Sunday, May 23, 2010

help me please!!I need your best answer..?

You are working as a physician in a neighborhood clinic that serves patients from a variety of socioeconomic backgrounds. Guidelines from your clinic supervisor indicate that you are to spend no more than ten minutes on any patients that you have previously seen. You end up spending an average of twenty minutes during each of three separate follow-up appointments with one individual. This woman is financially disadvantaged, drug dependent, and has a number of problems related to her primary illness. You are called in by your supervisor (possibly an M.B.A. and not a medical doctor) for not following clinic guidelines. How would you respond to your supervisor's reprimands? More generally, how do you feel about the tendency in the United States for people's health care to be treated increasingly as a business?
Answers:
To me, this sounds like a homework question. I'll give you my answer and opinoin, though (cause I like to do that). :)I would first say that the amount of time necessary for a patient visit depends on the number of problems and complexity of their condition. You have a professional obligation to render the proper care to each patient you see. Each time you see a patient, you complete a billing form which indicates the level of complexity (1-6) billing code for the visit, and this corresponds directly to the amount of time you would take and the amount of money paid for the visit. The clinic collects money (however small) for what you bill based on your assessment of the time required. More importantly, you should be able to predict (with some exceptions for new illnesses) what level visit you will have with the patient at their next visit. Since the clinic is compensated based on time required, they should schedule the patients based on this as well. For example, level 6 patient encounters can take 45-60 minutes easily while level 1 can take less than 5. I would say that if the clinic is billing for more time than was spent with the patient they are committing insurance fraud and if they expect me to participate, they are mistaken. Medicine is a business and as physicians, we are obligated to be both professionally and financially responsible. When a physician is an employee, they must conduct themselves with honesty and integrity for both the care given and the billing of insurance or government programs. There is no tendency in the US toward treating medicine like a business (that has always been the case), however, there IS a tendency toward treating doctors like a public utility, which is pushing many of my colleagues out of medicine altogether.Good luck with your paper.
I think it stinks.
Pt care should always come first. You sound like a caring physician. Perhaps this clinic is not the best place for you to be. We could use more physicians like you. Stick to your principles.
I'd move somewhere where health care is better.
to long but i think it's dumb
It's about the more money now and making as much as they can. It is no longer about the people.
yeah i thinks its stinks too
It is unfortunate that doctors are in in an environment that values weatlh over health. Think about private practice, that's where the money is anyway.
I would respond to the supervisor by reciting the Hippocratic oath. I think that medicine should be run as a business, after all doctors have bills to pay too, but like all good businesses there needs to be some flexibility and compassion. A human element has to remain also.
It's happening everywhere and in every business. There has to be a balance I think. Try to stand up for what you think is right in this situation. When this idiot comes in for a follow-up treat him in 10 minutes and see how he likes it. If he is coming in to have stitches removed only take out half of them and say he has to take out the rest by himself for example.
Not every ones Medical problems can be boiled down to seconds.
I'd look for a better place to work or start your own practice.
When meeting with your supervisor let him know that you are recording or going to write down his comments. Also, request that another employee also be in attendance to verify the information given by your supervisor. If needed, contact the medical board. I think the tendency is inhumane! I hope things work out the right way for you!
What in the world is going on in the world today, I've noticed when I go to the doctor they don't spend much time trying to understand whats wrong with me, there rushing me out the door to move on to the next person and it bothers me, that's why many people end up really sick or even dieing cause you go to the doctor these days and just guess what's wrong with you, they don't thoroughly check you anymore, this bothers me cause we spend so much a month paying for insurance and co pays and then we leave there thinking to our self why the heck did I even go to the doctor they didn't help me and it costs me a fortune.Why in the world can you only spend ten minutes with these clients, more than likely your boss will say cause there so many people to see we don't have time, well these hospitals need to hire more people that's the answer to that problem.how in the world can you get in trouble for spending more than ten minutes with a patient, to me it just shows you care about each person that comes in there, I'd respond to my supervisor by informing him you could get in trouble misdiagnosing people and it sometimes takes longer than ten minutes to figure out what is wrong with a person.i don't know, this irritates me,.good luck
The American people have brought this on themselves. They asked for affordable health care and they got it.HMO's. Doctor's have lost final word in health care. That decision is now made by adminiastators who look at bean counter records.
I am a nurse and worked in areas where there were many minorites and majority of people on medicaid. It is very sad when medical decisions are based on a business and numbers and quotas. We went into medicine to actually give people our time and attention now we have to worry about spending too much time with a patient and be a computer programmer too with our documentation. I think it is very sad. If the director has more of a business degree and outlook then she really shouldn't be in the position to oversee the clinical portion of the clinic. I would ask my fellow colleagues their opinion and tell her you are doing the best that you can but you went into medicine to help people not to help the economical numbers. Good luck!
I think this situation calls for the separation of work and, well, the rest of your life. Obviously, this physician is compassionate and wants to make an impact on society. But his desires conflict with the interests of the business he works for, affecting his employment status. I would apologize to the supervisor and start working according to his guidelines, but I would also start spending time volunteering at free clinics. That way I could fufill the interests of my supervisor and my desire to help the communtiy. But it is a shame that something as kind as medical care can be reduced to an uncaring business in these United States.
Everything about America is great, except for the health care system. Its cheaper to just die. I have a will, and in this will it states that I not be resuscitated for any reason, I would Rather die painfully from cancer than have to put my family through the financial burden of AMERICAN HEALTH CARE!! I praise "you" for your work and caring attitude towards those who need it. I say "you" should become a doctor, and help people the way "you" are now.
i think its terrible, because if something happens to that patient because you had to rush, your the one thats liable. i would find a practice that is pro patient, i work for an aurora hospital im not sure if the clinic is the exact same but we put patient care first.
The problem is that health care is getting too expensive for any of us but the really rich to afford. If you take a half-hour for 1 patient, when you could have seen 3, that means you are 3 times as expensive for the clinic as somebody who follows the rules. Can they hire 2 more people? will you take a cut in pay so they can do that? Do you have any sympathy for the people who did not get to talk to you that day and were told to come back another time?Not even your clinic has unlimited people, time or money.The rich don't want to pay for health care for poor people. Their doctors give them all the time they want. Keep voting Republican, so we can decrease the surplus population and then everybody who's left will be able to afford health care.
I would simply tell the supervisor that I became a physician to help people and if I am forced to break a few clinic guidelines to do so then so be it. Youre right about the horribly increasing habit of health care becoming a business but sadly there doesnt seem to be much we can do about it. I recently discovered that when a politician receives a letter he treats it as if 20 other people feel that way yet didn't send in a letter so maybe writing to your local Congressperson or Representative could help. I would also consider opening a clinic or private practice of my own. Best of luck and please pass on all our best wishes to this woman in need! Thank you for the amazing job you are doing helping all these people in trouble!
Sorry boss I'll try to do better.
Health care is a business. No one wants to work for free.
this is an ethical question and one you have to answer yourself.as a daughter to someone who needs constant medical attention this is appalling to me but increasing becoming a frequent habit.if this person is not a doctor or your supervisor tell him your opinion.i guarentee that your way will bring more business to your clinic
It really stinks! Its actualy quite sad. I'd hate to do your job. Its almost like you're not aloud to actually help people.
Tell them you took an oath to heal people, and you cannot heal someone without the necessary info.and that your conscience will not allow you to let someone walk out that you don't think you have done your best to heal. That a veterinarian may be able to heal with trail and error, but your are not working on animals.
i think that is suck the way the us treats health care.i lived in Louisiana and had good docs,i came to California 6 months ago and have been to many diff docs they have treated me like ** and didnt even want my records. all they was concrened about was if my insurance was HMO or POS which i tried to tell them i have both.i have never had trouble with how my ins was till i came here.all they was wanting was there money and never listened to what i had to say about my health.the patient should come first i really feel for you.
Easy, say you are thinking of the company. If your diagnosis is wrong - because of the complexity of the issue , then the practise may be sued but by making sure you had the full info and giving the right advice you have saved the company from a potention law suit and bad name.
Being the money grubbers they are, they might appreciate the fact that you are looking out for them.
Firstly, I would ask that the policy of ten minutes per patient be clarified- is this truly meant to be a "guideline" (which is there to provide guidance), or as a hard and fast rule? Clearly you had reason to consider it the former, and if so, your supervisor needs to make it clear what s/he expects.Secondly, I do indeed think health care should be treated as a business- with the PATIENT as the client. Not the payers. You are clearly trying to serve your clients' needs, and that's to be commended. Obviously, cost containment is an issue, but if this is an incident involving only one "client" whom you have reasonably determined needs more care, I think you should be able to reason with your supervisor. I think you can clearly make an argument that the level of care you are providing both in general and specifically in this case fits a business model. You are providing the best care now, to prevent future costly complications and/or errors.I don't mind health care being treated as a business- if the patient is considered the customer or client.
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I was ready to answer this question, but CALIDOC knocked it out well. It's difficult to deal with medicine as a business. I have a very difficult time with this myself. Unfortunately in medical school, there is no rotation in 'what the hell have I gotton myself into here'? You're not trained in the humanism of man, rather, the science of man. Your life is overwhelmed in the vast chasm, chaos. As someone who is so young and uninformed, it's a battle. You'll come to be in your own time. My promise from very early on was go to bed only if I had taken care to the best of my ability. I actually became to crazed , and became a psychologist. It turned out perfectly. I work with cardiac patients, and their families. It's the best. Good choices my friend. Kym duckling702@yahoo.com
Is good to help, but sometime you can not have time to help all the people. In this case u must choose (more time to one or little time to more people). U decide.

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