A duck walks into a doctor's office...

A few days ago a friend asked me to write about some things I look for in a doctor's office. I've been wanting to write about doctors behaving badly for a while now, but kept getting stuck because I couldn't pick a place to start. The doctor's office is perfect.

I'm sure our libertarian pals rejoice in the knowledge that consumer-patient satisfaction is becoming a key metric in determining quality of care and in the not too distant future, all health businesses will be paid based on the quality of care they provide. This will eventually invisibly backhand a certain number of health care providers into shape or, out of the free market. But that doesn't mean the consumer-patient today has to wait for the future.

Judging a doctor's office can be split into three categories: Evening wear; Bathing suit; Talent. Organization, Attitude, Appearance. I'm going to focus on organization here because it's something you can judge when you make (or try to make) the first appointment.

Also, serious disorganization pisses me off at the best of times. A severely disorganized business that provides health care makes me really nervous. The owner-doctor may blame his/her dumb administrative staff, but guess who hired the admin staff (or isn't hiring enough of them, or doesn't pay attention to what they're doing, or can't keep them because s/he's a big old jerk)?  I don't want that kind of person near me with a tongue depressor, much less a scalpel.

So starting with the first phone call, here's the ideal, with some not ideal things to watch for:

1. You call the health care business during normal office hours and get an an easy to understand message that gives the office hours, tells you to call 911 if you're having a medical emergency and the usual spiel about what number to push if you're a pharmacy, physician, a new patient, established patient, pharmaceutical company with a sack full of cash. Yadda.


2. You're a new patient, so you pick that. You're on hold for a reasonable amount of time or not at all (miracles can happen). Once someone picks up the call you aren't put on hold repeatedly or for long periods of time. The scheduler easily answers such questions as "Do you take my insurance?" If you don't ask about insurance, she should. If she doesn't ... I don't know what to say other than something's very wrong and maybe you ought to hang up.
   
   
3. Once someone has verified that the practice does indeed take your plan, the scheduler gets some basic information about why you want to ruin your day with a visit to a health care business. She needs this information so she can figure out which appointment slots/providers would work for you, what additional information you may need to bring and possibly whether the practice will need a pre-authorization (see above re: asking about insurance). Making the actual appointment is straightforward - you're given some dates and times, you pick one.
   
   
   Note that when I talk about a health care business seeing you, I mean any appropriate health care provider at the business: doctor, nurse practitioner, physician assistant, etc. People who insist on seeing an MD/DO are being numbskulls should expect to wait longer.
   
4. The scheduler tells you what to bring. This being the 21st century, she may direct you to the practice's website where you can download forms to fill out in advance. She also ought to reiterate the date and time of the appointment and tell you the appointment cancellation policy.  
   
5. And you're done. Or you ended the call somewhere early because you were put on hold one too many times and the hold music was Lenny Kravitz.

Keep in mind throughout the scheduling process that short of hunting down people in the street or some other exciting but illegal activity, seeing consumer-patients is how money gets into the normal health care business. No appointments, no patients, no cash.

A health care business that can't schedule an appointment without a lot of stumble-bumming is a business that is failing Health Care Business 001. So really, you can stop reading here, because if the scheduling process is a disaster, it's only going to get worse. I've never encountered a practice that muffed the scheduling process that didn't also have some of the problems I outline below:

1. In general, the next time you hear from the health care business should be the reminder call shortly before the appointment. I expect that to be 12 to 24 hours before the cancellation window closes. Since the calls can be automated, there's really no good reason for the call to be late, but in my experience, it's a 50/50 chance I'll get the call on time.
   
2. Now comes the big day! You go to the practice for your first appointment. The person at the check-in window has your chart right there, either in a folder or queued up on her monitor. You are not subjected to a blank stare and confused fumbling for charts or pecking at the computer. I mean, WTF? You're there to give these people money. Possibly lots of it. Anyway. You're asked to sign in, you hand over your insurance card and ID and get the little packet of forms to fill out, unless you filled them out in advance.
   
3. And there's the appointment itself. Appointment start in the perfect world would be the time the health care provider walks into the exam room and starts poking at the customer. I base it on the time the MA or RN calls me back to take my vital signs and to review why I'm classing up the joint there. But does it start on time? How about close to on time? How about It's 9.20 and the appointment was at 8:30 time? If it is very late, does someone at least tell me what's up, apologize, give me a lollipop?

May I wax anecdotal for a moment? I had a cardiologist a while back who, as a person, I found incredibly groovy, and the doctor brings a big sweet pooch to work. I no longer see that doctor, or the dog. Why? The practice is a big fragrant bouquet of fucks and the doctor was always, always, always, at least 30 minutes late, is why. It sucks - especially not seeing the dog any more - but going to a cardiologist who raises my blood pressure seemed ... counter-intuitive.

At any rate, practices that are chronically very late (which includes taking a patient to the exam room at the scheduled time and then leaving them so long they have to make a nest out of back issues of People R Us to stay warm) are another thing that irk your health care plan.

It means the health care business is making a number of errors on a regular basis. If those errors are intentional it can mean the doctor is behaving badly. Or the doctor may start behaving badly to make up for the fact s/he is always running late (and short of cash). But for the consumer-patient, it means less than optimal care. Also a nasty chill from sitting around in those people envelopes they give you. If it at all possible to not put up with it, don't. If it can't be avoided, rat 'em out to your insurance carrier.