What Makes Doctors Angry

     All doctors get angry/frustrated/exasperated about the  things we have to do that take us away from the practice of medicine. I have read and heard many of their complaints in my various capacities, and I am listing a few of them. The complaints deal with the states, the federal government, and of course the patients.

1) The patient who asks you to renew a prescription, but doesn't know the pharmacy phone number.

2) The patient on vacation who forgot his/her medicine, and has the local pharmacy number, but doesn't know the dosage or frequency of the medicine (and sometimes not even the name, just the "blood pressure medicine").

3) The patient who calls up with an anxiety attack, but can't come in right now to be seen because he/she has an important appointment.

4) The spouse who asks you to convince the patient to do something you know full well the patient has refused to do.

5) The spouse who asks you to call him/her on the telephone and keep the line open so it acts as an intercom and the spouse at home can see if the spouse in the office is telling the "truth".

6) The patient who comes into your office with the printed cure for his/her disease cut out of  the National Enquirer.

7) The patient who skips his/her blood pressure medicine for 24 hours before your appointment and then triumphantly announces this fact after the blood pressure has been found to be normal: "You see, I really didn't need the medicine". Then you have to try to explain the concept of the half-life of a drug, and how if the drug is taken every 24 hours, there is still at least half-strength left in the bloodstream.

8) Doctors are not supposed to treat their family, because of possible emotional interactions, but the state gives the children the power of "pulling the plug" on a comatose parent---terribly cruel for the children.

9) Arguing with an HMO that you know that their preferred drug (i.e. cheapest for them) for suppressing stomach acid is Prevacid, but only Aciphex works on this particular patient.

10) Trying to explain to an HMO that in this particular patient generic Ativan does not work, and only the brand name does.

11) Trying to explain to an HMO that although the allowed (i.e.paid for by them)  dose of a medicine is 40 mg/day, your patient needs 80 mg/day to control symptoms.

12) Trying to understand why all HMO's will only pay for 8 Viagra/Levitra/Cialis a month. I guess they figure that no married couple should have intercourse more often that once every 3 to 4 days. I always ask the HMO rep  how often he/she has  sex, just for the heck of it.

13) How Medicare can review 10 office charts at random, decide that you overbilled (i.e. your notes did not justify a fee of $75.06, but only $53.45) on 2 of the charts, and therefore you have to refund (2/10) or 20% of ALL the Medicare fees you received in the past 12 months, or allow them to do a chart by chart audit of all the visits by Medicare patients in the past 12 months, with you there to answer their questions.

14) How Medicare part D suddenly decided they would pay only for generic drugs, and not brand name, unless the doctor can convince them to make an exception for this particular patient. (Lots of luck with this one!)

15) How you have to call a central number to get permission for certain Xray studies such as CT scans and MRI's on HMO patients, and sometimes they insist on speaking with me rather than my secretary.

16) The fact that in  a one-man office I should need only two staff: a receptionist and a lab tech/chaperone. But I have a third employee who does nothing but call HMOs all day long for various permissions.

17)  The fact that most HMOs only allow a 30-day supply of medicine to be dispensed, so if a patient is going on vacation someone has to call up for authorization for a 60-day supply.

18) The fact that Medicare annually threatens to balance its budget by cutting fees by 23% to primary care doctors. The government always relents at the last minute (does anyone out there remember the TWU president in NYC, Mike Quill, threaten a midnight New Year's Eve strike of subway motormen?) but this pattern is not a way to generate enthusiasm for a primary care practice in medical students.

19) The spouse who not only comes into the consultation room, but also into the examination room, so as to hear anything the patient says to me.

20) The spouse who calls up to ask: did you tell my spouse "........" and you have to reply that that answer is confidential.