though, as it usually confuses him more.  Besides, he’s heard that doctors get mad if you look things up on the Internet.

He gave up trying to find answers on his own, called Dr. Ron’s office, and was set-up with an appointment.  This meant that he had to take time off of work, wait in the office for a long time, and then fit all of his questions into the brief time Dr. Ron is in the exam room and not focused on documentation. This usually is about 30 seconds.  But this is what Chuck, and everyone else in the country is used to, so Chuck puts up with the inconvenience this causes, dutifully paying his copay for those precious 30 seconds of attention.

In truth, Dr. Ron is not too happy with this arrangement. He went into medicine because he thought it would be cool to help people, have awesome knowledge nobody else knew, and to make his mom proud. He likes taking care of people, but is finding less and less of what he went into medicine for. Each year it seems like he spends less time with his patients, and more time with his computer.

This got much worse in the past few years as the government decided all doctors should be using computers in a “meaningful and useful” way. Unfortunately, “meaningful” and “useful are defined by the government, not doctors and patients, and Ron is not quite sure if the government wasn’t just being ironic when they decided on these definitions.

Despite the difficulties, Chuck likes Dr. Ron, who seems to spend more time with him and listen to his problems more than other doctors he’s had. A few times Dr. Ron spent a whopping 5 minutes talking with Chuck and answering his questions. This made Chuck feel a bit guilty, as Dr. Ron seemed pretty tired and stressed out.

Adventures in Health Care-Part II

Why, many may ask do I use “quotes” when I use the name “Chuck.”  To this, I respond, that it’s a “secret.”  Maybe you should get a “life.”

So when last we left Chuck, he was in the office of his “Primary Care Provider,” Dr. Ron.  Chuck fell over his cat and injured his back.  He didn’t think he had a problem that needed a doctor’s attention, but when he went to the Internet for answers (which everyone does, in case you didn’t know), he only got more confused (and a little scared).  He needed advice from someone he trusts, and, despite the wait times and co-pays, he likes and trusts Dr. Ron.

So, being the good soldier within the patient brigade, Chuck takes the whole afternoon off and sets his mind toward the exciting prospect of the hours of excitement at Dr. Ron’s office.

Despite the seeming reality TV scene in the waiting room, Chuck is happy to be in a place where he can get concrete answers to his questions and an end to his pain.  For Chuck, as with most patients, the visit to the doctor should go like this:

Step 1:  Chuck tells the doctor his problem.  Doctor Ron listens and knows what is wrong.

Step 2: Doctor tells Chuck what is causes his problem and comes up with a solution.

Step 3: Problem gone, Chuck can once again pursue his dream of being center fielder for the Toledo Mud Hens, and Dr. Ron is thrilled to be part of his success.

Not to be outdone in the expectations department, Dr. Ron expects the visit to happen like this:

1. Patient has questions and problems which Dr. Ron answers and solves (respectively).

2.  Patient happily pays for the encounter, as do all his satisfied customers.

3. Successful in medicine, Ron turns to his hidden fantasy: to compete on (and win) the popular “Doctor Idol” TV show.  His patients are proud of him.

So what’s wrong with these pictures (besides obvious anatomical inconsistencies, such as the regular disappearance of noses)?

Stay tuned….

Rob Lamberts, MD, is a primary care physician practicing somewhere in the southeastern United States. He blogs regularly at More Musings (of a Distractible Kind), where this post first appeared. For some strange reason, he is often stopped by strangers on the street who mistake him for former Atlanta Braves star John Smoltz and ask “Hey, are you John Smoltz?” He is not John Smoltz. He is not a former major league baseball player. He is a primary care physician.