Professional Courtesy to Physicians Has Its Limits

March 17, 2014

Pulling strings, asking for professional courtesy, whatever you want to call it, it can put physicians in a very awkward position.

Pulling strings, asking for professional courtesy, whatever you want to call it, it can put one in a very awkward position.

I have a busy practice; in some ways, busier than I can handle. I see patients in the office five days a week, starting at 8 a.m. on Monday through Thursday and 9:30 a.m. on Friday. And I'm there all day, except for the hour or two I go to the hospital to do rounds. That seems to surprise people. "What? No golf on Wednesday?" Uh, no. I don't like golf, and don't have time. "I don't want to come in at 8 o'clock if the doctor won't be here. What kind of doctor starts at 8?" I'll tell you what kind - the kind has too many patients to see.

Don't get me wrong. With today's reimbursement, especially in fields like mine where there is zero to few procedures, revenue is all about volume. More patients means more money. And I'm grateful for the patients. But I am only human, and can only see one patient at a time. And I will not compromise patient care to increase volume. That's why I won't shorten visits and I don't double-book. That unfortunately means that there is a wait to get patients in.

I feel bad, I truly do, for the patients who want to be seen right away but cannot be accommodated. I also feel bad for my staff that has to take the brunt of the anger and frustration. But I detest it when patients or their family members or their doctors try to pull strings.

I had one woman insist on speaking to me, telling my staff that she is on the hospital board. I called her and explained that it isn't that I don't want to see her, but that I just did not have an opening during the timeframe she was requesting. Her response, "I'll make it known to the board." Click. Now, I really wouldn't have cared if she did "make it known", but it only took one e-mail to confirm that she wasn't on the board of any institution I have any involvement in.

I'll have doctors call me to ask me to squeeze a patient in. Not because it's a medical emergency (because I do have spots saved for true emergencies), but because it's their spouse, or friend, or spouse's friend.  I want to say to them, "Here, look at my schedule. If you find a spot, put them in." I'm sorry, is your wife or neighbor more important than the people who have been waiting patiently (maybe) for three months? Is it fair that I squeeze in a doctor's sister with subclinical hypothyroidism before the pregnant woman with type 1 diabetes?

I expect more from my fellow physicians. I assume they work as hard as I do, have a crazy schedule, and have to deal with the ridiculous phone calls and paperwork. I also assume they can tell the difference between a true emergency and non-life-threatening condition. I am flattered that my colleagues trust me with the health and wellbeing of their loved ones, and I don't want to sound ungrateful, but I don't pull the doctor card when I make appointments for myself or my family and I don't ask for special favors. I pay my copay, I don't call after hours, and I don't ask to be squeezed in. And that's all I ask in return.