Spending Time with Patients

Foodie MD

While I spend time teaching patients to cook- that is fun- but what is professionally rewarding is physicians who spend time with their patients

She came to my office nervous, and almost in tears. When she sat down she moved her heavy purse onto the desk.

When I asked how I could help her she started to cry. In the next minute she cleared up but said that she was just a mess, at the end of her rope, and her doctor had sent her to me for surgery.

Her blood pressure had been elevated for a bit, so after we talked for another minute, I asked if I could take it again. When I did the blood pressure was low-normal.

We ask new patients to bring either a list of medications, or we ask them to bring their pills to the office. I asked her what medicines she took. Onto my desk spilled thirty different prescription bottles. I am not a primary care doctor, I am a surgeon, which means I don’t prescribe medications for blood pressure, unless the patient is in the hospital with high blood pressure, or diabetes, or other ailments.

I started looking at the bottles. “How much time do you spend with your doctor?”

“Honestly, Dr. Simpson, you just looking through my bottles is more time than I ever spend with my doctor or his nurse.”

“How many of these do you take?” I asked.

“I have no idea.” She replied.

So we went through them. One by one. Many she had no idea why they were prescribed, and many she didn’t like so had stopped taking. She had four blood pressure medicines, none of which she had taken today and her blood pressure was normal. She had three different pills for diabetes, none of which she had taken in a while.

I asked why she was on thyroid medicine. “My doctor said it would help me to loose weight.”

She had brought her labs with her, so I looked through those. No thyroid tests anywhere.

Prescription after prescription- and there was no rhyme, reason that this patient understood, and yet I was looking at thousands of dollars of medications.

When getting a referral from a physician it isn’t polite to send someone to another physician  – it just isn’t done. I was tempted, but found a way out of it. I called the primary care office and asked if they would mind if I made a referral to a gastroenterologist to see the patient, the busy nurse said this was not a problem. Since she was on medication for “GERD” she needed to be evaluated to see if she had a hiatal hernia before I did surgery.

“Joyce, I have a problem here, and I need your help.” When I call Joyce for help with a GI problem it is usually someone who is having a bleed  and needs intervention quickly. This was different – this means the patient needed someone who was an internist, and I knew she would go through each medication, take as much time as was needed and pair down the list.

I didn’t need to prep the GI doctor, I sent the patient over. About two hours later I got a call from Dr. Richards.

“Did you see all the meds she was on? ” she started, not even naming the patient.

“I did, and many she was not worked up for.”

When the patient came back to my office, after having a scope confirm there was no ulcer, no hiatal hernia, no evidence of GERD, and the patient didn’t need the three medications given to her for stomach issues – there was also a smiling patient, who had gone from thirty prescription medications to three: one for hypertension, one of diabetes, one for hyperlipidemia.

“She spent two hours with me, and going through my history and chart.”

I smiled – I knew she would.

Taking time with patients is that – it takes time. In this case, the intervention saved this patient and the health care system dollars.

Oh- the surgery went fine- the patient came off the diabetic medication after loosing some weight, and blood pressure medication soon thereafter. The patient is also cooking, attending my cooking classes – and in the last six years since this happened has gone from someone who was unemployed and on disability to happily back at work (and down 120 pounds). Sadly, my good friend, and GI doctor moved to another city- but there are a lot of great doctors out there I know who actually love to spend time with patients.

Dr. Terry Simpson About Dr. Terry Simpson
Dr. Terry Simpson received his undergraduate and graduate degrees from the University of Chicago where he spent several years in the Kovler Viral Oncology laboratories doing genetic engineering. He found he liked people more than petri dishes, and received his MD. Dr. Simpson, a renowned weight loss surgeon, is a leading advocate of culinary medicine. A frequent contributor to media outlets discussing health related topics and advances in medicine, he is also a proud dad, husband, author, cook, and surgeon “in that order.” For media inquiries, please visit www.terrysimpson.com.

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Comments

  1. Lynn says

    I wonder how obamacare will impact how much time doctors have for patients. Apparently it will cost the consumer more and reimburse the doctor less.

  2. thedoc says

    The time a doctor spends with a patient is up to the doctor. If the patient has insurance, now the doctor gets paid. Why you say the consumer will cost more is just incorrect. First, the consumer has insurance, so they can see a doctor before a small problem becomes a big one. We know that with more primary care the patient will have less chance to get to the hospital and have the issue taken care of before it becomes a large one. If a person does not have insurance they can go bankrupt with a health issue- and that costs far more. The leading cause of bankruptcy in the US is, even during the recession, health care. So, where you get the idea that this will cost more is from a someone who doesn’t like the idea of more health care for more people.

  3. Lynn says

    basically what I have been reading has said that those who are not eligible for help paying for insurance will pay higher premiums so that those who cannot pay as much will be insured. The payers are paying for those who cannot pay but they are paying more. It may cost a family of $20,000 per year for a family of 5 in 2014 which is higher than what they are currently paying. The taxpayers are funding this through higher premiums.

  4. thedoc says

    incorrect on all counts. The exchanges will drive down costs for all. The payers are not paying more for insurance, there is not a higher premium. Employers will pay a fee if they are not paying for healthcare if they have more employees. The rise in insurance costs has nothing to do with insuring more- in fact the more that are insured the costs will go down

  5. Lynn says

    from Daily Beast
    apparently news articles that for some, insurance will cost more, are circulating

  6. thedoc says

    Read the article — besides being poorly written, it misses the point. Insurance is about expanding a pool of people so that your rates decrease – much like automobile insurance. You want healthy people in the pool so the rates go down. Their argument is this: young people have few co-morbid factors so insurance is cheap and they are going into a pool so their rates will go up. The wrong part of this is simple: the insurance already pools people. When this happened in Massachusetts the rates went down for younger people. Look at it this way: we all pay into insurance, and if we are lucky will never use it which means insurance companies win. Some use healthcare system a lot- but will never be able to pay- so it pools. Like car insurance does. Higher risk pay more, and yet we modify that by increasing the pool. Now, the pool is small because few low risk people are in it – when it expands they won’t pay more – arg.

  7. Lynn says

    No one is sure what will happen on Oct 1. States and cities might dump retirement health care for municipal workers, on the federal government and many young people might opt for the penalty which is cheaper than insurance. No one is sure that the system won’t be clogged with retirees and short on the young, restless and healthy. Republican states don’t like the Medicaid expansion which is basically what the subsidies are. If Medicaid does not expand in those states, it will cause an estimated 19,000 avoidable deaths a year. The Republicans will basically never win another election if this happens because there is such a thing as low income voters.
    In some states there are few insurance choices and there is the hope that Obamacare will open those choices which could lower premiums.
    I guess that young people need to very much outweigh (not physically but in numbers) old people in the insurance pool but this may or may not happen.
    Meanwhile, when health care CEO’s have 7 and 8 digit salaries, medicine is always practiced defensively, and we pay for the poor teenager giving birth by charging $5 per tylenol pill to the insured patient, the price of health care itself needs an examination.

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