Friday, November 1, 2013

Family Medicine: One Hundred Eighteen Patients Today

I finished with various responses to the pile of papers, forms, reports and letters from various insurance companies.  It looked big.  So... I counted.  NINETY-TWO PATIENTS were represented by this pile.  I was surprised.  I was also discouraged.  There is no end in sight to the ridiculous waste and harassment by various entities in The Beast (Medical Industrial Complex).

AFTER, finishing with the last patient, I attacked the pile.

BEFORE the pile, twenty patients had presented themselves for various aspects of our neighborly Family Medicine practice yielding various diagnoses such as:  Well child exams, HTN, asthma, COPD, GERD, FMLA form, Health Maintenance-immunizations, mammogram ordering, colonoscopy discussion and referral, deferred immunization options for under-immunized, physical examination.  Contact dermatitis, multiple benign nevi, insulin resistance, snoring, sinusitis, allergic rhinitis, overuse syndrome-legs, venous insufficiency with edema of lower extremities, degenerative osteoarthritis of knee with effusion, acute situational reaction to custody hearings, acute situational reaction to relationship stress, GAD, ADHD, Depression, Insomnia, OA C-Spine, Degenerative Disc Disease C-Spine, Med Management opiates, Ureterolithiasis with hydronephrosis, nephrolithiasis, abdominal pain, acute viral bronchitis, Calf pain, family hx early coronary disease, uncontrolled type II DM, noncompliance with medical therapy, lumbar disc disease, trochanteric bursitis, fatigue, macrocytosis, hyperhomocystenemia, micro-albuminuria, family hx colon cancer, hematuria, menopausal symptoms.

Yes, there are many more than twenty diagnoses. There were more than I've noted above, even, due to the vastness of my scope of practice, which patients realize, appreciate and sometimes misuse (but we love them, so we're vulnerable when they ask for help and pile on three or four extra problems)

AFTER these many and several diagnoses/assessments in the twenty patients, six medical questions presented from patients calling in.  These were dispatched with a recommendation for clarification, office visits or urgent refill for one (when pt was in for acute, unrelated symptoms, "forgot" to get chronic disease med refilled and has one pill left- I succumb to one 30 day refill if pt agrees to make appointment to deal with chronic disease mgmt before we call it in-yes, it's coercion- or the practice of medicine).

We collected two hundred dollars today from insurance and patients.  I sense a bit of a problem, Folks.
This may not be a sustainable model of practice.  It's interesting and challenging.

What do you think?

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