There is NO hate in this article!  That’s a quote form my clinic.  This one is about effort and caring.  How health care providers, an dall of us, can DO BETTER!

The title is from quote from my best friend.  He’s another chiropractor in my clinic. That’s him on the phone. Just across the room. Right now. He’s talking with his fiancé. She is in the doctor’s office being seen for a dog bite that happened yesterday at a patient’s home. She has a puncture wound in her leg.

The fiancé is an ER nurse and a damn good one. She treated it herself yesterday at home -flushed, cleaned, bandaged it and covered it with a large Band-aid.

So why is she at the doctor today? That’s a good question. So I asked.

It’s her boss that wants her to go, it happened on her way to work, she was late because a freaking dog bit her and guess what? Now it’s a work issue and there needs to be a paper trail.

You just go to the doctor when something like this happens. I mean it could be rabies right?

In all honesty, it’s just something you do – you just GO!  So I won’t devolve into a conversation about what’s wrong with the system right now – its not that article.

So here she is texting us because she’s been in the waiting room for 2 hours and 10 minutes. By that time, the receptionist could see she was irate, so finally a tech was summoned to bring her to the back where she waited for another 30 minutes. Then the x-ray guy came in.

X-rays? Seriously dude? Why?

Because the the doctor thinks so? Nope, that’s not it, she hasn’t seen a doctor yet. And even then, X-RAY? Is there a chance of the tooth being embedded in there? I don’t believe she missed that at home in her assessment yesterday. No exam, no eval, no clinical decision – just because.  I’m grown up now but my mom’s advice still stands the test of time – “sometimes the answer is simply, because.”

Then there’s blood work… of course, there is. Again, I’m not saying this is an incorrect treatment – the point is there has STILL been no exam nor any reason that would dictate that’s what should be done. Look, doctoring is tough, I’m cool if it’s to rule out rabies but I have an issue with “because we have to check that box.”

“Because we our run our clinic like a mill” is not a valid reason either.

“It pays more”

Nope not good, nor ethical.

The doctor fiiinnnnalllly came in holding a google print out with the proper antibody suggestion (and suggestion for an x-ray) and then said I’ll just write you a script for this.   I imagine dirty scrubs and shoe untied, just exhausted and doesn’t care.

Look, we all have stories like that. The problem is her fiance’, my #2 dude over here,  was just at the minor ER yesterday to check on a case of gout he may be having – 2 hours and $200 bucks later he has an Ace BANDAGE and an article about sprained ankles.  This guy  is a sports based chiropractor. Sprained ankles are his bread and butter.  No blood work, no pee on a stick, not even interested in discussing with him the option of gout being an issue despite his exact wording, “I AM HERE TODAY BECAUSE I’D LIKE TO RULE IN/OUT GOUT OR OTHER METABOLIC CONDITIONS”  Agh. sssssssigh.

This is not an attack on the medical industry. I’m not sitting back here trying to reignite the Medical vs Chiro war here guys. Not when my profession continues to be one of the most distrusted and stressful professions out there. We’re the guys that tell you you’ll need 24 visits because your x-ray looks “off”  (ok not at my clinic, but chiropractors are still running this racket.)

This is an article not on that, but on incompetence and just lack of overall effort. It needs to be addressed. Addressed about healthcare in general. When did it get so poor.  Who’s to blame?

Easy answer:

Let’s just blame the big guys at big pharma and big insurance… those monocle-wearing, monopoly-guy-looking fat cats are just sitting up in the company high-rise lighting cigars with cash. And chuckling. Those damn guys are chuckling at something! With that look in their eye like they know a secret! With cigars and Brandy! Damn those guys! They’re  manipulating the system and forcing the doctors to practice this way.

Yeah, not really.

There is no easy answer.  And here’s the bait and switch – DOCTORS HAVEN’T BECOME INCOMPETENT, there are some exceptionally fantastic doctors out there right now running themselves ragged, trying to help and practicing –  a complete 180 from what I’ve described. This…laziness or lack of care or whatever – IT IS IN EVERY INDUSTRY!

It’s a lot of factors – Insurance? Sure, it plays a part.

I take insurance at my clinic. It’s not all it’s cracked up to be but can we as AMERICANS just get past the good guy, bad guy deal. Because if not, this issue continues. It’s simply a blame game.

If, as a doctor, I am going to take insurance there are certain requirements that HAVE to be performed before we can bill what we bill. Check boxes and bureaucracy. It’s just a part of it. Maybe my frfiends xray and blood work was part of that..(it wasn’t) but even then – someone has to tell her “here’s what we do first and why” and CARE.   

I opted to be in the “insurance club” and they require certain aspects to be handled certain ways. No fair? You call Bullshit?

Well if you do, as a doctor, you are more than welcome to opt out, and not be in the club.  No issues at all, no bad blood, no-one really will even miss you and you can still play 18 on the company course, no worries. But, as a doctor, if you want to be on the insurance’s website as a provider, then play by the rules.

And the rules always change and the rate of payment does as well. You may be required to do more to show you indeed do play by the club’s outlined policies. If you just don’t like that then you have options:

1) Fire the insurance companies. (as doctors we don’t have to take insurance.)  I’ve fired a couple different insurances.

That solution has its own instant problem.  Everyone that calls… EVERYONE, asks, as their first question, “do you take my insurance?”    (those two I fired..yeah, those are typically a fast hang up as soon as we say, NO…BUT..)

I’d love to be off insurances but man I’d be down to two clients a day. I’d love that… If I could bill $1,700 or so per client. I’ve got an office of employees that are on payroll, rent and upkeep. It costs something. But if I charge you a super high rate or and unfair rate, then I’d feel guilty for highway robbery so I’d quit and find a different job. This is the story you’ve heard a lot lately. Good doctors, out of the game – the hell with it they’ll just find a different job.

#2 problem with not taking insurance… you all, as hard working ADULTS, pay big money for that insurance, you want to use it.

I have a whole set of reasons for hating this mindset but hey, this isn’t THAT article. I’ll write that one if there is a demand or want for that. (hint: the term insurance means that you DON’T want to use it except in a catastrophe.)

#2 solution for the doctor:  see more people/charge more per visit (not if you take insurance then it’s a fixed price) and/or bill more services.

Problems: 

The doctors are wasted and tired

Bored

Have their own real life going on

You now breed  incompetence, long waiting times and anger as we’re hurrying and cramming.

Many doctors are working as an employee and don’t get to choose how they bill. Yes, many doctors don’t OWN their clinics anymore. It’s not cost effective and it’s crazy so they work for someone (or a corporation) and don’t make their own policy. Often because of this, they also are naturally, not as personally committed to maintaining an elevated service. Hell, most of them thought they’d be making a million a year and chilling at the beach down at club med – then real life showed up and blasted their dreams. The doctor doesn’t stink, his dreams have been crushed!

The solution of: charge more – problem: people hate you, key your car and think you’re the problem.

Bill more services: great, if they are:

1) needed

2) Actually performed

If neither of those are true, then we’re cheating. And there we get back to the title of this article.    There’s probably a lot of cheating going on. Despite the altruistic reasons for it, it’s still cheating – with the rule changes in effect there may be cheating that’s not even known.  The system is a galaxy of craziness and motion.

OK ,Chad – how about a working solution?

There’s not ONE– SORRY, no easy fix. Every presidential and congressional race for the last 5 decades has promised THE FIX – it’s not gonna happen guys – there’s deductibles, co-pays (I saw a $100 co-pay today!!), there’s abuse from the doctors, over use from the patients, tricky situations, $400,000 surgeries, etc. It’s a monster of an issue.

I can offer help… First, don’t hate. Don’t blame – don’t pick sides. It’s not a political, us vs. them situation. Not carrying insurance because you’re making a stand isn’t a solution – if you get hurt, we as taxpayers have to foot the bill and rates go up (part of the problem.)

Become self-aware, use common sense on your diagnostics, not Facebook – really search around and PAY for quality. Make sure it’s worth it. I know in my clinic, it’s expensive, but I try to make sure my clients walking out the door are thinking to themselves, “It’s worth it.”

Use the insurance liaisons – a lot of the companies now have an 800 number or face-time with a doctor in a cloud somewhere that listens to your issue and offers advice on how to proceed or who to see. It’s a cool service and typically 40-50 bucks – sweet! Call the 800 number on the back of your card and see if they have this “ask a doc” feature.

Sometimes just suck it up and go and bite it. You can hate it but there’s times you need it and that’s just how your particular guy operates – assume the doctor is soooo insanely great at her job, the demand to see her is soooo huge that there are literally dozens of waiting patients on the door step every morning and because of the purity of her soul and benevolence, she just CAN’T say no to anyone so her schedule is just jacked. It’ll make you feel better.

Then watch yourself… you can’t repeat the problem if you are a complainer.

Make sure you aren’t  the lazy, troublesome and incompetence you despise in your life. Nearly EVERY ONE of our company protocols are because of what I’ve seen and hated at other businesses – from the oil change guys, to the grocery clerks, to personal trainers and baristas.

Look this isn’t supposed to be an article about my clinic, I just want to be the change I’m griping about so I made the changes.

A pretty smart guy once said, “Be the change you want to see in the world” -M. Ghandi

I know, it’s not the EASY answer – the easy answer isn’t the best answer.

Pretend you’re the doctor, get into his or her shoes for a second.   We’re all human, sometimes my 10 minute re-exam is a monster that has incredibly complex decision making and is a challenge and I need to take 50 minutes on it. It botches up the schedule for everyone, but it just happens. Sometimes my cat kept me up all night and my kids woke up sick and bawling and I’m tired. I’ve had flat tires and guys that flipped me off in traffic.  Life comes to play. It sets me back all day – sorry guys.

Like usual, I’m getting  off track… I guess the answer here to “why are doctors so f’ing incompetent” is that they’re not – I mean some are, maybe it’s just a coincidence, but I don’t think they are. I don’t think most just show up  for the paycheck, I don’t think there are a lot of people trying to scam and cheat. I just think we all get caught up in life.

I DO think the etiquette and norms and expectations in all fields, in all jobs and just through our country and world continue to dwindle and slack however.

What we need, as a society, is to take it back. Earn our keep and just TRY HARDER!  From my other chiropractor a quote from his school days we’ve adopted – simple and to the point:

“Guys, Just do Better.”

That goes for all of us in our day-to-day. Work, life, fatherhood, spouse, attempts at water skiing, I don’t care! Just do Better. Be less lazy, care about what you do, put in a little effort, be the best you can especially when people are paying for your service – smile, make it fun and be the change.