Lack of Customer Service in the USA

[gemini5362]

I do not claim to be wise or even great at customer service, but on this point I will take some credit. I do not overbook or double book. But before I toot my own horn let me tell you why many if not most doctors do it.

It is a combination of money and genuine concern for patients. The money part is easy to understand. The more patients you see, the more money you make. Period. And the way the industry is configured, margins are narrow. Narrow margins drive volume. But, many times a doctor will have a full schedule but people still want to see that doctor that day. Many of my partners feel that getting them in that day is good customer service, and it is. It makes that patient happy. So that doctor makes someone happy and increases their income. So they do it a lot. And especially if that doctor is slow, well, it puts them behind and people have to wait. And it amazes me that so many people just take it for granted that they will have to wait two hours for a 10 minute appointment and it doesn't seem to bother them.

I'm like you. My time is valuable. I don't want to wait that long. And to a certain extent I think it is arrogant for doctors to assume that their time is more valuable than yours.

Now, I'm very different from most doctors in this respect. I am driven (my partners thing I'm a little nutty about it) to see my patients on time. If I tell someone to come in at a certain time, I feel obligated to do my best to see them then. And, to be honest, it suits my personality too, so I like it that way. My patients rarely wait more than 20-30 minutes and then it is usually due to an emergency or some type of patient complication. And when that happens, I apologize to the patient and they usually understand. There isn't much I can do about that sort of thing. With this system I'm happy because I like running on time and my patients are happy because I don't tie them up for hours.

But as you can see, there is a trade off. To stay on time, I can't really double book. That makes me less accessible. So let's say you have a sinus infection and want to see me this afternoon. I have no appointments left so I say no, I can see you tomorrow morning. You might not like that and might even consider it bad customer service. And, I make less money. And despite averaging more than 28 patients a day, I'm the lowest earner in the office. (But don't misunderstand, its still a good income and I am not complaining, its how I want it.)

So what happens is that patients who like me and value being seen on time gravitate toward me even though they know I might not drop everything to see them on the spot. Patients who like another doctor and value being seen at any time (and often having to wait long periods) gravitate toward other doctors. And this works out pretty well.

So, its a tradeoff. Neither way is totally right or totally wrong, but at least we offer both ways. We also rotate as walk in doctor. So one of us is always there with a totally open schedule for anyone who wants or needs urgent care that day. You might not get to see your doctor, but you'll get seen that day. Now, that is a first come first serve sort of thing and if lots of people are showing up for urgent care, well, they may have to wait. We explain that right up front and I really don't apologize for that.

Every office is different and there are many other factors such as how fast/efficient a doctor is or how many regular appointments they schedule per hour. Some patients really like a doctor who will spend a ton of time with them even for small problems. That sort of doctor will always run behind. Other patients want a doctor who gets stuff done and gets them out the door. It is often a balancing act between the two extremes in order to make everyone happy. And some doctors are just slow.

Interesting post. Too many years ago for me to like to think about We had a gp with your attitude. I can not remember ever waiting for more than 30 minutes to see him or for one of my kids to see him. He was a phenomonal doctor and I was very disapointed when my company transferred me out of that city. My doctor I have now does not get me in that quickly but she does get me in within a couple of hours. There have been times when I have been sick and needed to see a doctor where I have been told they are extremely full and that i need to go to a walk in clinic. That approach seems to work fairly well. I dont get to see my doctor but the patients with appointments do not have to wait for her to see someone without an appointment.



Let me do some math. You see 30 patients a day. My doctor charges 100 dollars a visit. Assuming you are charging similar fees and even if you lose a huge chunk to overhead that is still a long ways from 28 cents an hour. .

 

[N80]

Let me do some math. You see 30 patients a day. My doctor charges 100 dollars a visit. Assuming you are charging similar fees and even if you lose a huge chunk to overhead that is still a long ways from 28 cents an hour. .

I'm not sure what you're trying to say, but remember (as I mentioned above), we don't see anything near that $100. That $100 is a fluff number. I'm not complaining, we currently get paid just fine, but you can't use that $100 to do the math cause it aint real.

And you are right, the overhead is huge. We run a tight ship (amomg the lowest overhead in the system) and I think it is still way over 50%, mostly to pay for all the employees to manage billing, referrals, posting, etc etc. Positions that exist to manage the terrible insurance system we all deal with (I'm a patient too, so I know how bad it is on that end as well.) Those positions provide no benefit to patient care. None.

 

[dmccarty]

Talking about overhead. A few years ago I heard a report about the premiums some Doctor's had to pay. I think this was around Washington DC and it was for practices that can get sued frequently. OB/GYN if I remember correctly. Though it might have been brain/spine related. I had to guess at how many patients a doctor would see per day and per month but when one did the math each patient's bill had a pretty large charge just to cover the premiums.

This was years ago so I can't remember the details anymore but each patient was paying for the overhead.

Later,
Dan

 

[jdbower]

OB/GYN is one of the worst from a liability perspective. I saw a few years ago that the average income for an OB/GYN was close to $500k a year, that sounds like a lot until you saw the next line. Average cost of malpractice insurance was around $400k a year. Then tack on cost of employees, cost of the facility, probably high 6 figures of equipment and you get even lower. Makes all that med school and having to be on call 24x7 worthwhile, doesn't it?

 

[N80]

Malpractice insurance is a big expense for all doctors, but much worse for some. And much worse in some places, particularly where there isn't much tort regulation.

However, the hospital system I work for carries its own liability insurance and has its own legal department. So even though the actual cost will make your eyes bug out, mine is extremely low by national standards so that is one area in which I am very fortunate. It just comes at the price of being an employee and being just another cog in a very typical corporate machine and all the bull manure that comes with it. But that's life, no one gets to have their cake and eat it to.

I personally don't know how any doctors start their own, small, privately owned practices anymore. But I have great admiration for those who do, because in a perfect world I think that is the best way to do medicine and business. As things are, I don't have the patience or intestinal fortitude to do it.

 

[Bedlam]

I have had my long time doctor have to affiliate with the local hospital. Service went down hill fast. Almost everything has to go through the hospital. Even with computers., the hospital cant seem to 'talk' to the docs office. Ill have a test done and wait about 2 or 3 weeks, and go for follow up and he walks in and says hmm we haven't gotten the results. I'm like OK. so hows the golfing going. Seriously why would they waist his and my time?There is something wrong with that, and when he starts to complain to me how he is treated and how they don't communicate. All the hospital cares about is the bottom line. Which is contrary to their ads. LOL

 

[gemini5362]

I'm not sure what you're trying to say, but remember (as I mentioned above), we don't see anything near that $100. That $100 is a fluff number. I'm not complaining, we currently get paid just fine, but you can't use that $100 to do the math cause it aint real.

And you are right, the overhead is huge. We run a tight ship (amomg the lowest overhead in the system) and I think it is still way over 50%, mostly to pay for all the employees to manage billing, referrals, posting, etc etc. Positions that exist to manage the terrible insurance system we all deal with (I'm a patient too, so I know how bad it is on that end as well.) Those positions provide no benefit to patient care. None.

I am not going to try and defend the insurance corporations. I have had my share of problems with them just trying to collect claims. Most companies have overhead with people that are doing billing. I agree that insurance companies format makes it difficult to deal with a lot of the times but basically they are still a part of the billing department.

I am not sure what you are talking about when you call that 100.00 a fluff number. I get a statement from Blue Cross/ Blue shield telling me how much my doctor has billed them. How much they discount. How much my copay is and how much they paid them. When You add my copay to the amount they pay them it is right at 100.00 a visit. I am not sure what is fluff about that. It was mentioned here about the cost of equipment. I believe that any tests that are run which require special equipment is a seperate charge for that equipment. If my doctor takes x rays I get charged seperately for those x rays. If there is blood tests run those are a seperate billing. Once again I am not knocking what doctors make they have a lot of responsibilities and takes an awesome amount of trainging to get where they are. I have however never seen a doctor that has been practicing for a few years living in a shack. When you state that you are making more than 28 cents an hour that is I am sure a true statement but perhaps misleading. Are you a GP or a Specialist ?

 

[N80]

I agree that insurance companies format makes it difficult to deal with a lot of the times but basically they are still a part of the billing department.

I don't think you are paying attention. Billing is not the only issue with insurance companies. We have to have full time staff positions to make referrals to other physicians and we have staff that spend most of their time fighting with insurance companies to pay for your medication.

But what you really seem to be misunderstanding is that this hurts the patient. Not me. In other words, if I didn't require all this staff to get what should be very simple and transparent tasks done, I could charge you a lot less and still make the same amount of money. So make no mistake, just like overhead in any other business, it mostly hurts the customer. So when you hear me complain about that, its for the customer's sake not mine.

I am not sure what you are talking about when you call that 100.00 a fluff number.

I've explained it the best way I know how.

I get a statement from Blue Cross/ Blue shield telling me how much my doctor has billed them. How much they discount. How much my copay is and how much they paid them. When You add my copay to the amount they pay them it is right at 100.00 a visit.

I'm not going to try to decipher your medical bill since I can hardly figure out my own. And I have no idea how your doctor works with your version of BC/BS, but if you could get the right person on the phone at BC/BS, you're likely to find that that $100 is not what the doctor gets. But if it is, fine. That's one example. My office takes over 20 different forms of insurance. They're all different.

But again, I think you're missing the point. I did not share any of this to bemoan my situation. I shared it to explain why costs are so high for YOU and even worse for people without insurance. This system is not hurting me. And despite that I'm still willing to point out why I think it is a bad system. You do what you want with the info.

If my doctor takes x rays I get charged seperately for those x rays. If there is blood tests run those are a seperate billing.

So what's you point. Doesn't a mechanic charge for each thing that he does? And if it requires expensive equipment doesn't he have to pay for it? Why should it be different with your doctor? And once again, you're likely unaware of how that works. We make very little off of x-ray and lab. Even with our contracting clout, office lab and x-ray get severely lowballed by the insurers. Sometimes just breaking even. But we have it anyway because it makes life easier on both us and our patients.

I have however never seen a doctor that has been practicing for a few years living in a shack.

I'm not sure what your point is. Would you expect to see a doctor living in a shack? Why? Besides, you should have seen what i lived in in medical school and residency. And for the record, a resident is a doctor. By the time you see what a doctor who has been in practice a few years, he had been in training, as a doctor, for 3-7 years not including med school.

When you state that you are making more than 28 cents an hour that is I am sure a true statement but perhaps misleading.

I don't recall ever saying anything about 28 cents an hour. Maybe I've forgotten but I don't know what you are talking about.

Are you a GP or a Specialist ?

You might call me a GP, but I'm a residency trained Family Medicine 'specialist' and I'm board certified.

But, if you don't like what doctors make, vote for Obama and Hilary. We'll be making the same as the postmaster and dog catcher.......and you'd probably get better care from the dog catcher when that happens.

 

[gemini5362]

let me briefly reply to your last post and I am not trying to say disparaging things about you or your profession.

If you say that blue cross does not pay the amount they send to me in the paperwork that I recieve, I am not sure why they would tell me that they do that. I just know that I recieve pretty simple paperwork it tells me how much the doctor bills how much they pay for that how much they are going to pay the doctor and how much I have to pay the doctor. If those numbers are fraudulent that would be interesting to know.


I think you have a perfect right to charge for xrays and specialty equipment. I was replying to a post where they talked about the high cost of equipment in a doctors office. Yes that is a high cost but it is payed for directly by patient billing. I am assuming of course that the charges for xrays, blood testsing equipment etcetera are applied to retiring the debt against those items. By combining in a clinic you have the equipment spending less time idle and I would hope you are able to retire that debt more quickly.


I understand why doctors make the money they do and I have said in earlier posts that the educational costs, the time, the responsibilites etc are extremely difficult and you should be paid appropriately.

Since I am a part time real estate agent I have seen some of the homes that doctors in this area live in that they are selling because they are moving to another home and they are quite a distance from being shacks. I realize that doctors that have finished residency and are starting a practice might be tight for money it does not take a long time to get ahead.

I believe what started this line of the post was my comment about letting people have access to more classes of medications at the pharmacy without seeing a pharmacist first. We obviously have a different opinion about that. I still think it would be beneficial to have our country have laws that allowed antibiotics and other non addictive drugs available from a pharmacy without a prescription. It is done in other countries. I feel like it would go a long ways towards helping with the cost of medicine in the United States. I know that you dont think that way. I dont think anyone should be able to sell their home without having to go through a realtor. I am sure most attorneys feel that people should not be able to do any legal activity without an attorney( before anyone mentions practicing law without a license. You can defend yourself if you are on trial for first degree murder, You can write your own contracts etc. ) Mechanics feel that no one should be able to buy car parts etc.

 

[jdbower]

While some equipment like X-Ray machines could be paid for through procedure charges, I doubt you've been charged directly for use of the exam table or the sterilization equipment. Plus some equipment can't reasonably be paid for by the people who use it - if there are too few people in need of dialysis in a region the hospital may not be able to charge enough for the procedure (at least in good conscience) and has to amortize the cost over the other patients somehow (whether it's a direct billing increase, increased taxes, or reducing the doctor's salary so you don't attract the cream of the crop anymore).

But the point is that looking at what the insurance company pays and trying to deduce what a doctor makes is irrelevant, it's like going to the grocery store to get the price of corn and then counting the ears in a farmer's field to figure out how much he makes, ignoring the cost of the seed, fertilizer, tractors, etc. In your case at $100 a pop the ear of corn you've sampled is from an upscale organic market, typically doctors get paid from the cardboard bin at the end of the Walmart aisle.

I dont think anyone should be able to sell their home without having to go through a realtor.

Actually George stated that it's his belief (and one that I share) that improper use of medications like this will INCREASE his business and may be one of the reasons why a lot of socialized health care countries have so many issues - if something's free and easy to obtain it's not treated with the respect it deserves.

Ironically, as you've phrased this (and I'm willing to assuming it's a phrasing issue) is the root cause of the lack of customer service in the USA (not to derail the conversation back to the original track ). It shouldn't be that a service should want people to be forced to use them, a service needs to carve out a niche that makes the extra money required worthwhile. I've dealt with realtors who were awful, I had to bring a list of properties from realtor.com myself because they wouldn't listen to what I wanted (or were too incompetent to figure out the search) and all they did was drive me around because only they could open the locks - that wasn't worth the 3% commission they get (even worse was when I used Foxton's to buy where the Foxtons realtor was absolutely fantastic and the seller's did nothing, Foxton's only got 1% and the seller got 5%). On the other hand I've also had realtors who were able to tell what we did and didn't like about a house and were able to guide us into a more appropriate purchase - without regard to the size of their commission. Because they went out of their way with the customer service they deserve their commission. It's the entitled attitude of some people that breeds contempt and the associated lack of service when they don't get what they think they deserve. As I mentioned this isn't directed towards you directly, just towards the out of context statement that probably doesn't represent what you really mean.

 

[N80]

I believe what started this line of the post was my comment about letting people have access to more classes of medications at the pharmacy without seeing a pharmacist first. We obviously have a different opinion about that.

No, as JD said, we probably don't. I think it is better for patients not to be able to aquire such medications without some sort of professional oversight. I already see enough people hurt themselves with over the counter medicines and 'natural' products as it is. But make no mistake, if you opened the pharmacies today, my business would double, not diminish. And again, this is not a doctor issue. I/we have nothing to do with it. Its all Uncle Sam.

 

[gemini5362]

No, as JD said, we probably don't. I think it is better for patients not to be able to aquire such medications without some sort of professional oversight. I already see enough people hurt themselves with over the counter medicines and 'natural' products as it is. But make no mistake, if you opened the pharmacies today, my business would double, not diminish. And again, this is not a doctor issue. I/we have nothing to do with it. Its all Uncle Sam.

So If I understand you right the two of you think that it is better for the hundreds of thousands of people in this country who do not have health insurance and cannot afford to go to the doctor to do without medications than it is for pharmacies to be allowed to sell antibiotics and certain drugs over the counter? Possibly if they did not have to pay the doctors fee on top of the cost of medication more people could afford medications.

 

[jdbower]

So If I understand you right the two of you think that it is better for the hundreds of thousands of people in this country who do not have health insurance and cannot afford to go to the doctor to do without medications than it is for pharmacies to be allowed to sell antibiotics and certain drugs over the counter?

It's not quite that simple. First of all, if you can't afford medical care you should look into Medicaid and/or free clinics. Second, the cost of the doctor's visit will likely pay for itself in the number of people who buy the wrong medication - just because the symptoms are the same doesn't mean the disease is the same. Finally, the lives saved passively by allowing doctors to monitor the community for drug resistant varieties is priceless. It's a tradeoff, you're increasing the cost of health care a little but you're increasing overall health quality by a lot.

 

[N80]

So If I understand you right the two of you think that it is better for the hundreds of thousands of people in this country who do not have health insurance and cannot afford to go to the doctor to do without medications than it is for pharmacies to be allowed to sell antibiotics and certain drugs over the counter? Possibly if they did not have to pay the doctors fee on top of the cost of medication more people could afford medications.

I'm not sure what to say that I haven't already said, but yes, in the interest of public health...in other words, in the interest of the fewest people being harmed, I think it is best that many medicines, most importantly antibiotics, remain prescription only.

And you yourself use the words 'certain drugs'. If you think it would be a better world if people could get medicine without a visit to a doctor then why not ALL medicine? Narcotics, antipsychotics, chemo, anti-arhythmics, stimulants, anti-coagulants. Do those sound to scary? Why? So if even you think only certain drugs should be prescription then who decides which ones? You? Me?

And your continued reference to antibiotics is pretty clear evidence to me that antibiotics in particular need to remain prescription only. You clearly don't understand, or don't want to understand the implications of inappropriate use of antibiotics for yourself or the population at large. There hasn't been a significant develop in anti-bacterial therapy in years and strains of bacteria like MRSA are getting harder and harder to treat. Inappropriate use of antibiotics is the cause. The level of inappropriate use would skyrocket if antibiotics could be obtained by people, like yourself (and most everyone else) who have no clue what they are doing.

In addition to that, how would the average citizen know that 10% of people who have anaphylaxis with penicillin could also have anaphylaxis with cefdinir? How many people would have to die making that mistake before some genius decided maybe everyone shouldn't have access to antibiotics? Would you recognize the symptoms of Stephens-Johnson syndrome, or erythema nodosum resulting from certain classes of antibiotics? Would you know which flouroquinalones would interfere with your Coumadin levels or shorten your Q-T interval in combination with other medications?

All of that is not to sound smart, its all common stuff to physicians, but it isn't common stuff, or even manageable to non-medical personnel, its to point out that a cough or a sore throat does not equal an antibiotic and that there is a big difference between an antibiotic and a Hall's mentholyptus.

In short, yes.

 

[gemini5362]

While some equipment like X-Ray machines could be paid for through procedure charges, I doubt you've been charged directly for use of the exam table or the sterilization equipment. Plus some equipment can't reasonably be paid for by the people who use it - if there are too few people in need of dialysis in a region the hospital may not be able to charge enough for the procedure (at least in good conscience) and has to amortize the cost over the other patients somehow (whether it's a direct billing increase, increased taxes, or reducing the doctor's salary so you don't attract the cream of the crop anymore).

Lets compare your post with another profession. Automobile Mechanic. Some of their specialty machines are charged directly such as front end alignment machines and computerized engine analyzers. When those are used on your car there is a fee for that particular machines use. The wrenches and screwdrives that a mechanic uses are not a specialty fee and are included in the overall bill for your repairs. I expect the exam tables and sterilization equipment would fall into that catergory.

But the point is that looking at what the insurance company pays and trying to deduce what a doctor makes is irrelevant, it's like going to the grocery store to get the price of corn and then counting the ears in a farmer's field to figure out how much he makes, ignoring the cost of the seed, fertilizer, tractors, etc. In your case at $100 a pop the ear of corn you've sampled is from an upscale organic market, typically doctors get paid from the cardboard bin at the end of the Walmart aisle.

I took the amount of patients that he said he saw in a day and multiplied that times what I have seen doctors traditionally charge in my area. I have trouble believing that my doctors charges of 100.00 per visit are the high end of the price scale. I believe that when I saw a neurosurgeon his 350.00 for a consultation was more the upscale organice market. I would have to be shown numbers to see a physician in the united states that typically charges what you seem to be calling the cardboard bin at the end of the walmart aisle fees. ( I assume you are saying that they are considerably less than 100.00 a visit.) I showed your comments about the 100.00 a pop ear of corn being the upscale organic market typical fees being more toward the cardboard bin at the end of the Walmart aisle to an attorney I know. I know for a fact that this attorney used to represent doctors in contract negotiations and draw up leases for doctors clinics. When I showed the attorney your post they burst out laughing. They thought it was hilarious that you feel 100.00 per visit was the high end of the scale.



Actually George stated that it's his belief (and one that I share) that improper use of medications like this will INCREASE his business and may be one of the reasons why a lot of socialized health care countries have so many issues - if something's free and easy to obtain it's not treated with the respect it deserves.

You and George are very entitled to your beliefs. I am of the belief from some of the reading I have done that one of the bigger problems with medication is that someone either does not finish their medication when they start feeling better and that allows the disease to return in form that is more resistant to the drug it was being treated with.

Ironically, as you've phrased this (and I'm willing to assuming it's a phrasing issue) is the root cause of the lack of customer service in the USA (not to derail the conversation back to the original track ). It shouldn't be that a service should want people to be forced to use them, a service needs to carve out a niche that makes the extra money required worthwhile. I've dealt with realtors who were awful, I had to bring a list of properties from realtor.com myself because they wouldn't listen to what I wanted (or were too incompetent to figure out the search) and all they did was drive me around because only they could open the locks - that wasn't worth the 3% commission they get (even worse was when I used Foxton's to buy where the Foxtons realtor was absolutely fantastic and the seller's did nothing, Foxton's only got 1% and the seller got 5%). On the other hand I've also had realtors who were able to tell what we did and didn't like about a house and were able to guide us into a more appropriate purchase - without regard to the size of their commission. Because they went out of their way with the customer service they deserve their commission. It's the entitled attitude of some people that breeds contempt and the associated lack of service when they don't get what they think they deserve. As I mentioned this isn't directed towards you directly, just towards the out of context statement that probably doesn't represent what you really mean.

I agree with you about realtors. I have a real estate license although I dont sell any more I am more of an investor I still have my license. I am not trying to defend realtors but when I did sell real estate I drove a lot of people around using expensive gasoline and putting miles on my car. I would show them houses see what they were interested in, spend hours on research and show them more houses. After a week or two of showing houses something new would come on the market and I would call them up to tell them about it. The client would inform me that they had been driving around town and saw this house that they just loved. They called the realtor whose sign was posted and when that realtor showed them the house the bought it. One of the first things all realtors in this area do is inform their clients that any house that has a realtors sign on it can be shown by any realtor. If they see anything they like just call us and we can show it to you. What if the medical profession was run that way. Doctors not getting paid until they cure the disease not while they are treating you. How would they feel if they had been treating a patient for two weeks and the patient called and said I ran across an ad in sundays paper by doctor new idea and I called him and he cured me so I am paying him and all the time and money you spent treating me I am not paying you for. That sounds ridiculous but that is exactly what happens to realtors all the time.

One of the reason that only realtors can open locks is that gives some acountability to who goes in the house. Most realtor lock boxes record who opens them. If something gets damaged or stolen it points out who had been in the house.


I am not knocking the medical field and actually in my opinion for the most part their customer service is vey good. Yes you have to wait in the waiting room but it is not a job where a doctor can say I am only going to give this patient 13 minutes then leave whether I know what is wrong with them or not. Doctors provide a lot of services. Are they expensive absolutely but they have a lot of time, and money invested in getting where they are at. They should be paid accordingly. The more you invest the higher your overall rewards are.

 

[gemini5362]

I'm not sure what to say that I haven't already said, but yes, in the interest of public health...in other words, in the interest of the fewest people being harmed, I think it is best that many medicines, most importantly antibiotics, remain prescription only.

And you yourself use the words 'certain drugs'. If you think it would be a better world if people could get medicine without a visit to a doctor then why not ALL medicine? Narcotics, antipsychotics, chemo, anti-arhythmics, stimulants, anti-coagulants. Do those sound to scary? Why? So if even you think only certain drugs should be prescription then who decides which ones? You? Me?

And your continued reference to antibiotics is pretty clear evidence to me that antibiotics in particular need to remain prescription only. You clearly don't understand, or don't want to understand the implications of inappropriate use of antibiotics for yourself or the population at large. There hasn't been a significant develop in anti-bacterial therapy in years and strains of bacteria like MRSA are getting harder and harder to treat. Inappropriate use of antibiotics is the cause. The level of inappropriate use would skyrocket if antibiotics could be obtained by people, like yourself (and most everyone else) who have no clue what they are doing.

In addition to that, how would the average citizen know that 10% of people who have anaphylaxis with penicillin could also have anaphylaxis with cefdinir? How many people would have to die making that mistake before some genius decided maybe everyone shouldn't have access to antibiotics? Would you recognize the symptoms of Stephens-Johnson syndrome, or erythema nodosum resulting from certain classes of antibiotics? Would you know which flouroquinalones would interfere with your Coumadin levels or shorten your Q-T interval in combination with other medications?

All of that is not to sound smart, its all common stuff to physicians, but it isn't common stuff, or even manageable to non-medical personnel, its to point out that a cough or a sore throat does not equal an antibiotic and that there is a big difference between an antibiotic and a Hall's mentholyptus.

In short, yes.

You are entitled to your opinion and while I agree with you that the average person would not know the examples you give. How often do doctors not get a good background from the patient and make just such a mistake. Or how often does a patient see multiple doctors. Right now I have three doctors I see on a regular basis a general practioner, a pulmonologist, and a cardiologist. What if one of them prescribes a medication. I start taking the new medication and a short time after I start taking it I get pneumonia I go to see my doctor and am feeling so bad I forget to tell me doctor about the new medications I am taking so my doctor prescribes something that fatally interreacts with it. I personally trust my pharmacist to watch out for drug inter reactions. I shop at the same pharmacy and my pharmacist knows exactly what medications I am taking.

I hate to let the cat out of the bad but there are a lot of people that are buying medications that are not doctor prescribed. You can go to mexico and buy them. A lot of people that live on the border do that. There are a lot of people who dont have insurance that goes to the local feed store and buy animal antibiotics when they think they need medication. Some people just go to the pet store and buy antibiotics for pets. There are people getting anti biotics without doctors prescription now. I would just like to see it be available in an american pharmacy.


I am just using antibiotics as one example. Personally the only drugs I would like to see require a doctors prescription are drugs that are addictive. I dont think anyone should be able to just go to the pharmacy and get valium for instance.

 

[gemini5362]

Just to have an on topic post I made a purchase today at an ATWOODS. I am not sure how big a chain they are and who knows what that store is. To me they are like a discount TSC store. I bought a new tiller today. When I paid for it they issued a pickup slip. A clerk took it back to the repair section of the store where they put oil in it and gas and made sure it was operational before they loaded it for me. That did not take very long but Iwill make sure that I recommend them for others buying gas powered products.

 

[N80]

You are entitled to your opinion and while I agree with you that the average person would not know the examples you give. How often do doctors not get a good background from the patient and make just such a mistake.

This does not argue in your favor. If the professionals who do this can screw it up, then non-professionals will screw it up even worse. The fact that we doctors make mistakes just shows how complex this is and is not some sort of 'excuse' to let people with less medical experience do the same job.

Or how often does a patient see multiple doctors. Right now I have three doctors I see on a regular basis a general practioner, a pulmonologist, and a cardiologist. What if one of them prescribes a medication. I start taking the new medication and a short time after I start taking it I get pneumonia I go to see my doctor and am feeling so bad I forget to tell me doctor about the new medications I am taking so my doctor prescribes something that fatally interreacts with it.

Well, I'm sure you will agree that that is a two party screw up. It IS a patient's responsibility to give their doctors pertinent information. It IS a doctors responsibility to solicite that information.

I personally trust my pharmacist to watch out for drug inter reactions. I shop at the same pharmacy and my pharmacist knows exactly what medications I am taking.

And that's great. But many, if not most, patients get their meds from multiple pharmacies, often through the mail, the VA, etc etc. So while that might be fine for you, it isn't the norm. So that does nothing for your argument either.

I hate to let the cat out of the bad but there are a lot of people that are buying medications that are not doctor prescribed. You can go to mexico and buy them. A lot of people that live on the border do that. There are a lot of people who dont have insurance that goes to the local feed store and buy animal antibiotics when they think they need medication.

A lot of people huff paint and freebase cocaine. People drive without seatbelts. A lot of diabetics drink 2 liter regular soft drinks daily and a lot of people with heart disease eat at McDonalds. A lot of people experiment with their friend's medicines. So don't worry, people doing stupid things is a cat that's been out of the bag for a long time. And I'm not even going to get into the stupidity of buying important medications from across the border in Mexico! But make no mistake about it, its that kind of behavior that keeps me a busy man.

Some people just go to the pet store and buy antibiotics for pets. There are people getting anti biotics without doctors prescription now. I would just like to see it be available in an american pharmacy.

Again, my job is not to be a 'stupid police'. You can't legislate, or even enforce common sense. Ignorance is the most dangerous disease in this country.

am just using antibiotics as one example. Personally the only drugs I would like to see require a doctors prescription are drugs that are addictive. I dont think anyone should be able to just go to the pharmacy and get valium for instance.

You're just exposing your lack of understanding here. Valium is harmless compared to antibiotics and the other medications I listed above. Makes you about as sleepy as a benadryl and about as drunk as a beer. This is another perfect example of why people like you (the general population) should not have access to prescribed medications without a prescription. You simply do not understand. And I don't think I can help.

But remember. It isn't up to me. My opinion is no more important than yours. This is a government issue. If you think it needs to be changed, contact your elected officials.

 

[gemini5362]

It's not quite that simple. First of all, if you can't afford medical care you should look into Medicaid and/or free clinics. Second, the cost of the doctor's visit will likely pay for itself in the number of people who buy the wrong medication - just because the symptoms are the same doesn't mean the disease is the same. Finally, the lives saved passively by allowing doctors to monitor the community for drug resistant varieties is priceless. It's a tradeoff, you're increasing the cost of health care a little but you're increasing overall health quality by a lot.

Actually medicaid is rather hard to get. If you have a job it is next to impossible. I have a son making 8.00 per hour he would not qualify for medicaid but try living on those wages sometime.

Free clinics are often hard to get into also. I think in the city I live in there is one free clinic for all the people that have jobs but dont have health benfits. I have not been there so I dont know how long the waiting list is to see a doctor but i would imagine that it is fairly long.


The overall problem that I seem to be concerned about is highlighted by your statement that " your're increasing the cost of health care a little but you're increasing overall health quality by a lot." Assuming that statement is correct. The bare plain facts are that in the United States a lot of people do not have health insurance and cannot afford health care. They have no one monitoring them for drug resistant varieties. Giving the general public a chance to get drugs by walking into a pharmacy is one way of lowering the cost for health care. You and george can say what you want but it is done in other countries. I have lived in other countries where that is done and the cost of health care is lower. If George is correct that it will increase his buisness then good for him he will be able to recoup the investment that his education cost him that much more quickly.

 

[gemini5362]

This does not argue in your favor. If the professionals who do this can screw it up, then non-professionals will screw it up even worse. The fact that we doctors make mistakes just shows how complex this is and is not some sort of 'excuse' to let people with less medical experience do the same job.



Well, I'm sure you will agree that that is a two party screw up. It IS a patient's responsibility to give their doctors pertinent information. It IS a doctors responsibility to solicite that information.



And that's great. But many, if not most, patients get their meds from multiple pharmacies, often through the mail, the VA, etc etc. So while that might be fine for you, it isn't the norm. So that does nothing for your argument either.



A lot of people huff paint and freebase cocaine. People drive without seatbelts. A lot of diabetics drink 2 liter regular soft drinks daily and a lot of people with heart disease eat at McDonalds. A lot of people experiment with their friend's medicines. So don't worry, people doing stupid things is a cat that's been out of the bag for a long time. And I'm not even going to get into the stupidity of buying important medications from across the border in Mexico! But make no mistake about it, its that kind of behavior that keeps me a busy man.



Again, my job is not to be a 'stupid police'. You can't legislate, or even enforce common sense. Ignorance is the most dangerous disease in this country.



You're just exposing your lack of understanding here. Valium is harmless compared to antibiotics and the other medications I listed above. Makes you about as sleepy as a benadryl and about as drunk as a beer. This is another perfect example of why people like you (the general population) should not have access to prescribed medications without a prescription. You simply do not understand. And I don't think I can help.

But remember. It isn't up to me. My opinion is no more important than yours. This is a government issue. If you think it needs to be changed, contact your elected officials.

I am going to try and keep this short.

1. If professionals screw it up it must be too complex for non professionals to handle. Good arguement basically people without medical degrees are too stupid to read about drugs and make intelligent decisions.

2. Most people get their medications from multiple pharmacies, the va, online etc. Last time I looked the VA kept records of what they give you. I would imagine online pharacies do also but I dont know that for a fact. I think a lot of people have a pharmacy they use for whatever reason ( usually customer service comes into play here) I do not know many people that just walk into the first pharmacy they see and say fill my prescription. Most people I know use one pharacy and stay without until they have a reason to change

3. I am ignorant of various drugs other than the ones I have been prescribed which I try to find out as much as I can about. So if all valium does is make you sleepy then all heroin does is make you feel better so why should either one of those not be available at walmart available without a prescription. I believe I was trying to point out that we might want to limit addictive drugs to having a doctor prescribe them. When I lived in the middle east where I could get antibiotics and similar items without a prescription it seemed like drugs with addictive properties were still controlled through a doctor. Interesting enough my asthma medicine at the time METROTERENOL (sp) was one of the controlled drugs. I am sure that is because of its chemical makeup.


The bottom line is that you would rather see the hundreds of thousands of people in the United States that have very limited health care suffer than to have them able to get medications without prescriptions. Other countries allow people to get certain drugs without prescriptions and the news has not reported the huge epidemics of drug resistant diseases that are running rampage in these countries.


I am curious about one thing. If you have a patient that has been to you with a disease and you have prescribed antibiotics. Two weeks later this patient comes back uncured and with symptoms of the same disease but the patients symptoms of the disease are of less intensity. If you prescribe another round of the same antibiotics do you charge them for this second office call ?