Daniel Hoffman, MD

Hell hath no fury like a patient who wants all his tests done, reported today, and/or to see the specialist immediately.

I divide them up into two groups. The first are the patients that are quite ill and scared as they have waited too long to get medical help and are afraid things will not turn out well. They generally tend to come in later in the day, especially on Friday or Saturday morning at the office. Friday, I can send them to the hospital lab for blood then have the lab page me with the results so I can call the patient at home.

For radiology, I call the department and ask that the films be read and have a report called to me. I advise the patients the hospital will charge more for the services when done this way. I also tell them that they should not hesitate to go to the ER, as these labs and x-rays can be done there and a decision on treatment can be made immediately based on the results.

The second group are the patients with an aggressive personality who want everything done right this minute, even if it is not an emergency. I give them the x-ray and lab slips and tell them to go immediately to the hospital.

It's funny how they change when they're informed that the hospital will be charging more for the tests, as their insurance may not cover as it is not an emergency. Referral is made to the specialist and I give them the number for the physician's office so that they can call concerning the appointment.

Since almost all the specialists are hospital employees, referrals can take weeks to months for the patients to be seen. They can get on a cancellation list, but the appointment will be at the convenience of that office. Lastly, I recommend the ER but explain that the waiting time until seen can be several hours.

When they call back demanding things I also recommend they call their insurance company so that I can make an out of town referral to a regional center for evaluation of the problem. Again they are welcome to call the center and demand an immediate appointment.

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Patients who want things to be done right then and there are typically broken up into two groups. Here's a breakdown of both.

Two Types of Demanding Patients 

Being in private practice means that the patients are your income, not a bimonthly pay check. Therefore you must have the time, patience, and compassion to listen to them on the phone or in the office.

Don't you just love the patient that rambles on and doesn't get to the point when you have a busy day? Then there is the patient will a million questions no matter how simple the problem. The angry aggressive individual who is never going to be happy regardless of what happens. The patient who is timid and the spouse is doing all the talking. The demanding patient who wants his tests and care done right this minute.

The elderly patient who is afraid to tell you what is really happening for fear you will find something bad or something that will result in the children taking away the car or forcing them out of the house into assisted living or nursing home. The patient who is terrified due to their diagnosis as deep down they realize their remaining time is very limited.

The fake patient who will say anything they think you might want to hear to get a prescription for a controlled substance. The depressed patient who will not look you in the eye and you hope is not thinking about doing something harmful to themselves. The patient who needs forms filled out by your office and feels this should be a free service as they are special.

These are just a few of the patient types I see every day in the office. Each one requires special care, so that I can treat them properly and that they will stay in the practice. I have a great office manager, Chris, who has a heart of gold and is compassionate with the patience of a saint to help with these and other patients so that I can continue to practice medicine.

I do not drink but I must admit there are days that having one does not seem like a bad idea. I love the practice as it is a challenge every day and each day is different from the last.

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Each day, this doctor has to give care to a wide variety of challenging patients. As a practice owner, these patients represent his livelihood.

A Wide Variety of Challenging Patients 

With the start of the New Year, we experience a shift in my patient population. Insurances have changed and some of the patients have entered new plans in which I do not participate and others now have insurance which covers my office.

The largest problem is the Medicare patients, who get takeaway plans, which are really HMOs or state aid programs. Many get very upset when they find out I am not in these insurance plans. The best I can offer them is to see them at a lower rate, which cannot be billed to their insurance or will allow me to transfer their records to the new doctor.

This happened to one of my COPD patients, who was told by his new family physician he could not see them until April and if they have problems, they should go to the ER to get medication. Considering I was seeing her twice a month for flare-ups, this was a real problem for treating this patient as she will not be sure which doctor will see her or what they will do for the flare-ups.

One of my patients required hospitalization and was seen by a hospitalist, since the new doctor only works in the office. The hospitalist declined to call any specialists for consultation during his stay. After discharge, the family came back to see me about the problem. I called a specialist who saw the patient that day for the problem. He called me back very upset about the condition of the patient and sent him to the ER immediately.

The patient was admitted under my care and the surgeon operated on the patient that day. The surgeon then called in an infectious disease physician. The patient will go home on IV antibiotics for a month after discharge. Both specialists called the insurance company and explained why the patient was admitted to a different hospital not on the plan. They both told the family to retain legal consul against the new family doctor, hospitalist, and first hospital if the plan does not cover the out of network care.

This should make for an interesting year at my office.

A new year means some patients will have new insurance plans, meaning a lot of transition for this doctor's practice and his patients.

A Shifting Patient Population for this Doctor

Today is Thanksgiving and I have been thinking about things for which I am thankful.

I am still in full-time active practice working five and a half days a week at the office. This keeps me busy and alert as I have to make medical and administrative decisions on a daily basis. The majority of my office staff has been with me for between 10 to 30 years, so there is stability in the way things are done at the office.

The girls get along and know the patients so they have a good idea how much time to schedule for the regular patient visits based on patient diagnosis and personality. They are receptive enough to alert me to a potential problem visit, so if necessary I can have the patient get labs and X-rays at the hospital before being seen or divert them to the emergency room if I feel the problem is outside of the scope of an office visit.

I must admit my staff has been understanding as we will be open and seeing patients on Friday and Saturday as usual, although the girls will be switching off so that they can still do their shopping for all the specials this weekend.

I am still independent which means I can run my own office the way I feel is appropriate in terms of patient care and billing. I also like the fact I have the choice of when I feel it is time to retire. The last physician in my training class was recently retired by his employer. He was replaced by a younger physician who is working at the practice for a smaller salary. I was able to practice long enough to buy a piece of property and build a house of my design as the bank made the loan based on the fact I own my practice.

I have a lot of things to be thankful for and I hope all of you had a wonderful Thanksgiving.

A great staff and remaining independent has given Dr. Hoffman a lot to be thankful for this holiday season. 

Author | Daniel Hoffman, MD

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