S/o What the f do you all want from doctors?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I didn't read the whole thread, but personally I wish more PCP offices offered "concierge light" models. I don't want to spend $250 per month to retain the services of a doctor I see once or twice a year but I would spend $250 per year or an extra $50 per visit over two visits per year if it meant I could see the same 1-2 providers on a regular visit and didn't get rushed out of there. Same thing goes for our pediatric practice.

I feel like Teledoc fills that role in my life now. For little sick visits, we just use that: it's immediate care at home. And the doctors we have had were always great.

I used Teledoc recently and it was so easy for a minor dermatology thing. I had a response within an hour.
I work in nutrition though, and dietitians complain about Teledoc because BCBS hires dietitians at low pay for Teledoc services, and then tries to get patients to use that instead of paying out for a private practice dietitian. Basically it saves costs but at the expense of the providers.

Well, sure. You just said yourself that for non-emergent visits it works just as well and is much more convenient. Of course insurance is trying to lower costs if there is no impact on the patient. Insurance, and health care, is not a jobs program for providers. Those dieticians are like the makers of buggy whips complaining about the automobile.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:To be honest, I don't understand why the healthcare system cannot be reformed such that primary care doctors can spend AT LEAST ONE HOUR with a patient per year.

Lawyers make lots of money and manage to spend an hour here and there with a client, c'mon.

Of course our system is broken and our population is chronically ill and too many dying unnecessarily has something to do with the standard of care being 20 minutes/year with one's primary care physician.

Any idiot can see that there is a strong relationship between those things.

The average primary care doctor has about 2500-3000 patients on their roster, and that's only possible if they are turning people away. People get angry when you decline to take on new patients, because "what am I supposed to do? I need a doctor!" But so do thousands of other people.

Let's say 2500 patients. One hour a year each is a total of 150,000 minutes a year. 2885 minutes a week, which is 577 minutes a workday (with 5 workdays a week). So if your doctor has a smaller than normal number of patients and spends no vacation ever, and takes no lunch break, he or she can open clinic at 8am and will close after working straight through at 6pm every day -- and there's 23 minutes available left over for using the bathroom and drinking water.

None of that includes phone calls, portal messages, or emails. And given that the average percentage of time spent on paperwork for a US physician is at least 40%, that doc will then work from 6pm until midnight on the paperwork, unless they were doing it at the computer while you were talking.

And none of that includes sick visits, or helping the family who was adamant that they are all healthy and won't take up much time because they are never sick -- until they are, and the 39 year old father has brain cancer, and the children are in trauma from it, and the 38 year old mother has clinical depression, and and and. Because those things don't happen often to one family, but spread out over 2500-3000 people, it's common enough.

What you want isn't possible under the current system, PP. It's just math. Can we design another system? Sure. That would be a great discussion. But being mad at the people trying to hold things together right now, just because they cannot make the impossible happen, is what is breaking them. They are leaving. The numbers just get harder, or you just turn more people away.

Not all of the patient's turn up every year e.g. my 20 something kids. If they have something urgent outside of the PCP's limited hours or can't get an urgent appointment, they end up at urgent care. I'm on my OB GYN's roster but don't have to go every year anymore.

And some patients come every 3 months. Look you can argue all day that doctors stink and have this attitude but all it does is cause more burn out and will lead to more doctors leaving. Blaming the doctors won’t really get you anywhere- it’s a systems issue.

I know personally for me, I went to med school seriously a bleeding heart and wanting to take care of patients. I’m in primary care and I do try to listen to patients and take my time but then other patients are waiting and I get backed up. Then I have to return labs which takes time later in the day and I want to be thorough. All of this with my family life is making it so I probably have at most 5 years in this field and I also work part time. So there goes another one and we keep on leaving.

Is being a doctor boring when you spend years working on horses day in and day out, and the zebra cases go off to specialists? I used to look at the pediatrician treating my kids for check ups, strep and ear infections over and over and wondered how they did it.

No peds but as an internist there is still tons of variety and intellectually stimulating work ups. What is hard is the emotional labor. I just released labs to a patient with detailed explanations. Nothing super concerning. She has an appointment in 2 weeks but yet she demands and calls wants to speak to me. You can’t do this for all 80-100 patients you see in a given week. It’s just exhausting .

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:To be honest, I don't understand why the healthcare system cannot be reformed such that primary care doctors can spend AT LEAST ONE HOUR with a patient per year.

Lawyers make lots of money and manage to spend an hour here and there with a client, c'mon.

Of course our system is broken and our population is chronically ill and too many dying unnecessarily has something to do with the standard of care being 20 minutes/year with one's primary care physician.

Any idiot can see that there is a strong relationship between those things.

The average primary care doctor has about 2500-3000 patients on their roster, and that's only possible if they are turning people away. People get angry when you decline to take on new patients, because "what am I supposed to do? I need a doctor!" But so do thousands of other people.

Let's say 2500 patients. One hour a year each is a total of 150,000 minutes a year. 2885 minutes a week, which is 577 minutes a workday (with 5 workdays a week). So if your doctor has a smaller than normal number of patients and spends no vacation ever, and takes no lunch break, he or she can open clinic at 8am and will close after working straight through at 6pm every day -- and there's 23 minutes available left over for using the bathroom and drinking water.

None of that includes phone calls, portal messages, or emails. And given that the average percentage of time spent on paperwork for a US physician is at least 40%, that doc will then work from 6pm until midnight on the paperwork, unless they were doing it at the computer while you were talking.

And none of that includes sick visits, or helping the family who was adamant that they are all healthy and won't take up much time because they are never sick -- until they are, and the 39 year old father has brain cancer, and the children are in trauma from it, and the 38 year old mother has clinical depression, and and and. Because those things don't happen often to one family, but spread out over 2500-3000 people, it's common enough.

What you want isn't possible under the current system, PP. It's just math. Can we design another system? Sure. That would be a great discussion. But being mad at the people trying to hold things together right now, just because they cannot make the impossible happen, is what is breaking them. They are leaving. The numbers just get harder, or you just turn more people away.

Not all of the patient's turn up every year e.g. my 20 something kids. If they have something urgent outside of the PCP's limited hours or can't get an urgent appointment, they end up at urgent care. I'm on my OB GYN's roster but don't have to go every year anymore.

And some patients come every 3 months. Look you can argue all day that doctors stink and have this attitude but all it does is cause more burn out and will lead to more doctors leaving. Blaming the doctors won’t really get you anywhere- it’s a systems issue.

I know personally for me, I went to med school seriously a bleeding heart and wanting to take care of patients. I’m in primary care and I do try to listen to patients and take my time but then other patients are waiting and I get backed up. Then I have to return labs which takes time later in the day and I want to be thorough. All of this with my family life is making it so I probably have at most 5 years in this field and I also work part time. So there goes another one and we keep on leaving.

Is being a doctor boring when you spend years working on horses day in and day out, and the zebra cases go off to specialists? I used to look at the pediatrician treating my kids for check ups, strep and ear infections over and over and wondered how they did it.

No peds but as an internist there is still tons of variety and intellectually stimulating work ups. What is hard is the emotional labor. I just released labs to a patient with detailed explanations. Nothing super concerning. She has an appointment in 2 weeks but yet she demands and calls wants to speak to me. You can’t do this for all 80-100 patients you see in a given week. It’s just exhausting .

I can't demand anything of my doctor or require them to pick up the phone. Can't you write "nothing super concerning, see you in two weeks".Bye bye. I'm assuming most of the other 80-100 patients aren't calling you. Is she royalty or something?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:To be honest, I don't understand why the healthcare system cannot be reformed such that primary care doctors can spend AT LEAST ONE HOUR with a patient per year.

Lawyers make lots of money and manage to spend an hour here and there with a client, c'mon.

Of course our system is broken and our population is chronically ill and too many dying unnecessarily has something to do with the standard of care being 20 minutes/year with one's primary care physician.

Any idiot can see that there is a strong relationship between those things.

The average primary care doctor has about 2500-3000 patients on their roster, and that's only possible if they are turning people away. People get angry when you decline to take on new patients, because "what am I supposed to do? I need a doctor!" But so do thousands of other people.

Let's say 2500 patients. One hour a year each is a total of 150,000 minutes a year. 2885 minutes a week, which is 577 minutes a workday (with 5 workdays a week). So if your doctor has a smaller than normal number of patients and spends no vacation ever, and takes no lunch break, he or she can open clinic at 8am and will close after working straight through at 6pm every day -- and there's 23 minutes available left over for using the bathroom and drinking water.

None of that includes phone calls, portal messages, or emails. And given that the average percentage of time spent on paperwork for a US physician is at least 40%, that doc will then work from 6pm until midnight on the paperwork, unless they were doing it at the computer while you were talking.

And none of that includes sick visits, or helping the family who was adamant that they are all healthy and won't take up much time because they are never sick -- until they are, and the 39 year old father has brain cancer, and the children are in trauma from it, and the 38 year old mother has clinical depression, and and and. Because those things don't happen often to one family, but spread out over 2500-3000 people, it's common enough.

What you want isn't possible under the current system, PP. It's just math. Can we design another system? Sure. That would be a great discussion. But being mad at the people trying to hold things together right now, just because they cannot make the impossible happen, is what is breaking them. They are leaving. The numbers just get harder, or you just turn more people away.

Not all of the patient's turn up every year e.g. my 20 something kids. If they have something urgent outside of the PCP's limited hours or can't get an urgent appointment, they end up at urgent care. I'm on my OB GYN's roster but don't have to go every year anymore.

And some patients come every 3 months. Look you can argue all day that doctors stink and have this attitude but all it does is cause more burn out and will lead to more doctors leaving. Blaming the doctors won’t really get you anywhere- it’s a systems issue.

I know personally for me, I went to med school seriously a bleeding heart and wanting to take care of patients. I’m in primary care and I do try to listen to patients and take my time but then other patients are waiting and I get backed up. Then I have to return labs which takes time later in the day and I want to be thorough. All of this with my family life is making it so I probably have at most 5 years in this field and I also work part time. So there goes another one and we keep on leaving.

Is being a doctor boring when you spend years working on horses day in and day out, and the zebra cases go off to specialists? I used to look at the pediatrician treating my kids for check ups, strep and ear infections over and over and wondered how they did it.

No peds but as an internist there is still tons of variety and intellectually stimulating work ups. What is hard is the emotional labor. I just released labs to a patient with detailed explanations. Nothing super concerning. She has an appointment in 2 weeks but yet she demands and calls wants to speak to me. You can’t do this for all 80-100 patients you see in a given week. It’s just exhausting .

I can't demand anything of my doctor or require them to pick up the phone. Can't you write "nothing super concerning, see you in two weeks".Bye bye. I'm assuming most of the other 80-100 patients aren't calling you. Is she royalty or something?

DP. Now she calls back daily and is rude to the front desk staff person, who is already stressed, but without frankly cursing or threatening. You can expect your front desk staff to complain to you and possibly switch jobs if you don't support them.

Whether or not you decide there is a therapeutic breakdown and decline to continue the person from your practice, she -- being angry and outraged, can leave as many negative reviews trashing your reputation, but you cannot respond with any refuting details or context because of HIPAA. That's annoying and will also put more stress on your staff, who may now be trying to answer questions about those comments.

But who cares, right? But if that patient then makes a complaint about you to the medical board, it follows you onward in many contexts even if there was no judgment against you. You have to report complaints on applications.

So ... you could set aside 30 minutes (because it will not be a 5 minute conversation) and try to deal with it head on, answer her questions, absorb the anger, and move on. And she will then tell people that "I gave him a piece of my mind, because I don't take 'no' for an answer," and so other people start to think this is how to get what they want.

None of this would have happened in 1984, by the way. Medicine is very different than it used to be, and the process continues to accelerate.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:To be honest, I don't understand why the healthcare system cannot be reformed such that primary care doctors can spend AT LEAST ONE HOUR with a patient per year.

Lawyers make lots of money and manage to spend an hour here and there with a client, c'mon.

Of course our system is broken and our population is chronically ill and too many dying unnecessarily has something to do with the standard of care being 20 minutes/year with one's primary care physician.

Any idiot can see that there is a strong relationship between those things.

The average primary care doctor has about 2500-3000 patients on their roster, and that's only possible if they are turning people away. People get angry when you decline to take on new patients, because "what am I supposed to do? I need a doctor!" But so do thousands of other people.

Let's say 2500 patients. One hour a year each is a total of 150,000 minutes a year. 2885 minutes a week, which is 577 minutes a workday (with 5 workdays a week). So if your doctor has a smaller than normal number of patients and spends no vacation ever, and takes no lunch break, he or she can open clinic at 8am and will close after working straight through at 6pm every day -- and there's 23 minutes available left over for using the bathroom and drinking water.

None of that includes phone calls, portal messages, or emails. And given that the average percentage of time spent on paperwork for a US physician is at least 40%, that doc will then work from 6pm until midnight on the paperwork, unless they were doing it at the computer while you were talking.

And none of that includes sick visits, or helping the family who was adamant that they are all healthy and won't take up much time because they are never sick -- until they are, and the 39 year old father has brain cancer, and the children are in trauma from it, and the 38 year old mother has clinical depression, and and and. Because those things don't happen often to one family, but spread out over 2500-3000 people, it's common enough.

What you want isn't possible under the current system, PP. It's just math. Can we design another system? Sure. That would be a great discussion. But being mad at the people trying to hold things together right now, just because they cannot make the impossible happen, is what is breaking them. They are leaving. The numbers just get harder, or you just turn more people away.

Not all of the patient's turn up every year e.g. my 20 something kids. If they have something urgent outside of the PCP's limited hours or can't get an urgent appointment, they end up at urgent care. I'm on my OB GYN's roster but don't have to go every year anymore.

And some patients come every 3 months. Look you can argue all day that doctors stink and have this attitude but all it does is cause more burn out and will lead to more doctors leaving. Blaming the doctors won’t really get you anywhere- it’s a systems issue.

I know personally for me, I went to med school seriously a bleeding heart and wanting to take care of patients. I’m in primary care and I do try to listen to patients and take my time but then other patients are waiting and I get backed up. Then I have to return labs which takes time later in the day and I want to be thorough. All of this with my family life is making it so I probably have at most 5 years in this field and I also work part time. So there goes another one and we keep on leaving.

Is being a doctor boring when you spend years working on horses day in and day out, and the zebra cases go off to specialists? I used to look at the pediatrician treating my kids for check ups, strep and ear infections over and over and wondered how they did it.

No peds but as an internist there is still tons of variety and intellectually stimulating work ups. What is hard is the emotional labor. I just released labs to a patient with detailed explanations. Nothing super concerning. She has an appointment in 2 weeks but yet she demands and calls wants to speak to me. You can’t do this for all 80-100 patients you see in a given week. It’s just exhausting .

I can't demand anything of my doctor or require them to pick up the phone. Can't you write "nothing super concerning, see you in two weeks".Bye bye. I'm assuming most of the other 80-100 patients aren't calling you. Is she royalty or something?

DP. Now she calls back daily and is rude to the front desk staff person, who is already stressed, but without frankly cursing or threatening. You can expect your front desk staff to complain to you and possibly switch jobs if you don't support them.

Whether or not you decide there is a therapeutic breakdown and decline to continue the person from your practice, she -- being angry and outraged, can leave as many negative reviews trashing your reputation, but you cannot respond with any refuting details or context because of HIPAA. That's annoying and will also put more stress on your staff, who may now be trying to answer questions about those comments.

But who cares, right? But if that patient then makes a complaint about you to the medical board, it follows you onward in many contexts even if there was no judgment against you. You have to report complaints on applications.

So ... you could set aside 30 minutes (because it will not be a 5 minute conversation) and try to deal with it head on, answer her questions, absorb the anger, and move on. And she will then tell people that "I gave him a piece of my mind, because I don't take 'no' for an answer," and so other people start to think this is how to get what they want.

None of this would have happened in 1984, by the way. Medicine is very different than it used to be, and the process continues to accelerate.

Good grief. Businesses deal with grumpy people all the time. It's not like you're dealing here with the outbreak of WW III or the collapse of the financial system.

If I'm grumpy, my first thought isn't "I'm reporting this person to the medical board". That's a lot of work and overkill. It's also counterproductive for a patient to be labeled difficult. The only person I ever considered reporting was an elderly doctor showing signs of Alzheimer's, and then I didn't. I did tell the referring doctor though.

My PCP dealt with complainers by having the meanest receptionist ever. I thought there was a special training school for mean school and medical receptionists because there are a lot of them.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:To be honest, I don't understand why the healthcare system cannot be reformed such that primary care doctors can spend AT LEAST ONE HOUR with a patient per year.

Lawyers make lots of money and manage to spend an hour here and there with a client, c'mon.

Of course our system is broken and our population is chronically ill and too many dying unnecessarily has something to do with the standard of care being 20 minutes/year with one's primary care physician.

Any idiot can see that there is a strong relationship between those things.

The average primary care doctor has about 2500-3000 patients on their roster, and that's only possible if they are turning people away. People get angry when you decline to take on new patients, because "what am I supposed to do? I need a doctor!" But so do thousands of other people.

Let's say 2500 patients. One hour a year each is a total of 150,000 minutes a year. 2885 minutes a week, which is 577 minutes a workday (with 5 workdays a week). So if your doctor has a smaller than normal number of patients and spends no vacation ever, and takes no lunch break, he or she can open clinic at 8am and will close after working straight through at 6pm every day -- and there's 23 minutes available left over for using the bathroom and drinking water.

None of that includes phone calls, portal messages, or emails. And given that the average percentage of time spent on paperwork for a US physician is at least 40%, that doc will then work from 6pm until midnight on the paperwork, unless they were doing it at the computer while you were talking.

And none of that includes sick visits, or helping the family who was adamant that they are all healthy and won't take up much time because they are never sick -- until they are, and the 39 year old father has brain cancer, and the children are in trauma from it, and the 38 year old mother has clinical depression, and and and. Because those things don't happen often to one family, but spread out over 2500-3000 people, it's common enough.

What you want isn't possible under the current system, PP. It's just math. Can we design another system? Sure. That would be a great discussion. But being mad at the people trying to hold things together right now, just because they cannot make the impossible happen, is what is breaking them. They are leaving. The numbers just get harder, or you just turn more people away.

Not all of the patient's turn up every year e.g. my 20 something kids. If they have something urgent outside of the PCP's limited hours or can't get an urgent appointment, they end up at urgent care. I'm on my OB GYN's roster but don't have to go every year anymore.

And some patients come every 3 months. Look you can argue all day that doctors stink and have this attitude but all it does is cause more burn out and will lead to more doctors leaving. Blaming the doctors won’t really get you anywhere- it’s a systems issue.

I know personally for me, I went to med school seriously a bleeding heart and wanting to take care of patients. I’m in primary care and I do try to listen to patients and take my time but then other patients are waiting and I get backed up. Then I have to return labs which takes time later in the day and I want to be thorough. All of this with my family life is making it so I probably have at most 5 years in this field and I also work part time. So there goes another one and we keep on leaving.

Is being a doctor boring when you spend years working on horses day in and day out, and the zebra cases go off to specialists? I used to look at the pediatrician treating my kids for check ups, strep and ear infections over and over and wondered how they did it.

No peds but as an internist there is still tons of variety and intellectually stimulating work ups. What is hard is the emotional labor. I just released labs to a patient with detailed explanations. Nothing super concerning. She has an appointment in 2 weeks but yet she demands and calls wants to speak to me. You can’t do this for all 80-100 patients you see in a given week. It’s just exhausting .

I can't demand anything of my doctor or require them to pick up the phone. Can't you write "nothing super concerning, see you in two weeks".Bye bye. I'm assuming most of the other 80-100 patients aren't calling you. Is she royalty or something?

DP. Now she calls back daily and is rude to the front desk staff person, who is already stressed, but without frankly cursing or threatening. You can expect your front desk staff to complain to you and possibly switch jobs if you don't support them.

Whether or not you decide there is a therapeutic breakdown and decline to continue the person from your practice, she -- being angry and outraged, can leave as many negative reviews trashing your reputation, but you cannot respond with any refuting details or context because of HIPAA. That's annoying and will also put more stress on your staff, who may now be trying to answer questions about those comments.

But who cares, right? But if that patient then makes a complaint about you to the medical board, it follows you onward in many contexts even if there was no judgment against you. You have to report complaints on applications.

So ... you could set aside 30 minutes (because it will not be a 5 minute conversation) and try to deal with it head on, answer her questions, absorb the anger, and move on. And she will then tell people that "I gave him a piece of my mind, because I don't take 'no' for an answer," and so other people start to think this is how to get what they want.

None of this would have happened in 1984, by the way. Medicine is very different than it used to be, and the process continues to accelerate.

Good grief. Businesses deal with grumpy people all the time. It's not like you're dealing here with the outbreak of WW III or the collapse of the financial system.

If I'm grumpy, my first thought isn't "I'm reporting this person to the medical board". That's a lot of work and overkill. It's also counterproductive for a patient to be labeled difficult. The only person I ever considered reporting was an elderly doctor showing signs of Alzheimer's, and then I didn't. I did tell the referring doctor though.

My PCP dealt with complainers by having the meanest receptionist ever. I thought there was a special training school for mean school and medical receptionists because there are a lot of them.

Fabulous. But out of some 3000 patients, there are surprisingly many that are not like you.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:To be honest, I don't understand why the healthcare system cannot be reformed such that primary care doctors can spend AT LEAST ONE HOUR with a patient per year.

Lawyers make lots of money and manage to spend an hour here and there with a client, c'mon.

Of course our system is broken and our population is chronically ill and too many dying unnecessarily has something to do with the standard of care being 20 minutes/year with one's primary care physician.

Any idiot can see that there is a strong relationship between those things.

The average primary care doctor has about 2500-3000 patients on their roster, and that's only possible if they are turning people away. People get angry when you decline to take on new patients, because "what am I supposed to do? I need a doctor!" But so do thousands of other people.

Let's say 2500 patients. One hour a year each is a total of 150,000 minutes a year. 2885 minutes a week, which is 577 minutes a workday (with 5 workdays a week). So if your doctor has a smaller than normal number of patients and spends no vacation ever, and takes no lunch break, he or she can open clinic at 8am and will close after working straight through at 6pm every day -- and there's 23 minutes available left over for using the bathroom and drinking water.

None of that includes phone calls, portal messages, or emails. And given that the average percentage of time spent on paperwork for a US physician is at least 40%, that doc will then work from 6pm until midnight on the paperwork, unless they were doing it at the computer while you were talking.

And none of that includes sick visits, or helping the family who was adamant that they are all healthy and won't take up much time because they are never sick -- until they are, and the 39 year old father has brain cancer, and the children are in trauma from it, and the 38 year old mother has clinical depression, and and and. Because those things don't happen often to one family, but spread out over 2500-3000 people, it's common enough.

What you want isn't possible under the current system, PP. It's just math. Can we design another system? Sure. That would be a great discussion. But being mad at the people trying to hold things together right now, just because they cannot make the impossible happen, is what is breaking them. They are leaving. The numbers just get harder, or you just turn more people away.

Not all of the patient's turn up every year e.g. my 20 something kids. If they have something urgent outside of the PCP's limited hours or can't get an urgent appointment, they end up at urgent care. I'm on my OB GYN's roster but don't have to go every year anymore.

And some patients come every 3 months. Look you can argue all day that doctors stink and have this attitude but all it does is cause more burn out and will lead to more doctors leaving. Blaming the doctors won’t really get you anywhere- it’s a systems issue.

I know personally for me, I went to med school seriously a bleeding heart and wanting to take care of patients. I’m in primary care and I do try to listen to patients and take my time but then other patients are waiting and I get backed up. Then I have to return labs which takes time later in the day and I want to be thorough. All of this with my family life is making it so I probably have at most 5 years in this field and I also work part time. So there goes another one and we keep on leaving.

Is being a doctor boring when you spend years working on horses day in and day out, and the zebra cases go off to specialists? I used to look at the pediatrician treating my kids for check ups, strep and ear infections over and over and wondered how they did it.

No peds but as an internist there is still tons of variety and intellectually stimulating work ups. What is hard is the emotional labor. I just released labs to a patient with detailed explanations. Nothing super concerning. She has an appointment in 2 weeks but yet she demands and calls wants to speak to me. You can’t do this for all 80-100 patients you see in a given week. It’s just exhausting .

I can't demand anything of my doctor or require them to pick up the phone. Can't you write "nothing super concerning, see you in two weeks".Bye bye. I'm assuming most of the other 80-100 patients aren't calling you. Is she royalty or something?

I literally wrote paragraphs with detailed instructions. If I don’t write it out and call then the call never happened in the patient’s mind and there’s no proof (I still have to document it too). Plus sometimes the patient doesn’t even pick up. I can see that she read the comments of her labs on my end. But still blowing up asking to explain something I wrote about already. Just exhausting

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:To be honest, I don't understand why the healthcare system cannot be reformed such that primary care doctors can spend AT LEAST ONE HOUR with a patient per year.

Lawyers make lots of money and manage to spend an hour here and there with a client, c'mon.

Of course our system is broken and our population is chronically ill and too many dying unnecessarily has something to do with the standard of care being 20 minutes/year with one's primary care physician.

Any idiot can see that there is a strong relationship between those things.

The average primary care doctor has about 2500-3000 patients on their roster, and that's only possible if they are turning people away. People get angry when you decline to take on new patients, because "what am I supposed to do? I need a doctor!" But so do thousands of other people.

Let's say 2500 patients. One hour a year each is a total of 150,000 minutes a year. 2885 minutes a week, which is 577 minutes a workday (with 5 workdays a week). So if your doctor has a smaller than normal number of patients and spends no vacation ever, and takes no lunch break, he or she can open clinic at 8am and will close after working straight through at 6pm every day -- and there's 23 minutes available left over for using the bathroom and drinking water.

None of that includes phone calls, portal messages, or emails. And given that the average percentage of time spent on paperwork for a US physician is at least 40%, that doc will then work from 6pm until midnight on the paperwork, unless they were doing it at the computer while you were talking.

And none of that includes sick visits, or helping the family who was adamant that they are all healthy and won't take up much time because they are never sick -- until they are, and the 39 year old father has brain cancer, and the children are in trauma from it, and the 38 year old mother has clinical depression, and and and. Because those things don't happen often to one family, but spread out over 2500-3000 people, it's common enough.

What you want isn't possible under the current system, PP. It's just math. Can we design another system? Sure. That would be a great discussion. But being mad at the people trying to hold things together right now, just because they cannot make the impossible happen, is what is breaking them. They are leaving. The numbers just get harder, or you just turn more people away.

Not all of the patient's turn up every year e.g. my 20 something kids. If they have something urgent outside of the PCP's limited hours or can't get an urgent appointment, they end up at urgent care. I'm on my OB GYN's roster but don't have to go every year anymore.

And some patients come every 3 months. Look you can argue all day that doctors stink and have this attitude but all it does is cause more burn out and will lead to more doctors leaving. Blaming the doctors won’t really get you anywhere- it’s a systems issue.

I know personally for me, I went to med school seriously a bleeding heart and wanting to take care of patients. I’m in primary care and I do try to listen to patients and take my time but then other patients are waiting and I get backed up. Then I have to return labs which takes time later in the day and I want to be thorough. All of this with my family life is making it so I probably have at most 5 years in this field and I also work part time. So there goes another one and we keep on leaving.

Is being a doctor boring when you spend years working on horses day in and day out, and the zebra cases go off to specialists? I used to look at the pediatrician treating my kids for check ups, strep and ear infections over and over and wondered how they did it.

No peds but as an internist there is still tons of variety and intellectually stimulating work ups. What is hard is the emotional labor. I just released labs to a patient with detailed explanations. Nothing super concerning. She has an appointment in 2 weeks but yet she demands and calls wants to speak to me. You can’t do this for all 80-100 patients you see in a given week. It’s just exhausting .

I can't demand anything of my doctor or require them to pick up the phone. Can't you write "nothing super concerning, see you in two weeks".Bye bye. I'm assuming most of the other 80-100 patients aren't calling you. Is she royalty or something?

DP. Now she calls back daily and is rude to the front desk staff person, who is already stressed, but without frankly cursing or threatening. You can expect your front desk staff to complain to you and possibly switch jobs if you don't support them.

Whether or not you decide there is a therapeutic breakdown and decline to continue the person from your practice, she -- being angry and outraged, can leave as many negative reviews trashing your reputation, but you cannot respond with any refuting details or context because of HIPAA. That's annoying and will also put more stress on your staff, who may now be trying to answer questions about those comments.

But who cares, right? But if that patient then makes a complaint about you to the medical board, it follows you onward in many contexts even if there was no judgment against you. You have to report complaints on applications.

So ... you could set aside 30 minutes (because it will not be a 5 minute conversation) and try to deal with it head on, answer her questions, absorb the anger, and move on. And she will then tell people that "I gave him a piece of my mind, because I don't take 'no' for an answer," and so other people start to think this is how to get what they want.

None of this would have happened in 1984, by the way. Medicine is very different than it used to be, and the process continues to accelerate.

Good grief. Businesses deal with grumpy people all the time. It's not like you're dealing here with the outbreak of WW III or the collapse of the financial system.

If I'm grumpy, my first thought isn't "I'm reporting this person to the medical board". That's a lot of work and overkill. It's also counterproductive for a patient to be labeled difficult. The only person I ever considered reporting was an elderly doctor showing signs of Alzheimer's, and then I didn't. I did tell the referring doctor though.

My PCP dealt with complainers by having the meanest receptionist ever. I thought there was a special training school for mean school and medical receptionists because there are a lot of them.

Fabulous. But out of some 3000 patients, there are surprisingly many that are not like you.

How many complaints against you are submitted each year?

[Anonymous]

PS: If you are a restaurant owner, or run a bookstore, or are a mechanic shop, there is no licensing board to take that kind of complaint. Sure, someone can contact the BBB, but that's a poot in the wind and we all know it.

Medical licensure is taken differently. When I applied for a license in my current state, I had to attest to listing all complaints ever lodged against me, any time my license was put on probation (even if there was no substantiation found), if I'd ever been diagnosed with depression or other mental illness, etc. These things follow you.

I don't have a record of complaints or other issues like that, but I was denied licensure in one state because I did not fit their requirements (I had too long between completing my USMLE Step I and Step III, because I did a combined MD/PhD). That was a problem for this one state, but not others.

Now I have to disclose that I was denied that application for license and authorize this to be checked out for the rest of my career -- just for that. It can mean missing a job opportunity, if it takes too long. And that is merely because my exams were too far apart. It's a stupid problem, but I still get to deal with it.

Yeah, right, business owner deal with grumpy people all the time. That's not even on the same planet as medical providers trying to protect a license. Which is fine -- it's just not as trivial as you are trying to make it out to be.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:To be honest, I don't understand why the healthcare system cannot be reformed such that primary care doctors can spend AT LEAST ONE HOUR with a patient per year.

Lawyers make lots of money and manage to spend an hour here and there with a client, c'mon.

Of course our system is broken and our population is chronically ill and too many dying unnecessarily has something to do with the standard of care being 20 minutes/year with one's primary care physician.

Any idiot can see that there is a strong relationship between those things.

The average primary care doctor has about 2500-3000 patients on their roster, and that's only possible if they are turning people away. People get angry when you decline to take on new patients, because "what am I supposed to do? I need a doctor!" But so do thousands of other people.

Let's say 2500 patients. One hour a year each is a total of 150,000 minutes a year. 2885 minutes a week, which is 577 minutes a workday (with 5 workdays a week). So if your doctor has a smaller than normal number of patients and spends no vacation ever, and takes no lunch break, he or she can open clinic at 8am and will close after working straight through at 6pm every day -- and there's 23 minutes available left over for using the bathroom and drinking water.

None of that includes phone calls, portal messages, or emails. And given that the average percentage of time spent on paperwork for a US physician is at least 40%, that doc will then work from 6pm until midnight on the paperwork, unless they were doing it at the computer while you were talking.

And none of that includes sick visits, or helping the family who was adamant that they are all healthy and won't take up much time because they are never sick -- until they are, and the 39 year old father has brain cancer, and the children are in trauma from it, and the 38 year old mother has clinical depression, and and and. Because those things don't happen often to one family, but spread out over 2500-3000 people, it's common enough.

What you want isn't possible under the current system, PP. It's just math. Can we design another system? Sure. That would be a great discussion. But being mad at the people trying to hold things together right now, just because they cannot make the impossible happen, is what is breaking them. They are leaving. The numbers just get harder, or you just turn more people away.

Not all of the patient's turn up every year e.g. my 20 something kids. If they have something urgent outside of the PCP's limited hours or can't get an urgent appointment, they end up at urgent care. I'm on my OB GYN's roster but don't have to go every year anymore.

And some patients come every 3 months. Look you can argue all day that doctors stink and have this attitude but all it does is cause more burn out and will lead to more doctors leaving. Blaming the doctors won’t really get you anywhere- it’s a systems issue.

I know personally for me, I went to med school seriously a bleeding heart and wanting to take care of patients. I’m in primary care and I do try to listen to patients and take my time but then other patients are waiting and I get backed up. Then I have to return labs which takes time later in the day and I want to be thorough. All of this with my family life is making it so I probably have at most 5 years in this field and I also work part time. So there goes another one and we keep on leaving.

Is being a doctor boring when you spend years working on horses day in and day out, and the zebra cases go off to specialists? I used to look at the pediatrician treating my kids for check ups, strep and ear infections over and over and wondered how they did it.

No peds but as an internist there is still tons of variety and intellectually stimulating work ups. What is hard is the emotional labor. I just released labs to a patient with detailed explanations. Nothing super concerning. She has an appointment in 2 weeks but yet she demands and calls wants to speak to me. You can’t do this for all 80-100 patients you see in a given week. It’s just exhausting .

I can't demand anything of my doctor or require them to pick up the phone. Can't you write "nothing super concerning, see you in two weeks".Bye bye. I'm assuming most of the other 80-100 patients aren't calling you. Is she royalty or something?

DP. Now she calls back daily and is rude to the front desk staff person, who is already stressed, but without frankly cursing or threatening. You can expect your front desk staff to complain to you and possibly switch jobs if you don't support them.

Whether or not you decide there is a therapeutic breakdown and decline to continue the person from your practice, she -- being angry and outraged, can leave as many negative reviews trashing your reputation, but you cannot respond with any refuting details or context because of HIPAA. That's annoying and will also put more stress on your staff, who may now be trying to answer questions about those comments.

But who cares, right? But if that patient then makes a complaint about you to the medical board, it follows you onward in many contexts even if there was no judgment against you. You have to report complaints on applications.

So ... you could set aside 30 minutes (because it will not be a 5 minute conversation) and try to deal with it head on, answer her questions, absorb the anger, and move on. And she will then tell people that "I gave him a piece of my mind, because I don't take 'no' for an answer," and so other people start to think this is how to get what they want.

None of this would have happened in 1984, by the way. Medicine is very different than it used to be, and the process continues to accelerate.

Good grief. Businesses deal with grumpy people all the time. It's not like you're dealing here with the outbreak of WW III or the collapse of the financial system.

If I'm grumpy, my first thought isn't "I'm reporting this person to the medical board". That's a lot of work and overkill. It's also counterproductive for a patient to be labeled difficult. The only person I ever considered reporting was an elderly doctor showing signs of Alzheimer's, and then I didn't. I did tell the referring doctor though.

My PCP dealt with complainers by having the meanest receptionist ever. I thought there was a special training school for mean school and medical receptionists because there are a lot of them.

Fabulous. But out of some 3000 patients, there are surprisingly many that are not like you.

How many complaints against you are submitted each year?

I haven't had one, but I've dealt with this in another way - see above. On the other hand, I haven't worked in private practice in the US.

If you can't see why this is not a real problem for the PP that posted above, then we just have to agree to disagree. And watch more people leave the profession as well, and get less and less compassionate and open to these calls.

So it goes.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:To be honest, I don't understand why the healthcare system cannot be reformed such that primary care doctors can spend AT LEAST ONE HOUR with a patient per year.

Lawyers make lots of money and manage to spend an hour here and there with a client, c'mon.

Of course our system is broken and our population is chronically ill and too many dying unnecessarily has something to do with the standard of care being 20 minutes/year with one's primary care physician.

Any idiot can see that there is a strong relationship between those things.

The average primary care doctor has about 2500-3000 patients on their roster, and that's only possible if they are turning people away. People get angry when you decline to take on new patients, because "what am I supposed to do? I need a doctor!" But so do thousands of other people.

Let's say 2500 patients. One hour a year each is a total of 150,000 minutes a year. 2885 minutes a week, which is 577 minutes a workday (with 5 workdays a week). So if your doctor has a smaller than normal number of patients and spends no vacation ever, and takes no lunch break, he or she can open clinic at 8am and will close after working straight through at 6pm every day -- and there's 23 minutes available left over for using the bathroom and drinking water.

None of that includes phone calls, portal messages, or emails. And given that the average percentage of time spent on paperwork for a US physician is at least 40%, that doc will then work from 6pm until midnight on the paperwork, unless they were doing it at the computer while you were talking.

And none of that includes sick visits, or helping the family who was adamant that they are all healthy and won't take up much time because they are never sick -- until they are, and the 39 year old father has brain cancer, and the children are in trauma from it, and the 38 year old mother has clinical depression, and and and. Because those things don't happen often to one family, but spread out over 2500-3000 people, it's common enough.

What you want isn't possible under the current system, PP. It's just math. Can we design another system? Sure. That would be a great discussion. But being mad at the people trying to hold things together right now, just because they cannot make the impossible happen, is what is breaking them. They are leaving. The numbers just get harder, or you just turn more people away.

Not all of the patient's turn up every year e.g. my 20 something kids. If they have something urgent outside of the PCP's limited hours or can't get an urgent appointment, they end up at urgent care. I'm on my OB GYN's roster but don't have to go every year anymore.

And some patients come every 3 months. Look you can argue all day that doctors stink and have this attitude but all it does is cause more burn out and will lead to more doctors leaving. Blaming the doctors won’t really get you anywhere- it’s a systems issue.

I know personally for me, I went to med school seriously a bleeding heart and wanting to take care of patients. I’m in primary care and I do try to listen to patients and take my time but then other patients are waiting and I get backed up. Then I have to return labs which takes time later in the day and I want to be thorough. All of this with my family life is making it so I probably have at most 5 years in this field and I also work part time. So there goes another one and we keep on leaving.

Is being a doctor boring when you spend years working on horses day in and day out, and the zebra cases go off to specialists? I used to look at the pediatrician treating my kids for check ups, strep and ear infections over and over and wondered how they did it.

No peds but as an internist there is still tons of variety and intellectually stimulating work ups. What is hard is the emotional labor. I just released labs to a patient with detailed explanations. Nothing super concerning. She has an appointment in 2 weeks but yet she demands and calls wants to speak to me. You can’t do this for all 80-100 patients you see in a given week. It’s just exhausting .

I can't demand anything of my doctor or require them to pick up the phone. Can't you write "nothing super concerning, see you in two weeks".Bye bye. I'm assuming most of the other 80-100 patients aren't calling you. Is she royalty or something?

I literally wrote paragraphs with detailed instructions. If I don’t write it out and call then the call never happened in the patient’s mind and there’s no proof (I still have to document it too). Plus sometimes the patient doesn’t even pick up. I can see that she read the comments of her labs on my end. But still blowing up asking to explain something I wrote about already. Just exhausting

Why did you write paragraphs when you think it's nothing urgent and you're seeing her in 2 weeks anyway. I'm lucky if the doctor writes a sentence. They usually write nothing. Detailed explanations invite questions. FWIW when a doctor calls me it often says "private" because they don't want me seeing their number, and I don't pick up because my phone tells me it's a scam call.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:To be honest, I don't understand why the healthcare system cannot be reformed such that primary care doctors can spend AT LEAST ONE HOUR with a patient per year.

Lawyers make lots of money and manage to spend an hour here and there with a client, c'mon.

Of course our system is broken and our population is chronically ill and too many dying unnecessarily has something to do with the standard of care being 20 minutes/year with one's primary care physician.

Any idiot can see that there is a strong relationship between those things.

The average primary care doctor has about 2500-3000 patients on their roster, and that's only possible if they are turning people away. People get angry when you decline to take on new patients, because "what am I supposed to do? I need a doctor!" But so do thousands of other people.

Let's say 2500 patients. One hour a year each is a total of 150,000 minutes a year. 2885 minutes a week, which is 577 minutes a workday (with 5 workdays a week). So if your doctor has a smaller than normal number of patients and spends no vacation ever, and takes no lunch break, he or she can open clinic at 8am and will close after working straight through at 6pm every day -- and there's 23 minutes available left over for using the bathroom and drinking water.

None of that includes phone calls, portal messages, or emails. And given that the average percentage of time spent on paperwork for a US physician is at least 40%, that doc will then work from 6pm until midnight on the paperwork, unless they were doing it at the computer while you were talking.

And none of that includes sick visits, or helping the family who was adamant that they are all healthy and won't take up much time because they are never sick -- until they are, and the 39 year old father has brain cancer, and the children are in trauma from it, and the 38 year old mother has clinical depression, and and and. Because those things don't happen often to one family, but spread out over 2500-3000 people, it's common enough.

What you want isn't possible under the current system, PP. It's just math. Can we design another system? Sure. That would be a great discussion. But being mad at the people trying to hold things together right now, just because they cannot make the impossible happen, is what is breaking them. They are leaving. The numbers just get harder, or you just turn more people away.

This. End thread.

No, it’s not end thread.

Obviously it’s time to build more medical schools or create more slots for medical students and to thereby expand the pool of physicians substantially.

But the AMA and many practicing physicians don’t want to see the practice of medicine expanded that way because it would ultimately meaner lower salaries. We could invest heavily in subsidized medical education to compensate in part, but there would still be reduced potential for the type of salaries that put luxury vehicles in the driveway and leisure craft in a slip at the local marina etc.

[Anonymous]

*points up*

Yet another case in point, FWIW. This is how "conversations" go. No surprise.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:To be honest, I don't understand why the healthcare system cannot be reformed such that primary care doctors can spend AT LEAST ONE HOUR with a patient per year.

Lawyers make lots of money and manage to spend an hour here and there with a client, c'mon.

Of course our system is broken and our population is chronically ill and too many dying unnecessarily has something to do with the standard of care being 20 minutes/year with one's primary care physician.

Any idiot can see that there is a strong relationship between those things.

The average primary care doctor has about 2500-3000 patients on their roster, and that's only possible if they are turning people away. People get angry when you decline to take on new patients, because "what am I supposed to do? I need a doctor!" But so do thousands of other people.

Let's say 2500 patients. One hour a year each is a total of 150,000 minutes a year. 2885 minutes a week, which is 577 minutes a workday (with 5 workdays a week). So if your doctor has a smaller than normal number of patients and spends no vacation ever, and takes no lunch break, he or she can open clinic at 8am and will close after working straight through at 6pm every day -- and there's 23 minutes available left over for using the bathroom and drinking water.

None of that includes phone calls, portal messages, or emails. And given that the average percentage of time spent on paperwork for a US physician is at least 40%, that doc will then work from 6pm until midnight on the paperwork, unless they were doing it at the computer while you were talking.

And none of that includes sick visits, or helping the family who was adamant that they are all healthy and won't take up much time because they are never sick -- until they are, and the 39 year old father has brain cancer, and the children are in trauma from it, and the 38 year old mother has clinical depression, and and and. Because those things don't happen often to one family, but spread out over 2500-3000 people, it's common enough.

What you want isn't possible under the current system, PP. It's just math. Can we design another system? Sure. That would be a great discussion. But being mad at the people trying to hold things together right now, just because they cannot make the impossible happen, is what is breaking them. They are leaving. The numbers just get harder, or you just turn more people away.

Not all of the patient's turn up every year e.g. my 20 something kids. If they have something urgent outside of the PCP's limited hours or can't get an urgent appointment, they end up at urgent care. I'm on my OB GYN's roster but don't have to go every year anymore.

And some patients come every 3 months. Look you can argue all day that doctors stink and have this attitude but all it does is cause more burn out and will lead to more doctors leaving. Blaming the doctors won’t really get you anywhere- it’s a systems issue.

I know personally for me, I went to med school seriously a bleeding heart and wanting to take care of patients. I’m in primary care and I do try to listen to patients and take my time but then other patients are waiting and I get backed up. Then I have to return labs which takes time later in the day and I want to be thorough. All of this with my family life is making it so I probably have at most 5 years in this field and I also work part time. So there goes another one and we keep on leaving.

Is being a doctor boring when you spend years working on horses day in and day out, and the zebra cases go off to specialists? I used to look at the pediatrician treating my kids for check ups, strep and ear infections over and over and wondered how they did it.

No peds but as an internist there is still tons of variety and intellectually stimulating work ups. What is hard is the emotional labor. I just released labs to a patient with detailed explanations. Nothing super concerning. She has an appointment in 2 weeks but yet she demands and calls wants to speak to me. You can’t do this for all 80-100 patients you see in a given week. It’s just exhausting .

I can't demand anything of my doctor or require them to pick up the phone. Can't you write "nothing super concerning, see you in two weeks".Bye bye. I'm assuming most of the other 80-100 patients aren't calling you. Is she royalty or something?

DP. Now she calls back daily and is rude to the front desk staff person, who is already stressed, but without frankly cursing or threatening. You can expect your front desk staff to complain to you and possibly switch jobs if you don't support them.

Whether or not you decide there is a therapeutic breakdown and decline to continue the person from your practice, she -- being angry and outraged, can leave as many negative reviews trashing your reputation, but you cannot respond with any refuting details or context because of HIPAA. That's annoying and will also put more stress on your staff, who may now be trying to answer questions about those comments.

But who cares, right? But if that patient then makes a complaint about you to the medical board, it follows you onward in many contexts even if there was no judgment against you. You have to report complaints on applications.

So ... you could set aside 30 minutes (because it will not be a 5 minute conversation) and try to deal with it head on, answer her questions, absorb the anger, and move on. And she will then tell people that "I gave him a piece of my mind, because I don't take 'no' for an answer," and so other people start to think this is how to get what they want.

None of this would have happened in 1984, by the way. Medicine is very different than it used to be, and the process continues to accelerate.

Good grief. Businesses deal with grumpy people all the time. It's not like you're dealing here with the outbreak of WW III or the collapse of the financial system.

If I'm grumpy, my first thought isn't "I'm reporting this person to the medical board". That's a lot of work and overkill. It's also counterproductive for a patient to be labeled difficult. The only person I ever considered reporting was an elderly doctor showing signs of Alzheimer's, and then I didn't. I did tell the referring doctor though.

My PCP dealt with complainers by having the meanest receptionist ever. I thought there was a special training school for mean school and medical receptionists because there are a lot of them.

Fabulous. But out of some 3000 patients, there are surprisingly many that are not like you.

How many complaints against you are submitted each year?

I haven't had one, but I've dealt with this in another way - see above. On the other hand, I haven't worked in private practice in the US.

If you can't see why this is not a real problem for the PP that posted above, then we just have to agree to disagree. And watch more people leave the profession as well, and get less and less compassionate and open to these calls.

So it goes.

Imagine if a city worker quit their job because someone phoned up complained their trash can wasn't emptied. There are entire customer service departments devoted to this stuff.

The doctors I see seem to have no problem pushing back or dumping disruptive patients.

You seem scared of 3000 patients yet not one of them has submitted a complaint.

[Anonymous]

Sure, PP. I'm certain you have a thorough understanding and are acting in good faith.

You seem pretty representative of the patients doctors deal with, so we have that going for us.