Sunday, September 26, 2010

Things They Should Study: what percentage of medical appointments are due to red tape?

Most of the medical appointments I've had in my adult life have been to renew my birth control prescription. Red tape requires that I see a doctor to keep taking the same medication I've always been taking.

My employer requires a doctor's note if you want to get your workstation ergonomized. My insurance requires a note from your primary care physician before it will cover the services of certain specialists.

After getting strep throat every year for most of my life, I can recognize it. However, I still have to go to the doctor to get a prescription for antibiotics.

Gardasil required four doctor's appointments: one to get the prescription, and three to have the doctor administer it.

Apart from a minimal amount of psychiatry, all the medical attention I've received in my adult life has been because of red tape. I didn't actually want or need to go to a doctor, I already knew what I needed, the doctor was just the gatekeeper.

In light of the idea that was recently floating around in Quebec to have patients pay a user fee every time they go to a doctor, I wonder what percentage of all medical appointments are like this? It really is not fair at all to make rules that the doctor has to be the gatekeeper even when you know what you need, and then charge people for going to the doctor.

7 comments:

Hanna said...

The red tape is all about covering butts. Imagine a patient asks for antibiotics, the Dr simply calls in prescription without seeing him/her and the patient really has throat cancer . Patient ends up suing Dr for malpractice when patient was the one who self-diagnosed and requested drugs. *sigh* It's a vicious circle.
I totally agree with you, but the above scenario is probably why they don't do it.

laura k said...

I don't think of the need to see a doctor for an Rx as red tape. I'd rather see the doctor in person, let her take the BP or ask whatever questions she needs to, and get the prescription. I don't find it a huge inconvenience.

magnolia_2000 said...

yea laura you'll do anything to get those pain pills for your fake illness.

impudent strumpet said...

Hanna: I was thinking more along the lines of going to the pharmacy without even going through the doctor. Wouldn't work for all meds, but surely when it's non-narcotic and the patient has used it for a while and continues to use it at a the same steady rate, a doctor's involvement is unnecessary.

L-girl: I find it inconvenient because my doctor's hours are basically the same as my work hours, so I have to use my sick leave and then most of the time is spent waiting in the waiting room. YMMV. But in the context of the proposed Quebec user fee, what's relevant is that the patient doesn't want to go to the doctor, the patient isn't trying to use medical resources, it's totally the doctor's idea.

Magnolia: ur doin it wrong.

laura k said...

I was forgetting about the usual inconvenience of appointments when one does not have a flexible weekday schedule. Even with an accommodating schedule, appointments can take up a lot of time.

When I (or a traveling companion) needed health care in a non-North American country, we were able to deal with pharmacists directly. This happened in Peru, France and Italy. A small sample size, but I learned that other health systems do account for this.

The pharmacist asked pertinent q's, then was legally authorized to prescribe within a certain range, with the caution that if there was no improvement in x time period, to see a doctor.

I could also see that model for contraceptives and other simple situations.

And you're right: if you're going to institute a user's fee, you should give users the option of using less.

impudent strumpet said...

Adding another data point, it's the same for the UK.

I was also thinking this would be especially useful in the aftermath of the Wellesley fire. They did eventually get something together for getting people their meds, but it would be so much easier if people could just go to their local pharmacy and ask for more of the same please. Even if just in small amounts to tide them over until they can see a doctor.

Once upon a time, my birth control schedule got misaligned with my pap smear schedule. So I had to make an appointment, take time off work, and wait in the waiting room for nearly an hour just so the doctor could write me another few months' prescription to tide me over until OHIP would cover my next physical. Not cool.

laura k said...

it would be so much easier if people could just go to their local pharmacy and ask for more of the same please. Even if just in small amounts to tide them over until they can see a doctor.

My doctor's office and pharmacy will do this. If you explain that you only need x amount til your appointment, they will fax an Rx to the pharmacy.

But I guess it depends on the doctor's practice. My doctor recently moved practices, and her old office wouldn't do this. They were very short-staffed, and had a policy that if you need an Rx, you have to make an appointment, no exceptions.

You have changed my mind on this one. :)