Doctor Visits

Some days the cynical part of me takes control and starts writing. Today is one of those days.

Let's set the scene. It's a dialysis day. Most of the patients here with me are either sleeping or watching TV. Some do both at the same time!

With all of this activity going on, guess who walks in? A doctor or a nurse practitioner. From what I understand, Medicare requires them to make a monthly visit to see their dialysis patients. It doesn't matter if there are no changes to report or if the patient has any questions. The doctor appears at a convenient day for them to make their rounds. The whole event can take anywhere from 10 - 15 minutes and then like a tornado disappearing back into the clouds, the doctor (or the nurse practitioner) is gone.

While I can't say that I've heard all the conversations that take place, I can tell you what happens when Dr. Frock is in the house to visit his patients. He's got three of us here on Tuesday, Thursday, and Saturday. He generally starts with me.

He gets my latest lab results, which could be 2-4 weeks old, depending on the timing of his visit. He goes over the results, usually in a less detailed manner than the dietician does the first day the results are back in, and then he asks some questions about how I'm feeling, he listens to my heart and lungs, and then rolls on over to my neighbor.

Sometimes, I get bonus coverage, and he'll listen to my fistula (since my fistula has been on the DL for a couple months, he's done this the last two times he's visited) and he'll check my legs for swelling.

Each month I get an Explanation of Benefits report from the insurance company, and there's his visit, listed along with the other items on the report. Any guesses on what the charges are for these visits? Go on, guess. I'll wait.

Since this may differ between patients and insurance carriers, let's just say that the original charge is in the $400 range, but thanks to my insurance carrier, Dr. Frock gets about $150 less than that.

Now, I don't begrudge anyone for making their living. I have grown to respect the care and expertise I've received from the doctors I've encountered. So, before anyone thinks I think the doctors should make these visits for nothing, sit back down in your chair.

If these doctor visits are a Medicare requirement, it would seem to me that a boatload of money could be saved by removing the requirement that these visits have to take place monthly. I don't need to see my doctor monthly. Certainly not for all the information we share. There's no real value in that for me as a patient.

The clinic nurses look out for their patients pretty darn good. When we need something that requires a doctor's approval or input, there's never any hesitation on the staff's part to make contact. If I feel like
I need some questions answered, I could always call Dr. Frock and ask if he could come to the clinic for a visit. A scheduled visit would be more useful for the doctor and the patient.

I know, the cynic in me is probably missing the bigger picture in these visits. On the other hand, with no shortage of patients on dialysis, I don't think that nephrologists are going to be wondering where their next meal is coming from for quite some time.

It should also be clear here that I think Dr. Frock is a fine doctor. I enjoy talking with him, but I lke talking to lots of people. That doesn't mean I want to get a bill for each conversation.

That's my rant for the day. It's something that has always gnawed at me, so I needed to get this off my chest. I'm better now. Do any of the other dialysis patients that may look in on this blog ever wonder about these doctor visits?

Speaking of doctor visits, and taking a much less cynical tone, I'm scheduled to see Dr. Feldhaus today. I'm hoping to hear him give me the all clear, so the nurses can start back to using my fistula. Getting the fistula off the DL  means that I'm closer to getting the catheter removed from my chest. That will be a red letter day for sure!