Patient Care Often Extends to a Physician's Personal Time

March 3, 2014

As a physician practicing where I live, I often interact with patients outside the office. Shouldn't I, and others, get compensated for that time?

I’ve mentioned before that I live, work, and play in the same town. That means that from time to time, I run into patients. So I am conscious that they may witness me being a crazy, angry, screaming mom, or that I may be seen eating the very things I tell them not to eat. I have seen them at the grocery store, church, and at school activities. Usually, our interactions are limited to a "Hi! Imagine seeing you here," kind of thing.

Every now and then though, it turns into a mini-consultation. "Oh, I’m glad I ran into you. I need a refill." That one is pretty easy. I tell them to call the office in the morning, because between Sunday morning and Monday morning, I am apt to forget. Or, "I was planning on calling, I wanted to talk to you about how tired I’m feeling." I feel that’s a little trickier. I don’t want them to feel that I am blowing them off, but I also don’t want to have this conversation in the middle of the produce section. I will usually tell them to call me at the office like they were planning to so we can have more privacy (apparently more my concern than theirs, HIPAA be damned).

Recently, I was at the gym, where, it so happens, several of my patients go. On the plus side, they see me, and they know that I don’t just talk the talk, I walk the walk. Or run the run, as the case may be. I had just come out of the shower, when I overheard someone talking about her newly diagnosed diabetes and how she can’t lie to endocrinologist because she downloads her pump and can see exactly what her blood sugars are. I realized it was my patient and said, "Yes, we do." OK, so I asked for it. I could have just gotten dressed. She had not recognized me without make up and half naked, but I went and opened my mouth. That resulted in a 10 minute or 15 minute conversation about how she has been doing. She ended the conversation by saying, "I’ve taken up enough of your free time." I jokingly replied, "I’ll send you my bill."

Of course, I wouldn’t do such a thing. And even if I did, you know insurance wouldn’t pay for it. And patients wouldn’t tolerate such things. But isn’t that what lawyers and accountants do? OK, maybe not all of them, and not under all circumstances, but I know that they bill for their time; time on the phone as well as face-to-face time. If they’re talking shop, they’re talking on the clock.

Can you imagine if physicians could bill for having half-hour conversations with patients and their families over the phone or in the church foyer? There is so much non-face-to-face time physicians spend that is uncompensated; that is deemed all part and parcel of patient care. Funny that it seems we are one of the few professions where we are not compensated for our time. Heck, my staff gets paid overtime, but if I have to make two phone calls to the patient, three calls to her insurance company, and two calls to her pharmacy, and stay an extra hour in the office making me late to pick up my kids, I get diddly.