by Linda M. Girgis, MD, Family Practitioner
I often hear patients complain their doctor barely spends time with them at their appointments. Many feel rushed in and out, dumped on the curb, their wallets lighter by a co-pay. But, the truth is far from assembly line medicine. Patients rarely stop to consider the time we spend outside the exam room on their behalf, and it is hours a day.
Prescriptions eat up hours
Pharmacies often call us when a patient’s insurance rejects a prescribed medication. Instead of letting our patients battle it out with their insurance companies, we do the task ourselves. We spend time trying to find equally effective alternatives that may be on their insurers formularies. If not, then we are condemned to do the dreaded prior-authorization. The whole process can take up to half an hour of just being on hold waiting to speak to a living person. Or it can mean filling out prior authorization paperwork required by a particular insurance company. The patient just sees the prescription waiting for them at the pharmacy and not the work that went into getting it into their hands.
Diagnostic testing causes headaches
Authorizations for diagnostic testing can take hours, sometimes days, occasionally months. It includes a phone call to the insurance company, or a case management company as many now use. These calls can take 30-45 minutes of hold time to reach the responsible party. Office notes need to be faxed over for review. Often, the decision is made for a one-on-one peer consultation before approvals are granted. This means the doctor has to have a phone discussion with the medical director of the insurance company. Usually, this is a 15-minute call but can be longer.
When I’m fighting insurance companies, I can’t be in the exam room. These days the majority of my time is stolen by people with checklists following up on the work I do. They never see a patient or understand the nuances of a case. Doctors simply cannot examine patients and do these tasks at the same time. Every day, there are more and more regulations requiring us to do more paperwork and record more metrics.
EMRs and my former personal time
Doctors do not have the leisure to go home at the end of the day and just put our feet up and relax. Many days, I take my laptop home to work on patient charts after hours. To ensure we’re using our chart software in a meaningful way, the government dictates what information is important (even if we don’t agree). We are often filling in data points that are useful to the government for tracking purposes, but not to our individual patients. While we may spend 15 minutes with a patient in the exam room, recording that visit often takes longer. So, while most people go home and put their jobs down for the day, many of us are spending more time with patient charts.
On Call Is Still A Way Of Life
Doctors must be available 24/7 for patient care. Many of us take call hours and are available all night for calls and emergencies. We often sleep with phones next to us in case we’re needed, regularly jolted by a 4 am call. While this is not time in the exam room, this is time available to our patients to provide them better care. Yes, I’ve even taken a call at 3 am on Christmas morning, my children dreaming of Santa and presents.
Patients might feel they are at war with us as they try to get more face-to-face time. We feel we are in a war of paperwork and insurance bureaucracy to make sure our patients get the care they need. All we ask is for patients to take a little time and think about what happens outside of the exam room. That’s medicine too. Maybe if we work together we can reform the system, tame the paper tigers and put us back where we belong, with our patients.
Dr. Linda Girgis MD, FAAFP is a family physician in South River, New Jersey. She has been in private practice since 2001. She holds board certification from the American Board of Family Medicine and is affiliated with St. Peter’s University Hospital and Raritan Bay Hospital. She teaches medical students and residents from Drexel University, UMDNJ, and other institutions. Dr. Girgis earned her medical degree from St. George’s University School of Medicine. She completed her internship and residency at Sacred Heart Hospital, through Temple University. She has appeared in US News and on NBC Nightly News. When Dr. Linda isn’t spending time with patients, she travels, most recently to Egypt.