When many people think about the U.S. health care system, they think of hospitals, doctors and nurses.  They may remember when their children were born or the time they spent visiting their grandparents while they were in the hospital.  Professionals in these hospitals care for patients or clients with the goal of making them better.  And while Marcus Welby or Dr, Gregory House may be your image of health care, there is another side we should talk about. 

Health care is a business.  And as a business, one of the primary goals is to make money. 

Now, I know, this is not news.  But we must not lose sight of the conflict between the need to care or cure and the need to make a profit.  It is very real and drives much of the chaos that we experience.

Physicians basically have two things to sell.  Expertise and time.  They are highly educated people who have knowledge and experience that they share with the public for a price.  It’s what they do.  But unlike other businesses, their ability to maximize their earning potential is limited by the number of hours in a day, unless they hire physician extenders like nurse practitioners or physician assistants.  And since they are people, they do other things that people do, like sleep.  So they cannot bill for unlimited hours or minutes because they are human.

Enter the insurance industry.  Physicians or their partners, sign contracts with insurers for members or clients as they say in the industry.  They are paid based on services they provide and based on the number of members they are contracted to care for.  With some managed care contracts, the physician is paid a monthly fee regardless of whether the patient comes in or not. 

Visits to the doctor are measured in minutes, not hours.  The more patients he or she can see, the more money they can potentially make.  It’s that simple.  And they cannot just raise their rates when they feel the need, because most of them have contracts that bind them to a fee structure.  Is it just me or is it getting uncomfortable in here? 

This brings me to my point.  Time is money.  Patients are not widgets. Unlike an assembly line, the doctor cannot turn up the machinery and process more of them. Patients are needy creatures who want the doctor’s time and attention.  What the patient doesn’t understand is that since time is money, they have about 10 minutes to state the problem, get a diagnosis and usually a prescription, and vamoose.

What if you have a lot of problems and it’s going to take longer than 10 minutes? 

Tell the receptionist when you make the appointment that you need an extended time.  You’ll pay for it most likely, but the doctor won’t be double booked while you talk about all of the other issues you brought with you.  If you don’t, you’ll be into the most interesting part of the story, the doctor will edge out the door and you’ll leave feeling like a jilted bride (or groom) at the alter.

This is one of the reasons we should all bring a list of questions to ask, a bag with our medications in it and someone who has a clear head.  This is going to go fast and we’ve got to be prepared!  And of course, we want to be polite and not be late, because after all….. oh, well, you know.

Next time we’ll talk more about time as it relates to tips on working with the office staff. 

Today, I thought we’d take a trip to the doctor.  You know what that’s like.  You wait and wait and when you get in there it seems like you get the bums rush. Most people leave with a prescription or samples, but have no idea what they’re for.  At the end of this exercise, we’re asked for a co-pay or the entire physicians fee or told to make appointments with specialists we’ve never heard of.  If you ask many people what the doctor or nurse practitioner said, they can’t tell you.  

If you read leading magazines, especially those written for parents or families, they will give you advice about going to the doctor.  Some of it is actually good.  First they tell you to have a list of questions for the doctor or NP because we all know they will ask if you have any questions.  We’re even told to write them down so we won’t forget.  Not bad advice especially if you’ve ever had that deer in the headlights feeling leaving the office. Next, we’re told to bring in a list of medications so they know what we’re taking.  This is a good idea, but doesn’t go far enough.  Finally, we’re told to stand up for our rights and make it clear that we won’t wait longer than 10 minutes and if we do, we’ll bill the doctor for OUR time.  This is one of my favorites because it ensures that you will have a really bad relationship with the doctor and even worse, the office staff.

So, let’s take the advice, point by point.  First, it is wise to have a list of questions to ask the doctor or NP.  Write them down and write down the answers as well.  If you have a friend or family member who can go with you, by all means have them in there especially if you are expecting a diagnosis that is new or might require complicated care.  It’s always better to have two sets of ears, especially when yours are terrified. 

Next, bring your medications, not just a list.  Put the bottles in a bag and bring them in with you.  If you are taking supplemental drugs or vitamins, include them.  And if you are doing anything else; eating special foods, herbs or drinking teas, be sure you tell them.  Often we’re not asked about alternative treatment but whether you are asked or not, tell the truth.  Most people who are using over the counter drugs or alternative treatments are afraid to tell that they are.  It’s ok,  your doctor or NP just needs to know to make sure there are no drug interactions or complications as a result. 

Finally, show up a bit early for your appointment.  Be sure they know you’re there and bring something to read in case you have to wait awhile. Whatever you do, don’t alienate the staff.  You want them to care about you, not think you’re a jerk. I know the magazines tell you to stand up for yourself and demand your rights but this is not the time. In the next post we’ll discuss why time is so important and then I think some of this will begin to make sense.        

What I hope to do here is discuss aspects of health care where my experience, contacts and knowledge will shed some light on what has become the most expensive accident our country has known. 

 I"ll keep the introduction short, but I think it's important for you to know that I have been involved with this system for the past 30+ years.  I've been a bedside nurse in large and small hospitals, a manager at clinical sites and in managed care, and an entrepreneur in a small health care business.  While I wouldn't say I have seen it all, I've seen enough.  Health care is changing and it's not changing for the better, either.  Now, I'm teaching in a university school of nursing, working through students to mentor and foster change so they'll be ready when it happens.  I want you to have the same information, so you can navigate the system.

Have you ever bought a car or a house?  Most of us have at some point in our lives.  Not usually a fun experience, but one in which we feel somewhat informed, thanks to readily available information. 

What if I told you that you will spend more money on health care in your lifetime than you will on cars and if you're like most people, houses?  It's true.  Not only is health care expensive, but we will spend an inordinate amount of money on it either directly or indirectly during our lifetime. 


We all ask for services with the belief that we will be well taken care of for a reasonable price.  That's because we trust our health care providers and the hospitals and clinics where we receive treatment.  We don't always trust the car salesman or the realtor. 

So should you trust your doctor, nurse or other provider?  Yes and no.  You should be able to trust that they know what they're talking about unless proven otherwise.  Often they want to work with you and expect that you will know what your goals are and how committed you are to achieving them. 

 You should not go in with blind faith however, and believe the doctor, nurse, etc. "knows best" and will always work in your best interest.  They're people just like we are.  Sometimes they don't know what's best or even what to do. And as people, they often work to their best interest first.  Sound shocking? Welcome to health care!

As your Healthcare Examiner, I hope to kick the tires and look under the hood so to speak.  Let me know if you have questions, thoughts or experiences to share.  I'm looking forward to hearing from you!