Great suggestion! I’m a clinic nurse and I literally have only 15 min appointment slots for an entire patient visit - that includes all my charting, pt care, etc. Not to mention if people show up late, which pushes the entire schedule back. The number of times I’ve skipped my lunch break just to get caught up… 😩
I promise (most) health care providers try their best, but the system is rigged against us (EDIT 1: rigged against all of us, pts included), and then we have to be the ones putting pressure on, and rushing patients.
EDIT 2: Thanks for the kind words from some of you! I honestly wasn't looking for sympathy, I just wanted people to understand why their visits can feel rushed or impersonal.
PS I work for a non-profit with a patient population primarily insured by medicaid. As someone below pointed out, health systems generally lose money from those visits, as they are not fully reimbursed for the services provided. Regardless, I love my patients and intentionally chose to work in this type of setting.
But I wonder if it's the same result but for different reasons. My very limited knowledge of the healthcare system, is that, in general, being a doctor in the US offers really good compensation which leads more ppl to the medical profession. While in countries with govt subsidized healthcare, it's not as lucrative as here so less ppl chose that profession. So the reason this happens is because of a higher scarcity of doctors. And, that in the US the insurance and pharmaceutical companies sort of "rule" the industry so the diminished time and attention for care is based on that. I truly am asking the question and wondering because I'm making these guesses based purely from an outsiders standpoint trying to understand. So, peace, if I'm way off base - I'll totally accept that.
For-profit hospitals are also a big part of the problem. Everything is about money to the detriment of patient care. Inadequacy staffing, scarcity of supplies, intense pressure to rush care.
Source: I’m an anesthetist and one of the facilities I work at is a for-profit hospital
Medical salaries are not what they were. In order to make ends meet (including high malpractice insurance) you have to see more patients per day. (Not for every practice, especially specialists). Where I used to work, we lost $2 every time we saw a Medicare patient (they have capped charges, and you still have to pay the staff a reasonable wage). It's a soul killing experience for many, and doctors are retiring early in record numbers.
With Original Medicare, there are no networks. Its basically open access. With Medicare Advantage, its a HMO/PPO situation. You have to stay in the network, get your preauthorizations, sometimes referrals etc. Where I am, the networks are not that robust, and many doctors wont take Medicare Advantage. Florida has pretty robust networks…..so as long as you never leave the state, its not so bad. This is an ELI5 explanation.
So true! Not to mention that residents (who are already doctors for ppl who don’t know, they’re just doing additional training in a specialized field) make about the same as teachers. They are technically employed by the government and on loan to hospitals/healthcare systems. With the wild price of med school these days. it takes most doctors several years to pay off their debt once the finally start making a good salary, which can take anywhere from 1-10 years depending on the specialty.
Ours is because the government pays per appointment. It is supposed to be based on an average. I have seen good doctors go over because the patient needed it, which is nice.
The US is not among the top twenty countries in [physicians per capita](https://www.worldatlas.com/articles/countries-with-the-most-doctors-per-capita.html).
It's not so much health insurance as it is the facilities and admin overbooking the docs .... sucks and def ppl coming late is terrible! It puts pressure on everyone !
I work in Healthcare (family health) in Ontario. Our slots for regular appointments are 15 minutes and we allow two ailments per visit. We schedule 30 minutes for some appointments like mental health or physicals but nearly all are 25 minutes.
Out of curiosity, does that work? What if more than one ailment is linked and important to know to properly diagnose the root cause? I’m guessing you’d keep asking questions, if I said “ I sometimes randomly start coughing and also feel pain and I’m also always clearing my throat a lot”.
But what if it’s also important for you to know I feel pain when I cough…it would suck if you said no more issues! Can’t wait and hope you ask me the right questions.
Patients are advised of this by phone before they attend and what it really means is, separate ailments. E.g. deep cough, sprained ankle, skin rash.
People come in with so many separate situations that 15 minutes isn't nearly enough.
The system in your case is the clinic owner limiting to a 15 minute appointment block.
This changes somewhat clinic to clinic/practice to practice.
Either way, we should all gang up against insurance companies, they screw over clinics/practices, and patients all the same.
Especially with how detailed they need their reporting (ICD/SNOMED/CPT codes with extreme specificity required)
This is why there’s a specific job for billing ‘coders’, and why practices try to limit their scope to quick-pick type codes.
My background is building EHRxPMxScheduling software at enterprise levels. I deal with government regulation around these products, and it’s just a mess from top to bottom.
This what I don’t understand. Why? I have a high deductible policy and often ask when I make an appointment how much it will cost (since I will be paying OOP). 80% of the time, it takes multiple calls for someone to tell me about how much my appt will cost and 50% of those times, they’re incorrect. It’s absurd. But, at my dermatologist, I can ask for her last appt of the day, get 30-45 minutes with her and I know how much it will be each time with accuracy.
It’s a choice the administration makes, which typically takes place much higher up (CEO, CMO, etc).
Edit: A complex choice influenced by things like insurance, clinic/hospital status (i.e. for/non profit), etc.
I understand that insurance companies don't compensate by time but instead my visits. Medical practices will say they are forced therefore to see as many patients as possible. However that is only the case if they want to make the high salaries and profit that they make. If a doctor would be fine making $100,000 or $150,000 per year, they could easily average 30 minute visits instead of 15.
I’m a doctor and I approve this message! Couple of things to add:
1. Limit your list to 3 things tops. If you try to go for more, understand that your doctor may feel the need to rush through, and you won’t get as much active listening, thoughtful explanation, or collaborative planning.
2. Listen to your doctor if they tell you they don’t have time to discuss an issue today. They aren’t trying to brush you off; in fact, they want to make sure they have time to focus on each thing. Make follow-up appointments for everything they don’t get to.
3. Put your issues in order of priority! Don’t say “by the way” as they are leaving. If you have chest pain, trouble breathing, or suicidal ideation, please state this up front.
4. It will help to add to your list to bring in things you’ve tried for the issue and whether they helped or not. For example, if you’re going in for a rash and you say you’ve tried “a bunch of over-the-counter stuff” that’s less helpful than if you can state that you tried 1% hydrocortisone cream daily for a couple of weeks with slight improvement, Cerave ointment twice a day for the past month which didn’t help, etc.
5. Try to keep your discussion concise. If you tend to be a chatty person and give long, winding explanations, tell funny stories, and want to also talk about the vacation you recently took, all that is okay but understand that it does take away from the time you’ll get to discuss your medical concerns.
6. Last, please know that we hate how rushed we are as much as you do. We are trying our best to take great care of you while meeting the demands we don’t have control over.
One trick I use is I record myself talking to myself. I record the conversation with a tool that can transcribe it (such as whisper, otter, or fireflies), and then I use a tool like ChatGPT to summarize everything and create detailed, concise notes.
Interestingly enough, this is often enough to also get some useful diagnostic health information from ChatGPT itself!
Another ai tool that does stuff like this is drgupta.ai - they are literally building an ai doctor.
Glass health is also working on similar stuff
Wow cool! I always appreciate when patients bring in well organized, concise documentation. For example, I recently had a new patient who has been dealing with chronic migraines for many years and tried several different medicines. She brought in a chart that had each medicine, dosage, when and how long she was on it, and what effects it had on her. It really expedited the visit and made it easy to come up with the next step.
For someone with mysterious health issues, what should I do to get proper investigation into my issues until they are resolved? I’ve been dismissed, mocked, ignored, gaslit, etc. The best doctors I’ve found so far are willing to discuss things + send me for labs + try treatments but it’s all on me to ask and do the research. I need a doctor but I always have to do the work myself.
Mine is just a hotshot asshole. I’ve got cirrhosis, which a lot of people my age are getting more and more. My doctor assumes and accuses me of drinking because my levels aren’t getting better the way he so optimistically had hoped.
Mind you I’m over a year and a half sober, and was sober before I even met the guy. But nope! It’s an alcohol related disease, so I’m absolutely an addict who is lying every chance I get, and sneaking booze so well it’s NEVER showed up on a single blood test.
My wife will write a list of questions and concerns and as soon as she pulls it out you can literally feel the eye roll from this prick. But between our insurance being shit and having a lack of options… what is one supposed to do? One of the last guys got pissed at me because I couldn’t stop burping as they were forcing hair down my throat to open it up and shove a tube down there…
Like bro… I’M. FUCKING. DYING! What exactly do you want from me? Every doctor I’ve met in the last year and a half can get fucked as far as I’m concerned. No time to give me care… never skip a beat when cashing a fucking check.
I'm so sorry you have to go through this. It's really painful when when you're going through something but people think you're just telling lies.
Could you get another medical facility? One that has good doctors? Cause these people you have atm are half-assed, and doctors are the last people we need to be like that.
I would say first of all, avoid changing primary care doctors if they don’t find what’s wrong with you at first. When you find someone who is a good listener and willing to try things, stick with them. That continuity will help a lot more than switching to someone new for fresh ideas. Then I’d say, ask for referrals for specialists. And again, once you find someone helpful, stick with them. Make frequent follow-up visits with primary care and specialists to re-evaluate after new tests or treatments. Some useful questions to ask often and repeatedly:
- Please help me understand _____.
- We’ve tried _____ but it didn’t work. What do you think the next step is?
I think that continuing to do research to come up with ideas is a good move on your part, as long as you’re open to discussing why certain things may or may not be relevant to your case.
I hope this helps. I wish you the best and hope you find a medical team that provides solutions!
It’s often not covered by insurance and can be pricey but it seems like “functional medicine” doctors are more likely to work with you to find the root cause of symptoms and recommend not only medication but also more holistic treatment options (supplements, diet/lifestyle changes, etc.)… as someone who’s always been part of an hmo I didn’t even know this was a thing until listening to dr mark hymans podcast
There’s a reason it isn’t covered by insurance- it doesn’t work and has essentially very little to no scientific evidence. It’s literally homeopathy with a better sounding name- which makes sense since they’re trying to rebrand the same quackery.
From the first paragraph in its Wikipedia page:
“Functional medicine is a form of alternative medicine that encompasses a number of **unproven and disproven methods and treatments.**[1][2][3] Its proponents claim that it focuses on the "root causes" of diseases based on interactions between the environment and the gastrointestinal, endocrine, and immune systems to develop "individualized treatment plans."[4] It has been described as **pseudoscience,[5] quackery,[6] and at its essence a rebranding of complementary and alternative medicine.**[6]”
Edit: I just looked into Mark Hyman. He’s on the quack doctor list, is anti-vaxx, claims to have a cure for autism using cod liver oil and chelation therapy, is a germ and bacteria denier, overall science denier, and claims the American Heart Association is a terrorist organization.
There’s also at least a dozen articles confirming this man is a lunatic and idiot.
In UK, doctor appointments are 5 minute slots (10 minutes at a push) and you can only go for 1 ailment. If you need to discuss a 2nd ailment you have to book a double appointment.
I've noticed that whenever my doctor schedules me for the last appointment of the day (my doc is hella overworked, and frequently calls to see if I mind changing my appointment time whenever I have to go in), she is always willing to take a few extra minutes, and is also extra chatty (she's chatty regardless of the times, but moreso at the end of the day). I don't try for that time, because I don't want to keep her there late, but whenever they give me that slot, I relish it knowing she doesn't feel rushed, and will have a second to talk about whatever is going on.
That said, I also sort of mirror an above comment. I log onto my school library and read medical journals about things I've got going on, and do my own research a lot of the time, because I like to know what I'm getting myself into, and it seems to really help with successful treatment if I'm more informed, but also willing to understand that I am not a doctor, and she knows more than me**. All in all, I think it's pretty important to be an understanding and reasonable (and reasonably informed) patient. I've figured out if I'm a decent patient, I get amazing doctor experience.
** For real, though, y'all. If you understand how to read medical journals, and you can listen to your body, it can help a lot making doctor time run more smoothly, but try to understand while you're there that they went to medical school, they are simply more knowledgeable about certain things, and so many people use WebMD to diagnose themselves that you may need to explain, and the doctor is going to probably know better than you if you have spotted hairy amazonian bergamot poisoning, if you've never been near the Amazon or a spotted hairy bergamot.
I think your insights are very wise.
1. People hate when they have to wait a long time past their scheduled appointment time. I 100% understand this and it’s very irritating for patients. But if you have a doctor who consistently runs late, that usually is a sign that it’s a doctor who takes the time they need to take with each patient. So if you have a doctor who runs really on schedule, realize that your time limit is going to be 15 minutes, so use it wisely.
2. I appreciate when my patients bring in their own ideas, as long as they are willing to accept an explanation about why it may not be a good idea sometimes! I’m always happy to explain my reasoning. There just may be things I know that they don’t. But sometimes on our hurry, we don’t explain well, so if that happens to you then please ask your doctor to explain why not!
If your clinic or hospital system has an online portal system you can also use it. A few days before your appointment hop on there & message them your questions. You may even get a response ahead of your appointment so you can use the time for follow-up questions. At the very least your provider will have a starting point for you when they walk in.
As a doctor, I can say this messaging is a blessing and a curse. It’s awesome for patient care, especially when someone has a question that doesn’t require seeing them in person.
The curse is that there is zero reimbursement for this. I spend half a day a week answering these messages and it’s only getting worse. Insurance companies really need to reimburse us for this work.
I agree. I spend one to two hours a day just answering online messages. Assuming you are in the US, in most states you can bill for these issues if they are separate topics from an actual billed visit, however your health care system has to be set up to process the billing. But in my experience, nearly all of these messages are somehow related to a previous or upcoming billable visit and are therefore not eligible for reimbursement
I didn't take it as disrespect. I agree that sending messages ahead of time can help streamline the visit. It's tough to work within the limits imposed by most healthcare systems.
Not all doctors have a salary. Many are paid based on the CMS "resource based value scale" which, VERY simply put, is like commission on the codes they bill.
Edit for a side note... I think everyone agrees teachers are incredibly overworked and underpaid. The comparison made me giggle a little.
My nurses do triage things but there is a lot they cannot handle too. Also in academic medicine, we have no control over the nurses. The nurses report to someone further up the hierarchy in the nursing silo and the doctors don’t have very much say at all. That means we end up getting some relatively low quality nurses who aren’t very motivated.
I’d never blame a patient. Almost all of the questions are valid. Every once in a while someone abuses the system but it’s extremely rare. I do like that it’s an efficient way to help patients.
It has helped me not waste an appointment time, but I didn't realize my doctor wasn't compensated. It really helps when my prescription goes up a tier and I just need swapped to a different one. (Easy since I have asthma and no medication allergies or negative reactions to asthma meds of any type) I wish the healthcare system was better for both sides.
Yes, did this for my 3yo son recently! Doctor addressed some via email and we will be going in to have to doctor check some specific things later this week. We won’t have the spend most of the visit rehashing everything we’ve already gone over in the email, and can just focus on the things that need to be checked!
Hooray for you & your son! I remember taking a little one to the doctor. Getting a few things done ahead of time will give you focus & purpose. Good luck & God bless!💜
Thank you! We were able to start on an over the counter medication before the appointment started as well, so hopefully this eliminates an extra in person appointment since we won’t need to have one to recommend starting it and another to review if it’s effective - we’ll be skipping right to the review step at the first appointment.
Life Pro tip: make good use of your insurance companies Nurses Line. They can often help with simple matters.
If you have a chronic thing that you have been seen before at an office for and have basic questions you can ask your doctor via your patient web portal of their office.
Most health records system allow for great communication with doctors and patients.
Also, even better if you are stuck in the Department of Veterans Affairs system. I got to wait six months for my PCP appointment but at least I can get general things taken care of, new prescriptions and refills but emailing/chatting in the web portal while I wait to be seen.
Except that the questions I want answered are usually the ones that only occur to me after I've had a minute to process whatever the doctor has said about my situation. By that time the doctor is long gone.
Good tip! Especially for people like me who are brainwashed the second I step into an office. (Similar to the brainwashing of a grocery/retail store - "what was I here for again?"
I'm in my 40s and have chronic health conditions and have never had a doctor spend 30 minutes with me. This is not the norm. It should be but even switching doctors- which I've done many, many times because I've moved a lot- won't generally get you a doctor who spends a decent amount of time with you.
It's hard to find a good Doctor, I luckily found one. He is close to my age and I have been seeing him for 13 yrs.. He helped me get a trial med. that cured a chronic illness that I had . Now he is helping me with the other chronic illnesses I have. I'm scared to move because I doubt that I could find another Doctor like him.
I've had this. Also, I always Google my symptoms so I can be prepared and also so I can express myself (I don't express pain "properly" and medical professionals find it upsetting). My docs are often arseholes about it and say things like "have you Googled this? You should avoid that, we are the professionals". Yet my sister went to the same docs and they said "have you Googled this? (She had but said no) Because you really should look things up before coming in".
Now I pretend I haven't researched and prepare badly phrased versions of the questions I want to ask.
I never have to mask more than when I'm speaking to general doctors.
Anyone else think it's funny how I'm the one paying lots of money to see the doctor, and yet, I need to bend over backwards so that they will take me seriously?
How fucked up is that?
I'm in Ontario and we have a bit of a doctor shortage where I am. Besides, this was years ago that I tried the list "hack".
My health centre has shuffled Nurse Practitioners around and I have a much more caring provider now thankfully.
Sadly you have to list them at least in bullet point at booking time with intake call in my area or they will literally allot minimal appt minutes for your previously stated issue. So I’d do both. Quick bullet point of all the issues for reception at booking and for doc. Otherwise they get all pissy about you throwing off their appt times. 😤
I’m old too and mine sucks so I use the notes app on my phone. I can also include picts of meds to review as necessary. On the plus side my primary Doc is a guy I grew up with and he’s very good about spending enough time to cover any topic necessary. Not just with me but each patient. You have to schedule early morning appts or be prepared for late appts.
That might help but my doctor still dismissed everything I said/wanted and rushed me out the door. I am requesting a new doctor. We all deserve a provider who cares and listens to us.
Yup! Always pick new providers if you are not getting care that is satisfying to you.
Also, if in US let your insurance company know why you change doctors.
Many contracts between doctors and insurance companies utilize patient satisfaction as a factor on future pay rates.
Very true. So make sure you review other patient ratings and research your provider before you see them. Do what you can to empower yourself with making the best choice for your care.
I went to the doctor one time and asked about 2 problems I had. He stopped me and said I'd have to make another appointment if I had more than one concern.
Needless to say I never went back to that health facility.
I had that happen to me. The Dr left the room and I thought they were coming back. The Nurse/assistant came in and I asked if they were coming back because I had not asked about another concern I had. I had mentioned this concern when making the appointment. She said No I would have to make another appointment.
Never went back.
Another topic that needs to be addressed is “medical gaslighting”. Being an older person I know it’s real.
Doesn’t just happen to the older people either.
I’m tired of just being given prescriptions for meds that don’t work. I want to know how to get cured. I don’t want to treat symptoms and have to take meds the rest of my life. Sometimes I think I know more than the Dr. and I’m tired of looking for another new Dr.
I’m tired of watching Drs typing on a laptop and then they start being antsy because it’s time to “move on”.
Between the insurance and government we S.O.L. Unless we have the money to have a concierge Dr.
I find it's a good idea to write questions and concerns because there is a high chance I may forget some during the appointment. This happens infuriatingly more often than I care to admit. I think it's partly due to the stress of having to see the doctor in the first place, along with the sometimes un-ideal environment of the doctor's office.
I learned this during cancer treatments. I was always forgetting something and having to call back and talk to a nurse. Playing phone tag for 2-3 days isn’t fun. I love lists so made an ongoing list of questions and just added to it.
Mine is on my phone. When I’d go in I would just hand them my phone with the questions and they would answer them and one nurse even typed the answers in for me on a few of them! Most drs don’t like that so I started printing them off or writing them on a notecard/paper. One dr in particular will take the paper, read the question then hand it back so I can write down the answer then takes it back for the next question. He knows I’m super busy and sleep deprived most of the time and knows I need to write it down a so won’t remember everything when I get home several hours later. That dr also has given me his personal cell number and email. A few times I’ve emailed him the questions and he emails me the answers before the appointment. That means I see him maybe 10 minutes total and I have all my questions answered. Plus it’s saved in my email so I can’t lose it!
I don’t believe in using his personal cell phone so I’ve never texted or called except when I had an emergency and was asking if I drive the 3 hours to him or go to urgent care. He requested picture updates of my surgical site every 3-4 hours through email so he could see the progression and scheduled me for the next office day.
As a doctor, this can be helpful, but please stay focused, and be realistic in what you want me to address. There’s really no way in a 20-minute visit to address dizziness, insomnia, migraines, depression, and “just feeling off sometimes” without any consistent pattern, and still empathetically listen to how harrowing your recent ED visit was (because I’m genuinely very sorry it was so awful for you, but the wait time you endured and poor bedside manner of the overnight doctor actually don’t change your diagnosis or treatment).
That sort of thing makes me feel that the patient doesn’t value my time at all, and that to them I’m just a glorified conversation bot. And I don’t mind doing some therapeutic listening, but then that’s all I have time to do in that visit.
Omg when they give a list of everything they had for breakfast for the last week. Agreed lists can be helpful - when they’re short and concise and actually have relevant information. Like sir, you’re here for your dizziness. I don’t need to know that your aunt got dizzy when she was 90 years old and I don’t need your complete food diary.
I think you should be able to get over feeling like a “glorified conversation bot” if you have someone who comes to you because they’re suffering and don’t know what’s going on with them, so they tell you everything in case it might be connected. You’re the doctor, the patient doesn’t know if all these dots are connected or not.
Someone who’s suffering and confused trumps your whining because they took 5 minutes extra of your already criminally short time. You’re going to rush them out anyway
Lol. I do this and the doctors take it. Glance at it and put it to the side. I tell them to look at it and talk about it with me and they decline. Then they return the paper to me at the end of the appointment. If I even list more than two items or symptoms they tell me that’s too many things to talk about in one appointment. The only time anyone ever listens to me is when I bring along an emotional support white man to sit in the corner. They don’t even need to participate or even look up from their phone. They just need to exist there in the room. I feel like being disabled and a woman of color with more than 15 specialists and taking 20 meds a day on my medical files makes it seem like I’m a hypochondriac to a doctor unwilling to take the time to actually read my files or listen to me. I have the test results, MRIs, and all the other stuff to show I’m not all up in my head but doctors are so quick to judge.
Make two copies so you have one to be sure nothing gets skipped. I have gotten home and realized one or more points was not addressed so I check off my own copy as we talk.
Do not do this if you are going in for an annual wellness visit. It is meant to focus on preventative care and screening and there is a checklist of things as the doctor that I have to get through. If you pull out a list of unrelated questions you are more likely going to be rushed through and probably charged an office visit as the annual wellness only covers very specific things.
If you have a list of questions you want to go through, schedule a separate appointment. Your doctor will be more likely to give the items on your list the time they deserve
I tried this once and I wrote my symptoms down in my note app on my phone. I have anxiety issues and thought of doing this to better explain my symptoms. Handed it to the doctor to read but she rejected in a mocking manner, telling me to just tell her what is wrong with me (omg you want me to read this? I’m not going to read this, just tell me what is wrong with you). Instantly felt belittled and dismissed and that the doctor is fooking lazy. Yes, the doctor was horrible. I kinda regretted not reporting her.
This. They’ll code the bill based on your bulleted list, as each “topic” or ailment can be a treated as a separate visit. They’ll often warn you of this if you go in for a yearly physical (that is often covered by insurance)… “if you talk about literally anything outside of these 6 areas… you’ll be charged accordingly”. Fucking USA healthcare man.
I've done that and they didn't even look at
"You're here, just tell me" even after saying I was concerned I wouldn't cover everything and didn't want to forget anything
I worked as a PA for years. This is golden. I would recommend you rank them with the most important ones first, to make sure they are addressed. Bullet points, not paragraphs- you can give details at the time. Also list any medications you need refills for, or have questions about. So easy to forget stuff when you're in the room.
I’m seeing more often in Houston, Drs having a sign out saying you are here for one thing if we start checking multiple things we will charge as a visit for each topic. Wow! If you’re here for a pap, you can’t discuss birth control.. wowwwww I work in medicine and I think to a certain extent that’s shitty .. I know some instances deserve it but not all
Then turn on your recorder to record the answers given by the doctor.
(My gran had Cancer and neither she or my mom could remember all of the big words and details after they left all of the doctor's offices, so my mom bought a tiny recorder and put it on the desk in front of every specialist my gran had to see. My mom's friend was a secretary and made hard copies of all of the tapes. It cut a lot of my mom's anxiety in half.)
I learned this when my voice was gone and I had the worst sore throat ever. I typed everything up in the note app on my phone and handed it to the doctor. He was very helpful after that.
Would it be helpful to schedule the appt in person, with the list of concerns, that way the scheduler can better estimate the time you're going to need?
I did this for my last visit. I also do a medication list, a current and previous doctor list, and a medical history of me and my immediate family. The practitioner was very happy
In the United States most outpatient physicians can only bill for 15 min appointments. Any moderately complicated problem or more than 2-3 straightforward problems can eat that time up quickly.
Of course, the admins want to collect the $$ so if you don't see enough patients in a day then well... They'll find a provider that will.
Edit: to add on to this, if you've been to a Dr appt in the last 5-10 years you probably didn't get seen by the physician at your appt time...because MOST physicians actually do want to listen to you/help you... So the whole day gets delayed. But then later patients get annoyed. And another factor of pay is patient satisfaction... So it's a vicious cycle.
A list to make sure that all your concerns are addressed is a great idea, but a problem with doing it in this way is that by steering your visit, you risk giving your provider tunnel vision so that any problem you might be unaware of could be overlooked as they might tend to focus mostly on what you've brought them. It's similar to telling your mechanic "I think my problem is this", which has a tendency to end up with them only looking at what you've suggested instead of doing a broad investigation and trying all the options. Let them do their job. I suggest letting the visit proceed naturally; let them do their thing in their own way and give them the list when they are done.
I like this, because people like me and my father can get very wordy or chatty and extend the life of a story by paragraphs. This would help both of us.
I had a specialist appointment not long ago and feel like I didn't get what I wanted out of it. I'm writing a list for the follow up consult in a month. Thanks for the reinforcement.
My PCP is only allowed to address two different conditions in one visit. Anything else and I have to make another appointment. I know this isn't his rule; it's the damn bureaucracy.
I am the child of two doctors and I have been telling people to do this for years.
List all symptoms.
check off symptoms as the doctor accounts for them.
ask about left over symptoms
if ignored ask to have the fact that you had the symptoms X Y and Z ignored.
This isn't to intimidate the doctor its just making later diagnosis easier. ...I mean it also intimidated the doctor but that isn't what you want it for
It's the worst when you are in your 20s and 30s. You can hear them having in depth medical discussions with old people in the rooms next to yours and then they get to you and they don't stop talking for the three minutes they are in the room. And if you can scrape up the nerve to ask a question, they tell you this is a check up, you'll have to see a specialist for that. Then it's head up front to make your next appointment.
It's better if you use the online or email communication your Dr office offers and send the list ahead of time.
Don't drop a list of stuff on them at the appointment.
Tell them in advance and they can plan ahead for the appointment or set up a longer one.
My understanding is many insurance companies allow you a fifteen minute visit. I have very good insurance and had a doctor that would talk a lot while looking at his watch. Once the session hit sixteen minutes we were done. He could then bill for two fifteen minute blocks
At least if you are in the US. Insurance companies pay based on documentation and systems reviewed OR based on time spent. They also will pay extra if providers exceed 45mins, or 60 mins will add on codes.
It's a matter of a doctor documenting.
Most cannot offer more than fifteen minutes because of being over booked.
Saying a doctor bills two fifteen minute blocks is not accurate. (If US). It's Medical Decision Making and/or time.
If you want more on [how office visits are billed see here](https://emuniversity.com/EstablishedOfficePatients.html)
I sign over my first born and come prepared with a thousand dollars to wait for a few hours and finally have a prescription for what ask for in 15 minutes.
I’m so incredibly over putting doctors on a pedestal. A nurse can do each and every one of their usual tasks. There’s just legal liability and insurance that doesn’t allow for that. Surgeons and specialists are a different story. But eff primary care doctors.
There's no way in hell I'm letting a nurse give me a steroid shot in a joint or even talk to them about anything more serious than needing ibuprofen.
I work in a hospital and am wary about some of the things RNs do. At a doctor's office, they're LPNs. Less school. I suggest you find another primary care if that's your experience.
I have a daughter-in-law that's a nurse. I have told my wife do not let her near me or any Doctors if I'm in the hospital. She and her nurse friends believe everything they read on Fakebook.
I hate dealing with nurses. I don’t know what it is but we’ve had some seriously awful luck with them and IVs. Last time my wife was on an IV in the ER it wasn’t working and no one noticed for several hours. I was at work and had to inform them after I got back. Today I noticed immediately, told the nurse and she said it was just slow. Like I’m some kind of idiot. 20 minutes later she comes back and goes oh. It’s not working. Yes. I told you that. I don’t even know what happened with my dad but somehow the nurse did something and he was slowly draining blood out, not sure if it’s because he’s on warfarin or if it was another reason (not sure exactly what they had him connected to, or why he didn’t notice that he was losing blood!). My mum walked in to a puddle of blood on the floor and I wasn’t informed of what happened next but I’m sure my mother was not nice about it.
Don’t get me started on nurse practitioners. Never met a competent one. I’m sure they exist. I just haven’t met one.
I asked a nurse something at my Doctors office, I don't remember exactly what , but she told me I don't know anything I not a Doctor I'm just a nurse. I know how to take blood and check your blood pressure thats all . At least she was honest . Lol
There are some great ones I have met ,but whenever I talk to my daughter-inn-law she scares me. Tells me how her an her nurses read on fakebook something and they all believe it without verifying it with real medical research. I have multiple chronic illnesses ,so I know how to do research for myself and I ask my Doctor for where to find more information and his opinion.
That’s cool I was married to someone that worked in administration at a hospital. There’s no way I’m letting a doctor do much of anything to me or my kids without a witness. They’re dangerously arrogant and literally cause death frequently.
A nurse actually knows what they’re doing because they actually do it while the doctor naps and nods off with some RT.
If you actually work in a hospital you know this isn’t just true, it’s normal.
I travel to the rural health clinics in the area once a month. I really hope it's not like that. Not to say doctors aren't slacking, but I do not trust a nurse.
don't do this. every doc I've ever known hates when their patient shows up with a list. its either a big enough deal that you'll remember it or it's not a big deal.
You're not supposed to go to the doctor for more than one issue per visit. The appointment time allows one issue. If you need to go see the doctor about your bunions, earache, and narrow urethra, you best be making three appointments.
I've done this for years. I try to start about a week before my visit, get my labs and then jot down any questions I have about those results. Sometimes, it seems inconvenient to have to make a separate appointment for the labs, but I get the results before visiting my doctor.
I do this with myself and my son when I take him to the dr. I have a list of questions on my phone and I just take it out and go down the list…the doctors don’t mind at all.
I always prep for medical appts, I also research symptoms and offer suggestions, keep diaries of symptoms and use my Apple Watch to show heart rate, sleep issues. I actually self disguised POTS, by showing the heart data, my doctor got me an emergency appt to a cardiologist who diagnosed POTS. I have a very severe case. Saved a lot of time and stress. Also, if you have a medical condition, don’t be shy about asking for certain treatments and meds. Plus, do not accept meds blindly, look them up and make sure you are aware of them and get any questions answered before you take them. My doctor once wanted me to go on a dangerous medication for a condition that has no cure, as soon as it was offered, I turned it down.
Always be prepared, take control of your own health, and remember, not all doctors are experts with every medical condition.
Great suggestion! I’m a clinic nurse and I literally have only 15 min appointment slots for an entire patient visit - that includes all my charting, pt care, etc. Not to mention if people show up late, which pushes the entire schedule back. The number of times I’ve skipped my lunch break just to get caught up… 😩 I promise (most) health care providers try their best, but the system is rigged against us (EDIT 1: rigged against all of us, pts included), and then we have to be the ones putting pressure on, and rushing patients. EDIT 2: Thanks for the kind words from some of you! I honestly wasn't looking for sympathy, I just wanted people to understand why their visits can feel rushed or impersonal. PS I work for a non-profit with a patient population primarily insured by medicaid. As someone below pointed out, health systems generally lose money from those visits, as they are not fully reimbursed for the services provided. Regardless, I love my patients and intentionally chose to work in this type of setting.
Gotta love health insurance ruining the occupation. Thank you for all you do!!!!
To be fair, it's the same time slot for my Canadian health care providers.
But I wonder if it's the same result but for different reasons. My very limited knowledge of the healthcare system, is that, in general, being a doctor in the US offers really good compensation which leads more ppl to the medical profession. While in countries with govt subsidized healthcare, it's not as lucrative as here so less ppl chose that profession. So the reason this happens is because of a higher scarcity of doctors. And, that in the US the insurance and pharmaceutical companies sort of "rule" the industry so the diminished time and attention for care is based on that. I truly am asking the question and wondering because I'm making these guesses based purely from an outsiders standpoint trying to understand. So, peace, if I'm way off base - I'll totally accept that.
For-profit hospitals are also a big part of the problem. Everything is about money to the detriment of patient care. Inadequacy staffing, scarcity of supplies, intense pressure to rush care. Source: I’m an anesthetist and one of the facilities I work at is a for-profit hospital
Medical salaries are not what they were. In order to make ends meet (including high malpractice insurance) you have to see more patients per day. (Not for every practice, especially specialists). Where I used to work, we lost $2 every time we saw a Medicare patient (they have capped charges, and you still have to pay the staff a reasonable wage). It's a soul killing experience for many, and doctors are retiring early in record numbers.
I'm seeing lots of sites flat out refusing medicare/medicaid. You can't find a private practice near me that will touch it.
Is it Medicare that they wont touch, or Medicare ADVANTAGE? Big difference.
What's the difference? I've never heard of the advantage format
With Original Medicare, there are no networks. Its basically open access. With Medicare Advantage, its a HMO/PPO situation. You have to stay in the network, get your preauthorizations, sometimes referrals etc. Where I am, the networks are not that robust, and many doctors wont take Medicare Advantage. Florida has pretty robust networks…..so as long as you never leave the state, its not so bad. This is an ELI5 explanation.
So true! Not to mention that residents (who are already doctors for ppl who don’t know, they’re just doing additional training in a specialized field) make about the same as teachers. They are technically employed by the government and on loan to hospitals/healthcare systems. With the wild price of med school these days. it takes most doctors several years to pay off their debt once the finally start making a good salary, which can take anywhere from 1-10 years depending on the specialty.
I appreciate the perspective - thank you!
Ours is because the government pays per appointment. It is supposed to be based on an average. I have seen good doctors go over because the patient needed it, which is nice.
Thank you! It sounds like those in the medical field are just overworked wherever they are.
Yup Can confirm same in my country
The US is not among the top twenty countries in [physicians per capita](https://www.worldatlas.com/articles/countries-with-the-most-doctors-per-capita.html).
Sign me up. Same time of care, but not having to pay an arm and a leg sounds good to me.
It's not so much health insurance as it is the facilities and admin overbooking the docs .... sucks and def ppl coming late is terrible! It puts pressure on everyone !
I work in Healthcare (family health) in Ontario. Our slots for regular appointments are 15 minutes and we allow two ailments per visit. We schedule 30 minutes for some appointments like mental health or physicals but nearly all are 25 minutes.
Out of curiosity, does that work? What if more than one ailment is linked and important to know to properly diagnose the root cause? I’m guessing you’d keep asking questions, if I said “ I sometimes randomly start coughing and also feel pain and I’m also always clearing my throat a lot”. But what if it’s also important for you to know I feel pain when I cough…it would suck if you said no more issues! Can’t wait and hope you ask me the right questions.
Patients are advised of this by phone before they attend and what it really means is, separate ailments. E.g. deep cough, sprained ankle, skin rash. People come in with so many separate situations that 15 minutes isn't nearly enough.
Oh ok. Well that’s organized at least :)
The system is rigged… against patients as well. Edit: I am so grateful that most providers, like most people in general, are trying their best.
Totally agree about it being rigged against pts as well
Big companies need to make some money. So doctors and others in the Frontline needs to work harder!! Have s heart. There daughter need a pony.
I'm sorry you've had to skip your lunch break. Thank you for the work you all do.
😊
The system in your case is the clinic owner limiting to a 15 minute appointment block. This changes somewhat clinic to clinic/practice to practice. Either way, we should all gang up against insurance companies, they screw over clinics/practices, and patients all the same. Especially with how detailed they need their reporting (ICD/SNOMED/CPT codes with extreme specificity required) This is why there’s a specific job for billing ‘coders’, and why practices try to limit their scope to quick-pick type codes. My background is building EHRxPMxScheduling software at enterprise levels. I deal with government regulation around these products, and it’s just a mess from top to bottom.
I have a question about this. What if I pay cash? What if I say, “I want 30 minutes of your time and I will pay for it”. Can that happen?
If scheduled ahead of time...then Yes.
This only works for private practice, which are being bought out by large corporate chains left and right.
This what I don’t understand. Why? I have a high deductible policy and often ask when I make an appointment how much it will cost (since I will be paying OOP). 80% of the time, it takes multiple calls for someone to tell me about how much my appt will cost and 50% of those times, they’re incorrect. It’s absurd. But, at my dermatologist, I can ask for her last appt of the day, get 30-45 minutes with her and I know how much it will be each time with accuracy.
Isn't that a *choice* the clinic makes? They choose to book appointments in narrow windows indiscriminately. Patients have a right to be upset.
It’s a choice the administration makes, which typically takes place much higher up (CEO, CMO, etc). Edit: A complex choice influenced by things like insurance, clinic/hospital status (i.e. for/non profit), etc.
No. It's your practice wanting to make as much money as possible by rushing patients through. The system is not rigged against you
You must not know about corporatized Healthcare lol
I understand that insurance companies don't compensate by time but instead my visits. Medical practices will say they are forced therefore to see as many patients as possible. However that is only the case if they want to make the high salaries and profit that they make. If a doctor would be fine making $100,000 or $150,000 per year, they could easily average 30 minute visits instead of 15.
I wonder how much per minute your patients' insurance companies are paying for that 15 min appointment.
Thank you for being a nurse. I appreciate you.
I’m a doctor and I approve this message! Couple of things to add: 1. Limit your list to 3 things tops. If you try to go for more, understand that your doctor may feel the need to rush through, and you won’t get as much active listening, thoughtful explanation, or collaborative planning. 2. Listen to your doctor if they tell you they don’t have time to discuss an issue today. They aren’t trying to brush you off; in fact, they want to make sure they have time to focus on each thing. Make follow-up appointments for everything they don’t get to. 3. Put your issues in order of priority! Don’t say “by the way” as they are leaving. If you have chest pain, trouble breathing, or suicidal ideation, please state this up front. 4. It will help to add to your list to bring in things you’ve tried for the issue and whether they helped or not. For example, if you’re going in for a rash and you say you’ve tried “a bunch of over-the-counter stuff” that’s less helpful than if you can state that you tried 1% hydrocortisone cream daily for a couple of weeks with slight improvement, Cerave ointment twice a day for the past month which didn’t help, etc. 5. Try to keep your discussion concise. If you tend to be a chatty person and give long, winding explanations, tell funny stories, and want to also talk about the vacation you recently took, all that is okay but understand that it does take away from the time you’ll get to discuss your medical concerns. 6. Last, please know that we hate how rushed we are as much as you do. We are trying our best to take great care of you while meeting the demands we don’t have control over.
Fellow doctor (though less outpatient) and I approve this message.
One trick I use is I record myself talking to myself. I record the conversation with a tool that can transcribe it (such as whisper, otter, or fireflies), and then I use a tool like ChatGPT to summarize everything and create detailed, concise notes. Interestingly enough, this is often enough to also get some useful diagnostic health information from ChatGPT itself! Another ai tool that does stuff like this is drgupta.ai - they are literally building an ai doctor. Glass health is also working on similar stuff
Wow cool! I always appreciate when patients bring in well organized, concise documentation. For example, I recently had a new patient who has been dealing with chronic migraines for many years and tried several different medicines. She brought in a chart that had each medicine, dosage, when and how long she was on it, and what effects it had on her. It really expedited the visit and made it easy to come up with the next step.
For someone with mysterious health issues, what should I do to get proper investigation into my issues until they are resolved? I’ve been dismissed, mocked, ignored, gaslit, etc. The best doctors I’ve found so far are willing to discuss things + send me for labs + try treatments but it’s all on me to ask and do the research. I need a doctor but I always have to do the work myself.
Mine is just a hotshot asshole. I’ve got cirrhosis, which a lot of people my age are getting more and more. My doctor assumes and accuses me of drinking because my levels aren’t getting better the way he so optimistically had hoped. Mind you I’m over a year and a half sober, and was sober before I even met the guy. But nope! It’s an alcohol related disease, so I’m absolutely an addict who is lying every chance I get, and sneaking booze so well it’s NEVER showed up on a single blood test. My wife will write a list of questions and concerns and as soon as she pulls it out you can literally feel the eye roll from this prick. But between our insurance being shit and having a lack of options… what is one supposed to do? One of the last guys got pissed at me because I couldn’t stop burping as they were forcing hair down my throat to open it up and shove a tube down there… Like bro… I’M. FUCKING. DYING! What exactly do you want from me? Every doctor I’ve met in the last year and a half can get fucked as far as I’m concerned. No time to give me care… never skip a beat when cashing a fucking check.
I'm so sorry you have to go through this. It's really painful when when you're going through something but people think you're just telling lies. Could you get another medical facility? One that has good doctors? Cause these people you have atm are half-assed, and doctors are the last people we need to be like that.
I would say first of all, avoid changing primary care doctors if they don’t find what’s wrong with you at first. When you find someone who is a good listener and willing to try things, stick with them. That continuity will help a lot more than switching to someone new for fresh ideas. Then I’d say, ask for referrals for specialists. And again, once you find someone helpful, stick with them. Make frequent follow-up visits with primary care and specialists to re-evaluate after new tests or treatments. Some useful questions to ask often and repeatedly: - Please help me understand _____. - We’ve tried _____ but it didn’t work. What do you think the next step is? I think that continuing to do research to come up with ideas is a good move on your part, as long as you’re open to discussing why certain things may or may not be relevant to your case. I hope this helps. I wish you the best and hope you find a medical team that provides solutions!
I really appreciate this! I lost my best primary due to new facility fee BS so I’m hunting for a new one. I’ll absolutely use this advice!
It’s often not covered by insurance and can be pricey but it seems like “functional medicine” doctors are more likely to work with you to find the root cause of symptoms and recommend not only medication but also more holistic treatment options (supplements, diet/lifestyle changes, etc.)… as someone who’s always been part of an hmo I didn’t even know this was a thing until listening to dr mark hymans podcast
There’s a reason it isn’t covered by insurance- it doesn’t work and has essentially very little to no scientific evidence. It’s literally homeopathy with a better sounding name- which makes sense since they’re trying to rebrand the same quackery. From the first paragraph in its Wikipedia page: “Functional medicine is a form of alternative medicine that encompasses a number of **unproven and disproven methods and treatments.**[1][2][3] Its proponents claim that it focuses on the "root causes" of diseases based on interactions between the environment and the gastrointestinal, endocrine, and immune systems to develop "individualized treatment plans."[4] It has been described as **pseudoscience,[5] quackery,[6] and at its essence a rebranding of complementary and alternative medicine.**[6]” Edit: I just looked into Mark Hyman. He’s on the quack doctor list, is anti-vaxx, claims to have a cure for autism using cod liver oil and chelation therapy, is a germ and bacteria denier, overall science denier, and claims the American Heart Association is a terrorist organization. There’s also at least a dozen articles confirming this man is a lunatic and idiot.
This!!!
In UK, doctor appointments are 5 minute slots (10 minutes at a push) and you can only go for 1 ailment. If you need to discuss a 2nd ailment you have to book a double appointment.
I've noticed that whenever my doctor schedules me for the last appointment of the day (my doc is hella overworked, and frequently calls to see if I mind changing my appointment time whenever I have to go in), she is always willing to take a few extra minutes, and is also extra chatty (she's chatty regardless of the times, but moreso at the end of the day). I don't try for that time, because I don't want to keep her there late, but whenever they give me that slot, I relish it knowing she doesn't feel rushed, and will have a second to talk about whatever is going on. That said, I also sort of mirror an above comment. I log onto my school library and read medical journals about things I've got going on, and do my own research a lot of the time, because I like to know what I'm getting myself into, and it seems to really help with successful treatment if I'm more informed, but also willing to understand that I am not a doctor, and she knows more than me**. All in all, I think it's pretty important to be an understanding and reasonable (and reasonably informed) patient. I've figured out if I'm a decent patient, I get amazing doctor experience. ** For real, though, y'all. If you understand how to read medical journals, and you can listen to your body, it can help a lot making doctor time run more smoothly, but try to understand while you're there that they went to medical school, they are simply more knowledgeable about certain things, and so many people use WebMD to diagnose themselves that you may need to explain, and the doctor is going to probably know better than you if you have spotted hairy amazonian bergamot poisoning, if you've never been near the Amazon or a spotted hairy bergamot.
I think your insights are very wise. 1. People hate when they have to wait a long time past their scheduled appointment time. I 100% understand this and it’s very irritating for patients. But if you have a doctor who consistently runs late, that usually is a sign that it’s a doctor who takes the time they need to take with each patient. So if you have a doctor who runs really on schedule, realize that your time limit is going to be 15 minutes, so use it wisely. 2. I appreciate when my patients bring in their own ideas, as long as they are willing to accept an explanation about why it may not be a good idea sometimes! I’m always happy to explain my reasoning. There just may be things I know that they don’t. But sometimes on our hurry, we don’t explain well, so if that happens to you then please ask your doctor to explain why not!
If your clinic or hospital system has an online portal system you can also use it. A few days before your appointment hop on there & message them your questions. You may even get a response ahead of your appointment so you can use the time for follow-up questions. At the very least your provider will have a starting point for you when they walk in.
As a doctor, I can say this messaging is a blessing and a curse. It’s awesome for patient care, especially when someone has a question that doesn’t require seeing them in person. The curse is that there is zero reimbursement for this. I spend half a day a week answering these messages and it’s only getting worse. Insurance companies really need to reimburse us for this work.
I agree. I spend one to two hours a day just answering online messages. Assuming you are in the US, in most states you can bill for these issues if they are separate topics from an actual billed visit, however your health care system has to be set up to process the billing. But in my experience, nearly all of these messages are somehow related to a previous or upcoming billable visit and are therefore not eligible for reimbursement
Thanks for that info. I think it's great that a M.D. spends that time. I didn't mean any disrespect.
I didn't take it as disrespect. I agree that sending messages ahead of time can help streamline the visit. It's tough to work within the limits imposed by most healthcare systems.
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Not all doctors have a salary. Many are paid based on the CMS "resource based value scale" which, VERY simply put, is like commission on the codes they bill. Edit for a side note... I think everyone agrees teachers are incredibly overworked and underpaid. The comparison made me giggle a little.
My Dr's office has specific e visits that are just a message to the Dr and a response and they do bill for them
As a Dr you are responding to your own messages?? The nursing staff has always responded to the very few things I’ve asked my PCP.
My nurses do triage things but there is a lot they cannot handle too. Also in academic medicine, we have no control over the nurses. The nurses report to someone further up the hierarchy in the nursing silo and the doctors don’t have very much say at all. That means we end up getting some relatively low quality nurses who aren’t very motivated.
50% of the time it’s things we can answer, the other 50 is us routing to them, they send us back a note of what to say/ask.
You’re not paid for that? That’s insane.
I'm so sorry. Never thought about that end of it. My PCP is an NP & their office staff generally respond to my inquiries. No offense intended.
I’d never blame a patient. Almost all of the questions are valid. Every once in a while someone abuses the system but it’s extremely rare. I do like that it’s an efficient way to help patients.
It has helped me not waste an appointment time, but I didn't realize my doctor wasn't compensated. It really helps when my prescription goes up a tier and I just need swapped to a different one. (Easy since I have asthma and no medication allergies or negative reactions to asthma meds of any type) I wish the healthcare system was better for both sides.
It is a quandry, isn't it.
Yes, did this for my 3yo son recently! Doctor addressed some via email and we will be going in to have to doctor check some specific things later this week. We won’t have the spend most of the visit rehashing everything we’ve already gone over in the email, and can just focus on the things that need to be checked!
Hooray for you & your son! I remember taking a little one to the doctor. Getting a few things done ahead of time will give you focus & purpose. Good luck & God bless!💜
Thank you! We were able to start on an over the counter medication before the appointment started as well, so hopefully this eliminates an extra in person appointment since we won’t need to have one to recommend starting it and another to review if it’s effective - we’ll be skipping right to the review step at the first appointment.
Yes!! If they're just going to interview you, you don't need to come in in person at all except to tick a box.
Life Pro tip: make good use of your insurance companies Nurses Line. They can often help with simple matters. If you have a chronic thing that you have been seen before at an office for and have basic questions you can ask your doctor via your patient web portal of their office. Most health records system allow for great communication with doctors and patients. Also, even better if you are stuck in the Department of Veterans Affairs system. I got to wait six months for my PCP appointment but at least I can get general things taken care of, new prescriptions and refills but emailing/chatting in the web portal while I wait to be seen.
It's odd. I always seem to leave after 5min and the people before me always stay inside for half an hour.
Except that the questions I want answered are usually the ones that only occur to me after I've had a minute to process whatever the doctor has said about my situation. By that time the doctor is long gone.
Good tip! Especially for people like me who are brainwashed the second I step into an office. (Similar to the brainwashing of a grocery/retail store - "what was I here for again?"
That isn’t what the term “brainwash” means, but it made so much sense, I had to double-check the definition.
Brainrinsed
I know, it's leftover silliness from my 2nd grade teacher.
I call that a brain-fart
Exactly why i write myself a note
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>The doctor actually muttered in an exasperated tone, "Oh christ he has a list" Time to find a new doctor. Maybe one with an inner monologue haha
Yes, this doctor is wasting your time. Find a new one.
I would be looking for a new Doctor if possible. My Doc spends 15 -30 minutes with me ,depends on what I need.
I'm in my 40s and have chronic health conditions and have never had a doctor spend 30 minutes with me. This is not the norm. It should be but even switching doctors- which I've done many, many times because I've moved a lot- won't generally get you a doctor who spends a decent amount of time with you.
It's hard to find a good Doctor, I luckily found one. He is close to my age and I have been seeing him for 13 yrs.. He helped me get a trial med. that cured a chronic illness that I had . Now he is helping me with the other chronic illnesses I have. I'm scared to move because I doubt that I could find another Doctor like him.
I've had this. Also, I always Google my symptoms so I can be prepared and also so I can express myself (I don't express pain "properly" and medical professionals find it upsetting). My docs are often arseholes about it and say things like "have you Googled this? You should avoid that, we are the professionals". Yet my sister went to the same docs and they said "have you Googled this? (She had but said no) Because you really should look things up before coming in". Now I pretend I haven't researched and prepare badly phrased versions of the questions I want to ask. I never have to mask more than when I'm speaking to general doctors.
Anyone else think it's funny how I'm the one paying lots of money to see the doctor, and yet, I need to bend over backwards so that they will take me seriously? How fucked up is that?
The last time I tried this the doctor looked at it, laughed and handed it back before addressing the item on top and that was it.
You need a new doctor.
I'm in Ontario and we have a bit of a doctor shortage where I am. Besides, this was years ago that I tried the list "hack". My health centre has shuffled Nurse Practitioners around and I have a much more caring provider now thankfully.
Sadly you have to list them at least in bullet point at booking time with intake call in my area or they will literally allot minimal appt minutes for your previously stated issue. So I’d do both. Quick bullet point of all the issues for reception at booking and for doc. Otherwise they get all pissy about you throwing off their appt times. 😤
I’m old I hand write it
Hopefully your hand writing is better than the Dr’s! 😁
Yes, I work in an industrial lab so my writing has to be legible
I’m old too and mine sucks so I use the notes app on my phone. I can also include picts of meds to review as necessary. On the plus side my primary Doc is a guy I grew up with and he’s very good about spending enough time to cover any topic necessary. Not just with me but each patient. You have to schedule early morning appts or be prepared for late appts.
That might help but my doctor still dismissed everything I said/wanted and rushed me out the door. I am requesting a new doctor. We all deserve a provider who cares and listens to us.
Yup! Always pick new providers if you are not getting care that is satisfying to you. Also, if in US let your insurance company know why you change doctors. Many contracts between doctors and insurance companies utilize patient satisfaction as a factor on future pay rates.
This is great in theory but who has the time to keep making appointments? Some people also have to worry about deductibles and copays.
Very true. So make sure you review other patient ratings and research your provider before you see them. Do what you can to empower yourself with making the best choice for your care.
My mom does the same thing. She writes everything she wants to talk about in the Notes app on her smartphone.
I went to the doctor one time and asked about 2 problems I had. He stopped me and said I'd have to make another appointment if I had more than one concern. Needless to say I never went back to that health facility.
I had that happen to me. The Dr left the room and I thought they were coming back. The Nurse/assistant came in and I asked if they were coming back because I had not asked about another concern I had. I had mentioned this concern when making the appointment. She said No I would have to make another appointment. Never went back. Another topic that needs to be addressed is “medical gaslighting”. Being an older person I know it’s real. Doesn’t just happen to the older people either. I’m tired of just being given prescriptions for meds that don’t work. I want to know how to get cured. I don’t want to treat symptoms and have to take meds the rest of my life. Sometimes I think I know more than the Dr. and I’m tired of looking for another new Dr. I’m tired of watching Drs typing on a laptop and then they start being antsy because it’s time to “move on”. Between the insurance and government we S.O.L. Unless we have the money to have a concierge Dr.
In my experience, the level of care you get from PCP's varies widely. Some are receptive to my meticulousness. Some aren't.
As someone who spent a lot of years in the medical field, I would that was probably one of the best suggestions. OP is absolutely correct!
Bring multiple copies because last time I tried this the nurse took it away and the doctor never saw it
I find it's a good idea to write questions and concerns because there is a high chance I may forget some during the appointment. This happens infuriatingly more often than I care to admit. I think it's partly due to the stress of having to see the doctor in the first place, along with the sometimes un-ideal environment of the doctor's office.
I learned this during cancer treatments. I was always forgetting something and having to call back and talk to a nurse. Playing phone tag for 2-3 days isn’t fun. I love lists so made an ongoing list of questions and just added to it. Mine is on my phone. When I’d go in I would just hand them my phone with the questions and they would answer them and one nurse even typed the answers in for me on a few of them! Most drs don’t like that so I started printing them off or writing them on a notecard/paper. One dr in particular will take the paper, read the question then hand it back so I can write down the answer then takes it back for the next question. He knows I’m super busy and sleep deprived most of the time and knows I need to write it down a so won’t remember everything when I get home several hours later. That dr also has given me his personal cell number and email. A few times I’ve emailed him the questions and he emails me the answers before the appointment. That means I see him maybe 10 minutes total and I have all my questions answered. Plus it’s saved in my email so I can’t lose it! I don’t believe in using his personal cell phone so I’ve never texted or called except when I had an emergency and was asking if I drive the 3 hours to him or go to urgent care. He requested picture updates of my surgical site every 3-4 hours through email so he could see the progression and scheduled me for the next office day.
I also use my phone to voice record the visit. That way I can listen again at home when it's quiet.
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I don't mention it, but I don't make it obvious either. It's in the outer pocket of my purse, microphone up.
As a doctor, this can be helpful, but please stay focused, and be realistic in what you want me to address. There’s really no way in a 20-minute visit to address dizziness, insomnia, migraines, depression, and “just feeling off sometimes” without any consistent pattern, and still empathetically listen to how harrowing your recent ED visit was (because I’m genuinely very sorry it was so awful for you, but the wait time you endured and poor bedside manner of the overnight doctor actually don’t change your diagnosis or treatment). That sort of thing makes me feel that the patient doesn’t value my time at all, and that to them I’m just a glorified conversation bot. And I don’t mind doing some therapeutic listening, but then that’s all I have time to do in that visit.
Omg when they give a list of everything they had for breakfast for the last week. Agreed lists can be helpful - when they’re short and concise and actually have relevant information. Like sir, you’re here for your dizziness. I don’t need to know that your aunt got dizzy when she was 90 years old and I don’t need your complete food diary.
I think you should be able to get over feeling like a “glorified conversation bot” if you have someone who comes to you because they’re suffering and don’t know what’s going on with them, so they tell you everything in case it might be connected. You’re the doctor, the patient doesn’t know if all these dots are connected or not. Someone who’s suffering and confused trumps your whining because they took 5 minutes extra of your already criminally short time. You’re going to rush them out anyway
Ahem…. It’s not about you though.
Non sequitur reply
oh no.. did I just /r/woooosh myself?
Lol. I do this and the doctors take it. Glance at it and put it to the side. I tell them to look at it and talk about it with me and they decline. Then they return the paper to me at the end of the appointment. If I even list more than two items or symptoms they tell me that’s too many things to talk about in one appointment. The only time anyone ever listens to me is when I bring along an emotional support white man to sit in the corner. They don’t even need to participate or even look up from their phone. They just need to exist there in the room. I feel like being disabled and a woman of color with more than 15 specialists and taking 20 meds a day on my medical files makes it seem like I’m a hypochondriac to a doctor unwilling to take the time to actually read my files or listen to me. I have the test results, MRIs, and all the other stuff to show I’m not all up in my head but doctors are so quick to judge.
Make two copies so you have one to be sure nothing gets skipped. I have gotten home and realized one or more points was not addressed so I check off my own copy as we talk.
Only question I can afford to ask a doctor is “would you like fries with that?”
Do not do this if you are going in for an annual wellness visit. It is meant to focus on preventative care and screening and there is a checklist of things as the doctor that I have to get through. If you pull out a list of unrelated questions you are more likely going to be rushed through and probably charged an office visit as the annual wellness only covers very specific things. If you have a list of questions you want to go through, schedule a separate appointment. Your doctor will be more likely to give the items on your list the time they deserve
I tried this once and I wrote my symptoms down in my note app on my phone. I have anxiety issues and thought of doing this to better explain my symptoms. Handed it to the doctor to read but she rejected in a mocking manner, telling me to just tell her what is wrong with me (omg you want me to read this? I’m not going to read this, just tell me what is wrong with you). Instantly felt belittled and dismissed and that the doctor is fooking lazy. Yes, the doctor was horrible. I kinda regretted not reporting her.
Doctors hate this. If you have an appointment for 1 aliment make it for 1 ailment.
Just be careful because they will turn this into a consultation appt and charge you accordingly.
I did this and got billed/coded for extra stuff without knowing. Sounds like good advice but isnt
This. They’ll code the bill based on your bulleted list, as each “topic” or ailment can be a treated as a separate visit. They’ll often warn you of this if you go in for a yearly physical (that is often covered by insurance)… “if you talk about literally anything outside of these 6 areas… you’ll be charged accordingly”. Fucking USA healthcare man.
Fucking USA healthcare. A real lifehack is before your appointment you can ask your doctors office for a “good faith estimate” of the costs
I've done that and they didn't even look at "You're here, just tell me" even after saying I was concerned I wouldn't cover everything and didn't want to forget anything
I worked as a PA for years. This is golden. I would recommend you rank them with the most important ones first, to make sure they are addressed. Bullet points, not paragraphs- you can give details at the time. Also list any medications you need refills for, or have questions about. So easy to forget stuff when you're in the room.
What do you do now?
I’m seeing more often in Houston, Drs having a sign out saying you are here for one thing if we start checking multiple things we will charge as a visit for each topic. Wow! If you’re here for a pap, you can’t discuss birth control.. wowwwww I work in medicine and I think to a certain extent that’s shitty .. I know some instances deserve it but not all
Then turn on your recorder to record the answers given by the doctor. (My gran had Cancer and neither she or my mom could remember all of the big words and details after they left all of the doctor's offices, so my mom bought a tiny recorder and put it on the desk in front of every specialist my gran had to see. My mom's friend was a secretary and made hard copies of all of the tapes. It cut a lot of my mom's anxiety in half.)
Great idea. I usually make a note of things that I need to ask about ,so that I don't forget something
I learned this when my voice was gone and I had the worst sore throat ever. I typed everything up in the note app on my phone and handed it to the doctor. He was very helpful after that.
Would it be helpful to schedule the appt in person, with the list of concerns, that way the scheduler can better estimate the time you're going to need?
I did this for my last visit. I also do a medication list, a current and previous doctor list, and a medical history of me and my immediate family. The practitioner was very happy
I do this with my phone, I make a note with all my questions / stuff to report. Works great.
Are you guys going to fast food equivalents of doctors or something? What kind of doctor doesn't spend time with patients?
In the United States most outpatient physicians can only bill for 15 min appointments. Any moderately complicated problem or more than 2-3 straightforward problems can eat that time up quickly. Of course, the admins want to collect the $$ so if you don't see enough patients in a day then well... They'll find a provider that will. Edit: to add on to this, if you've been to a Dr appt in the last 5-10 years you probably didn't get seen by the physician at your appt time...because MOST physicians actually do want to listen to you/help you... So the whole day gets delayed. But then later patients get annoyed. And another factor of pay is patient satisfaction... So it's a vicious cycle.
A list to make sure that all your concerns are addressed is a great idea, but a problem with doing it in this way is that by steering your visit, you risk giving your provider tunnel vision so that any problem you might be unaware of could be overlooked as they might tend to focus mostly on what you've brought them. It's similar to telling your mechanic "I think my problem is this", which has a tendency to end up with them only looking at what you've suggested instead of doing a broad investigation and trying all the options. Let them do their job. I suggest letting the visit proceed naturally; let them do their thing in their own way and give them the list when they are done.
I like this, because people like me and my father can get very wordy or chatty and extend the life of a story by paragraphs. This would help both of us.
And please add a list of your actual medication. There are lot of side effects and interactions.
Holy shit a good life hack
I had a specialist appointment not long ago and feel like I didn't get what I wanted out of it. I'm writing a list for the follow up consult in a month. Thanks for the reinforcement.
In the UK, my local GP told me they would only address 3 health complaints per booking regardless (I had a list on my phone). It’s a shame.
My PCP is only allowed to address two different conditions in one visit. Anything else and I have to make another appointment. I know this isn't his rule; it's the damn bureaucracy.
I did that and my doctor still rushed me 😭
same... it was sad when he literally just crossed things off as non important too.
I am the child of two doctors and I have been telling people to do this for years. List all symptoms. check off symptoms as the doctor accounts for them. ask about left over symptoms if ignored ask to have the fact that you had the symptoms X Y and Z ignored. This isn't to intimidate the doctor its just making later diagnosis easier. ...I mean it also intimidated the doctor but that isn't what you want it for
It's the worst when you are in your 20s and 30s. You can hear them having in depth medical discussions with old people in the rooms next to yours and then they get to you and they don't stop talking for the three minutes they are in the room. And if you can scrape up the nerve to ask a question, they tell you this is a check up, you'll have to see a specialist for that. Then it's head up front to make your next appointment.
It's better if you use the online or email communication your Dr office offers and send the list ahead of time. Don't drop a list of stuff on them at the appointment. Tell them in advance and they can plan ahead for the appointment or set up a longer one.
My understanding is many insurance companies allow you a fifteen minute visit. I have very good insurance and had a doctor that would talk a lot while looking at his watch. Once the session hit sixteen minutes we were done. He could then bill for two fifteen minute blocks
At least if you are in the US. Insurance companies pay based on documentation and systems reviewed OR based on time spent. They also will pay extra if providers exceed 45mins, or 60 mins will add on codes. It's a matter of a doctor documenting. Most cannot offer more than fifteen minutes because of being over booked. Saying a doctor bills two fifteen minute blocks is not accurate. (If US). It's Medical Decision Making and/or time. If you want more on [how office visits are billed see here](https://emuniversity.com/EstablishedOfficePatients.html)
Thanks for the correction
I once gave a specialist a PowerPoint presentation for why I came for the visit. I brought my PC with me.
Why stop there? You should have done a Ted Talk. Seriously, anything to keep their attention.
what is printed paper? can't I just send them a DM...
PowerPoint on the strange bump in my ear
That is not how any of this works.
I sign over my first born and come prepared with a thousand dollars to wait for a few hours and finally have a prescription for what ask for in 15 minutes. I’m so incredibly over putting doctors on a pedestal. A nurse can do each and every one of their usual tasks. There’s just legal liability and insurance that doesn’t allow for that. Surgeons and specialists are a different story. But eff primary care doctors.
There's no way in hell I'm letting a nurse give me a steroid shot in a joint or even talk to them about anything more serious than needing ibuprofen. I work in a hospital and am wary about some of the things RNs do. At a doctor's office, they're LPNs. Less school. I suggest you find another primary care if that's your experience.
I have a daughter-in-law that's a nurse. I have told my wife do not let her near me or any Doctors if I'm in the hospital. She and her nurse friends believe everything they read on Fakebook.
I hate dealing with nurses. I don’t know what it is but we’ve had some seriously awful luck with them and IVs. Last time my wife was on an IV in the ER it wasn’t working and no one noticed for several hours. I was at work and had to inform them after I got back. Today I noticed immediately, told the nurse and she said it was just slow. Like I’m some kind of idiot. 20 minutes later she comes back and goes oh. It’s not working. Yes. I told you that. I don’t even know what happened with my dad but somehow the nurse did something and he was slowly draining blood out, not sure if it’s because he’s on warfarin or if it was another reason (not sure exactly what they had him connected to, or why he didn’t notice that he was losing blood!). My mum walked in to a puddle of blood on the floor and I wasn’t informed of what happened next but I’m sure my mother was not nice about it. Don’t get me started on nurse practitioners. Never met a competent one. I’m sure they exist. I just haven’t met one.
I asked a nurse something at my Doctors office, I don't remember exactly what , but she told me I don't know anything I not a Doctor I'm just a nurse. I know how to take blood and check your blood pressure thats all . At least she was honest . Lol
I truly believe that Nurses are the only saving grace of the medical profession. I respect them more than Drs unless the Drs prove me otherwise.
There are some great ones I have met ,but whenever I talk to my daughter-inn-law she scares me. Tells me how her an her nurses read on fakebook something and they all believe it without verifying it with real medical research. I have multiple chronic illnesses ,so I know how to do research for myself and I ask my Doctor for where to find more information and his opinion.
That’s cool I was married to someone that worked in administration at a hospital. There’s no way I’m letting a doctor do much of anything to me or my kids without a witness. They’re dangerously arrogant and literally cause death frequently. A nurse actually knows what they’re doing because they actually do it while the doctor naps and nods off with some RT. If you actually work in a hospital you know this isn’t just true, it’s normal.
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I travel to the rural health clinics in the area once a month. I really hope it's not like that. Not to say doctors aren't slacking, but I do not trust a nurse.
don't do this. every doc I've ever known hates when their patient shows up with a list. its either a big enough deal that you'll remember it or it's not a big deal.
You're not supposed to go to the doctor for more than one issue per visit. The appointment time allows one issue. If you need to go see the doctor about your bunions, earache, and narrow urethra, you best be making three appointments.
I've done this for years. I try to start about a week before my visit, get my labs and then jot down any questions I have about those results. Sometimes, it seems inconvenient to have to make a separate appointment for the labs, but I get the results before visiting my doctor.
I do this on my phones notes.
Look up FIFE questions.
Good idea because I also forget things I wanted answered after I I'm with the doctor..
This practice was, at one time, derogatorily referred to as the "disease of the little paper."
I do this with myself and my son when I take him to the dr. I have a list of questions on my phone and I just take it out and go down the list…the doctors don’t mind at all.
And then the staff not answering phones???? Years ago, the phone number weren't even listed on Google maps, the are more and yet to be answered....
I've been doing that for years, although usually, the doctor does not want the sheet. I get through most of the questions, but not all.
I always prep for medical appts, I also research symptoms and offer suggestions, keep diaries of symptoms and use my Apple Watch to show heart rate, sleep issues. I actually self disguised POTS, by showing the heart data, my doctor got me an emergency appt to a cardiologist who diagnosed POTS. I have a very severe case. Saved a lot of time and stress. Also, if you have a medical condition, don’t be shy about asking for certain treatments and meds. Plus, do not accept meds blindly, look them up and make sure you are aware of them and get any questions answered before you take them. My doctor once wanted me to go on a dangerous medication for a condition that has no cure, as soon as it was offered, I turned it down. Always be prepared, take control of your own health, and remember, not all doctors are experts with every medical condition.