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Doctor, my child and I need more time with you
September 19th, 2011
12:01 AM ET

Doctor, my child and I need more time with you

For new parents, advice from their pediatrician about soothing a crying infant or putting them to sleep is invaluable and often discussed at well-baby check-ups.  But a study published Monday in the journal Pediatrics found that a third of the time parents of young children spent 10 minutes less in the exam for a those check-ups and this may be depriving families of important preventive care for their children.

When doctors were asked how much time was needed for a well visit, they said on average about 17 minutes, according to the study.

Why the time crunch? Experts say doctors are being asked to do more in less time and though they would like to provide more care, they can't make it happen. The American Academy of Pediatrics (AAP) has specific guidelines for what pediatricians and families need to discuss during these regularly check-ups, which are not only for newborn, but are also recommended for children all the up to age 21.  While breast feeding, sleep positions, language development, and keeping your child safe are top priorities for parents of infants, pediatricians can also provide guidance and children get older, including how to toilet-train, deal with discipline issues, or how your child gets along with others. 

But some of these well-child visits are not always covered by health insurance. Some insurance companies pay nothing for these visits; others only pay for a certain number of these appointments each year.  Though the advent of HMOs has generally increased reimbursement levels, preventive care as a whole is still under-reimbursed and not looked upon as providing enough value for the expense, according to the AAP.

What's discussed in these wellness visits has evolved. In the 1960s and '70s doctors focused more on preventing infectious diseases such as polio, measles, and mumps. With the development of more vaccines, doctors are seeing fewer and fewer children with these illnesses.

"What we see more of now is disorders of anxiety, disorders of mood... depression, ADHD, drug and alcohol use...and autism," explains Dr. Joseph Hagan, Chairman of the AAP's Bright Futures Steering Committee.  Many of these conditions need screening to detect, and that takes time.  Also, if these behavioral and other health problems aren't detected in early, childhood issues can become even bigger problems in adulthood.  Health problems such as obesity, diabetes, and mental health concerns often manifest by adolescence.

"If we're really interested in reducing the impact and cost of chronic disease in our society, then we need to focus more on children's health and those things we can prevent and better understand  what we can do," explains Dr. Neal Halfon, Director of the UCLA Center for Healthier Children, Families, and Communities in Los Angeles, California and lead study author.

Halfon says there are things that pediatricians, parents and insurance providers can be do to address the time constraints often tied to preventive care:

1) Higher reimbursement for preventive care
2) A team approach to care so that non-physicians handle some of the screenings or other needs
3) Use of pre-visit questionnaires so clinicians can better prepare for visits
4) A tiered system so that higher risk children can get longer office visits

Parents can also learn to better use the short amount of time they have with their pediatrician.

"Be prepared when you go see your physician and use the time wisely," explains Halfon. "Make sure that you're asking the questions that you need to ask and that you're getting the answers you need."


soundoff (83 Responses)
  1. doight

    Is there any evidence that a longer visit actually makes a difference? I often joke that soon patients will have me look at their cars in the parking lot.

    September 19, 2011 at 09:59 | Report abuse | Reply
    • yo

      Agree with you. The "informed" patient is the worst for sucking up valuable time by arguing nonsense.

      September 19, 2011 at 10:52 | Report abuse |
    • Rbnlegend101

      If you are a doctor complaining about spending time listening to your patients and diagnosing their problems, post your real name, so your patients can be aware of how you feel about them.

      My wife went 12 years with undiagnosed celiac disease. Then we sat down with a doctor who had allocated a full hour for a review of her medical history. That doctor discovered the celiac disease, and also discovered that in my wife's entire life, she has never, not once, had a strep test turn out negative, and she has had at least three every year. Remove some tonsils and stop eating wheat and big surprise, her large cluster of unexplained unconnected symptoms went away. But you keep on diagnosing patients at a glance and wondering why the difficult cases never seem to get better.

      September 19, 2011 at 16:04 | Report abuse |
    • telling

      I wish there was a way to get certified a 'good' patient. You know, not a hypochrondriac, I'm not after drugs or trying to abuse antibiotics–'the I tried rest, ice, heat, elevation, not elevating, IcyHot, chinese medicine, I considered leeches, it absolutetly will not heal on its own' patient designation. I had 3 orthopedist worthy injuries visits in the past decade and had 3 surgeries. I've had only 2 doctor visits this year–1 bronchitis, 1 strep positive test. There should be a card where I get quick non-nonsense visits for being a good patient.

      September 19, 2011 at 18:12 | Report abuse |
    • T3chsupport

      I pay over $300 a month for health coverage for my family. Your perceived value on the time you are already scheduled to work really doesn't make a bit of difference to me. My dime, your time, that's how it works.

      Now quit whining and tell me what you think of this wart.

      September 19, 2011 at 21:06 | Report abuse |
    • Shrinkwrap

      That $300 goes to your insurance company, not your doctor. Pay your doctor $300 a month and we'll talk.

      September 20, 2011 at 13:24 | Report abuse |
    • lang

      Lit review for the original poster to get started on getting up to speed on the pt-physician relationship literature:
      .Wilson A, Childs S: The relationship between consultation length, process and outcomes in general practice: a systematic review. British Journal of General Practice 2002, 52:1012-1020. Further, there is strong evidence (do a lit serach) that when pts feel listened to, they are much less likely to pursue litigation (not that that is the main point here).

      24.Howie JG, Porter AM, Forbes JF: Quality and the use of time in general practice: widening the discussion.

      BMJ 1989, 298:1008-1010. PubMed Abstract | Publisher Full Text | PubMed Central Full Text

      September 20, 2011 at 13:52 | Report abuse |
  2. MollyMcButter

    I suppose if I'm paying for 15 minutes of your time doight, we should chat for that 15 minutes. No? At least my doctor agrees with me.

    September 19, 2011 at 10:09 | Report abuse | Reply
    • wilbur

      I had a couple good docs. One told me almost all health problems are caused by in this order: 1) lack of adequate exercise 2) bad diet 3) bad habits such as smoking. He explained daily exercise that causes elevated heart-rate mitigates effects of the other to an extent. Point being: if anti-biotics were legal (Pet stores sell BTW) doctors would be starving and nobody would abuse antibiotics.

      September 19, 2011 at 10:24 | Report abuse |
    • Not All Docs Play Golf

      Unfortunatey the 15 minutes you are paying for also includes the time needed for writing your prescriptions, ordering your Xrays, and dictating the appointment. Your 15 minutes is fully spent on the total profesional task performed for you, but a 15 min appointment does not mean a full 15 minutes of chatting.

      September 19, 2011 at 12:28 | Report abuse |
  3. wilbur

    New mothers, first baby. Best dealt with by the "midwife" industry first. Doctors are useless in the USA. They serve one purpose only: they have a prescription pad.

    September 19, 2011 at 10:19 | Report abuse | Reply
    • Dr. RB

      And tell me how it goes when there are some complication or need for emergency c/s.

      September 19, 2011 at 10:31 | Report abuse |
    • ajs mom

      I have to disagree. Not all pediatricians are pill pushers. We have an excellent dr. VERY conservative when it comes to drugs. Encourages lots of TLC for sick children and I find that I've become more comfortable assessing my childrens' illnesses rather than running to the dr. for every little sniffle.

      September 19, 2011 at 10:38 | Report abuse |
    • Rachel

      you should research and choose your drs better if this has been your experience

      September 19, 2011 at 12:57 | Report abuse |
    • Not All Docs Play Golf

      And what "one purpose" are YOU serving in posting this kind of misinformation? Go visit a modern women's hospital and see what wonderful things are being done for women and children in 2011. It's really amazing, far from "useless," as you accuse.." Or, stay in the dark ages and keep posting misinformation to people who deserve better advice than what you're giving.

      September 19, 2011 at 14:56 | Report abuse |
    • Dr. K

      Useless, eh? My appointments are booked for 15 mins, but no one gets less than 30-45 and that DOES NOT include billing, dictating, chart review, lab studies, radiology, or the school notes, prescriptions, and time wasted while parents text through the appointments. I have no lunch break, I go home with work everyday, and I have a quarter of a million dollars in medical school debt. 75% of my patients are Medicaid, which means that I get reimbursed for pretty much nothing. I work 80-100 hours a week for free. I have parents that demand prescriptions for Tylenol and diapers while they seem to find money for fancy manicures, cell phones, and cigarettes. I'm available 24h a day to diagnose your kids with life-threatening heart disease and then do something about it regardless of how long I've been awake, when my last meal was, or how long it's been since I've seen my family. Tell me again why we're useless? I'd love to hear something mindblowing.

      September 19, 2011 at 19:31 | Report abuse |
    • ML

      Doctors – persons upon whom we set our hopes during bad times and our dogs during good times. With extreme apologies to Ambrose Bierce.

      September 20, 2011 at 07:26 | Report abuse |
    • nikki

      DR K..you rock..i appreciate doctors like you..and btw ive never heard of a prescription for Tylenol or diapers....seems pathetic to me..and Wilbur..ur comment is as USELESS as a mosquito..i suggest you re read Dr K's statement..i cant believe the ignorance in all these comments regarding doctors

      September 20, 2011 at 08:31 | Report abuse |
    • drny

      As a pediatric ER doctor, I strongly disagree.

      September 20, 2011 at 14:28 | Report abuse |
  4. The_Mick

    The problem isn't with the doctors, it's with the number of doctors. In France, there's one doctor for every 400 people. In the USA there's one doctor for every 1240 people, many trained in 3rd-world countries. Any wonder we have a 50% higher child and infant mortality rate than France? There are fewer seats in American medical schools than there were in the 1980's. Who made sure that was the case? Do you hear the AMA crying about it?

    September 19, 2011 at 10:51 | Report abuse | Reply
    • Not All Docs Play Golf

      You're just ignorant of the facts if you believe there is some conspiracy on the part of the AMA to keep physician supplies down. Clearly shooting your mouth off. One of the main current concerns of medical organizations, such as the AMA and ACP, is the lack of access to primary care in the US. Organized medicine is trying to address these concerns, and people like you have no idea what you are talking about. Go back to the flying saucer blogs where you are more expert.

      September 19, 2011 at 13:40 | Report abuse |
    • AMA control

      The AMA very carefully controlls the number of students accepted for medical school each year. It also sets the standars for and therefore controlls the number of graduates who are certified and enter residency and then become licensed physicians. Unlicenced (by the AMA) physicians are not hired to perform clinical duties anywhere in the USA. This is no conspiracy, it is reality. Whether intended or not, it does help to protect availability of jobs as well as (to some extent) salaries. Physician numbers never experience "boom and bust" cycles and that is due to careful control by the AMA.

      September 19, 2011 at 18:27 | Report abuse |
    • Not All Docs Play Golf

      To "AMA control".....you have no credibility on this topic, because you mistakenly think, among your other incorrect ideas, that doctors are "licensed by the AMA." You are an idiot. The AMA is an optional professional organization that only about 40% of doctors even choose to belong to. Doctors are licensed by the state licensing board of each state, nothing to do with the AMA. Idiots like you sit around all day dreaming up conspiracies about monsters under your bed while you contribute nothing to society.

      September 19, 2011 at 20:46 | Report abuse |
    • Elspeth

      Mr. Not all docs play golf...

      Yes, the AMA is directly involved in managing how many doctors exist in the US. First, no medical school can operate in the US unless it has the blessing of the AMA. If one were to try it would find (1) that no student could obtain ANY type of financial aid because the US Dept of Ed requires medical schools to be accreditated by AMA in order for federal fin aid to be granted and (2) no graduate could be licensed in any state because all 50 states and DC require that to obtain a license you must have graduated from an AMA accredited school if the school is physically located inside the US.

      Additionally, in order to be licensed in ANY jurisdiction in the US you have to pass a three part exam. Part of that exam is controlled by the National Association of State Medical Board but part is controlled by the AMA. If you graduate from a medical program inside the US, in order to be deemed eligible to take any portion of the three part exam the school MUST be approved by the AMA. The only way you can take the exam when you have not attended an AMA accreditated is if you went to a school outside the US.

      The AMA wants there to be a shortage...just enough to keep prices for medical services "at the right price". Since not everyone can be a doctor and since one cannot practice medicine without a proper license which you cannot get in this country without the AMA saying so there is a premium on being a doctor. Additionally, because of the way this country finances education for needed professions like doctors, and because there is soooo much debt associated with this type of education, mostly due to the AMA not accreditating more medical schools, doctors can justify charging more for their services (shortage of providers + high cost paid to become provider = justified high cost of service) .

      The only reason that the AMA is NOW concerned with the shortage is because of the fact that they were so shortsighted in the actual needs of this country for doctors for so long. They failed to keep the pressure at a normalized level on an economic scale. Demand greatly outstripped supply faster that the AMA predicted (who would have actually expected that the earliest baby boomers would live as long as they are; when they were born cancer and heart disease were sure killers not just chronic conditions- they couldn't have predicted that Alzhemiers and Autism would be some of the biggest long term concerns and that care had gotten so good that people regularly live into their late 80s and 90s. Heck even in the early 80s breast cancer had less than a 50% 5 year survival rate)

      So, TLDR, the AMA is directly responsible for the doctor shortage in this country.

      (Btw, the same arguments can be made regarding attorneys and the ABA. Absent the existence of the ABA and it's accreditating powers there would be tens of thousands more attorneys in this country. Now a lot of people would think that a horrible thing, but if there were lots more qualified attorneys then the cost of having an attorney would be way way less because the cost of the education would be way way less so there would be less justification for $600/hr billing)

      September 19, 2011 at 22:32 | Report abuse |
    • Shrinkwrap

      Increasing the number of Medical Students will not help without the Federal Government increasing the number of Residency Programs, especially in Primary Care fields.

      Even that will not help if Primary Care salaries and job satisfaction do not rise, because no one wants to do it because the job sucks. Why should I, a medical student with $300,000 of debt and half a life time spent slaving away learning medicine, spend the rest of my life making less money, being VERY RUSHED, doing tons of paperwork, and listening to people complain?

      I can make 2x as much, working 1/2 the hours, doing practically the same job in an ER...or, I can be an anesthesiologist and make 2x the salary while my patients sleep, or I can be a radiologist and make 3-4x the salary not even having to interact with people (or their complaining) at all.

      You won't get more Primary Care Providers (whether Doctors, NPs, or PA's) until job satisfaction and salaries increase. And, that means more pay, more time to spend with patients, and a better quality of life.

      September 20, 2011 at 13:31 | Report abuse |
    • drny

      @ Elspeth – yes, medical schools can operate without the blessing of the AMA, however it looks better if the school is AMA accredited.

      September 20, 2011 at 14:34 | Report abuse |
    • Don F.

      The the issue with the number of Dr's is a systemic issue. Dr training is very selective and very limited, generating fewer than needed per year and with a very investment often heavly on the back of the Dr. That model is broken and is being forced to change. The other end of the spectrum are the poor patients - the ones who over use the system, often at the last minute and in a very expensive mode, who make poor decisions and can not manage life (have poor life skills). Sadly these are the same folks who tax the system from a financial point of view because their care coverage is at a rate below cost and often they have no skin in the game in the form of a copay. It is amazing the number of adults who do no have basic health skills (can't sleep of a round of the flu with fluids and an anti inflamatory).

      On the other hand Dr offices are not particularly effecient either. I have two maintenance perscriptions. They are on different cycles. That means that the Dr office has to deal with two separate renewals - bottom line that means pulling the chart at least twice during the course of a year to renew the perscriptions. If I were the Dr, I would review the maintenance meds at the annual physical, write the renewals for 14 months (that is the period of the annual physical) and be done with it. So in the course of the year the office has to deal with my chart three times instead of once. Three times a year the Dr has to read my chart enough to become familiar with me and my issues so he can perform professionally, when he could do it once.

      September 28, 2011 at 18:01 | Report abuse |
  5. WhoKnewIt

    I do believe there are several issues here. 1. Health Insurance companies can be blamed for many a complaint by patients AND Doctors. They use the assembly line mentality...get em' in and move em' out. If you don't you'll be dropped....2. Not enough Doctors. My granddaughter had many issues at birth and now at 8 months old still weighs only 12 pounds. Testing started and 8 weeks later my son/DIL received a LETTER IN THE MAIL telling them their child had a "duplicate chromosome" and would have "many issues that we don't know about yet". IN THE MAIL? Really? When they called to get some further information the Dr. never returned their call, never answered their questions. The nurse told them to make an appointment but that if "it wasn't an emergency the wait was about 2 1/2 months". 3. Doctors that really don't seem to care if they treat you or not...if you don't like it go someplace else....know why??? Because there are 100 other people waiting the 2 1/2 months to see them and they will be thrilled to bump up in the line by 1 day!

    Really, if YOU were a Doctor would you want to run your practice with a stop watch? In this country it has come down to one thing and one thing only "it's all about the money"....

    September 19, 2011 at 11:05 | Report abuse | Reply
    • CincyCat

      Most doctors I know (and I'm related to a few) would rather NOT have to watch the clock at each appt. Unfortunately, they are usually accountable to the practice manager, who in turn is usually accountable to a regional medical services management "group". Their job is to treat patients, yes, but they must also be able to generate funds to support the office at the same time. Admins, records, other office staff building lease-holders and utilities, etc, also have to be paid, and they can't bill insurance for their services...

      September 19, 2011 at 12:01 | Report abuse |
    • Not All Docs Play Golf

      Sorry you had such a bad, atypical experience. No amount of being busy excuses what is really a process problem with the office you described. Processes for getting back to patients with results, or prioritizing access to follow up of abnormal results is a matter of having reliable and appropriate processes in place. Sounds like the ofice you describe needs to look at improving these protocols. One piece of advice....while it's important to get second opinions and specialist consults when needed, sometimes patients can actually negatively impact their care by having too many people involved in the care, so find a good primary doctor you have trust in, one who has good office processes, and let them ccordinate the care, referrals, etc., so that you have a home base that can advocate for you in an aotherwise intimitdating and complex medical system.

      September 19, 2011 at 14:42 | Report abuse |
    • Rbnlegend101

      That's not at all atypical. My wife went 12 years with incorrect disgnosis after incorrect diagnosis. That's over 20 doctors in a variety of specialties. The most common diagnosis was "lose weight", even though the symptoms preceeded the weight gain. The correct diagnosis was fairly simple to arrive at when a medical professional spent enough time to read through her medical records, actually reading them instead of skimming looking for key words.

      Doctors want to help. I believe that. But, they have financial limitations, time limitations, and they already know that chronic health problems are hard to effectively help. So the best approach is to try to help a lot of easy cases, and hurry the hard ones through.

      Try going to a doctor without revealing your credentials sometime. Or better yet, take your kid in for medical treatment and keep your mouth shut. Let someone who isn't a doctor and has no medical training interact with your chld's caregiver. Get a real picture of how medical care works, or fails to work.

      September 19, 2011 at 16:13 | Report abuse |
  6. Debbie

    My own personal experience is that when the doctor and parent and patient have a few non-rushed moments, sometimes some important bit of communication can pop out. Maybe there is something that gets mentioned that is not specifically on the questionnaire, etc.
    I'm not advocating wasting time, but sometimes a minute or two of conversation can be valuable.

    September 19, 2011 at 11:18 | Report abuse | Reply
    • Katarina

      Today, I went to the beach with my kids. I found a sea shell and gave it to my 4 year old daughter and said You can hear the ocean if you put this to your ear. She put the shell to her ear and sarcemed. There was a hermit crab inside and it pinched her ear. She never wants to go back! LoL I know this is completely off topic but I had to tell someone!

      March 4, 2012 at 09:05 | Report abuse |
  7. CincyCat

    Wow... I must be spoiled by my Dr office (Family Med). Not only do "well" appts take well over 20 minutes, but they have a computer system in each room that prompts them to ask ME questions if I don't rememeber to ask any. This goes for the adult visits and also the child visits. They also gave me a handout for the kids that had their current weight, height, etc, on it, as well as health info & tips for their age range, and I get a printout of their current immunizations to take with me for school – without my having to ask.

    We can usually get in the same day for "sick" visits, and within a couple of weeks for all other needs, including "well" appts.

    And yes, they are on my regular plain-Jane company offered high-deductible health insurance plan.

    September 19, 2011 at 11:57 | Report abuse | Reply
    • Melina

      Cindy you are not alone. My doctor carries a laptop with him to the room so he can take more time with us. My kids are all 13 and older. The first thing he asks them about is their grades. He takes a "whole person" approach and spends time talking to my kids and getting them involved in their own care.

      September 19, 2011 at 15:59 | Report abuse |
    • abrown

      Who is your MD? My pediatritian doesn't take call, we have to call childrens nursing line if there is a problem. The same goes for my childrens dentist if they are out of town. I haven't been able to find a decent vet either, they all try to sell you things so your bill is twice as high. It is all about money, .

      September 19, 2011 at 16:49 | Report abuse |
  8. Not All Docs Play Golf

    Believe me, doctors would LOVE to have a non-rushed pace and be able to enjoy practicing medicine. Don't fault the doctors. But the facts of overhead costs, and the fact that an unpredictable number of patients will call and want to be seen acutely on any given day, makes the art of scheduling a real challenge. If anyone hates the rushed pace, it's us doctors. It is not how we would choose to practice, and it's not fun on our end being rushed. But the pace is dictated to us by economic realities. It's not about getting rich, it's about not starving and being able to remain in business (at least among us primary care doctors).

    September 19, 2011 at 12:24 | Report abuse | Reply
    • Elspeth

      Well then if you darn "doctors" would all get together and tell the HMOs etc "NO!" in no uncertain terms then maybe things would change. Blaming "the economy," "the hmo's" or any one else for their own negligence ( failing to actually provide care paid for, failing to listen to patients long enough to obtain enough information to make a dx, failing to order appropriate tests, failure to read medical records, etc. Are ALL negligent acts. If you harm or kill a patient your licensing board is not going to accept "I couldn't because the HMO wouldn't let me). As a doctor YOU have a legal and medical ethical OBLIGATION to spend as much time with each patient as is medically necessary, not just that amount of time which is economically expedient. YOU are the one who has been granted the PRIVLEGE of practicing medicine. YOU do not have the right to practice negligent and then try to pass the buck and say that it's "economic".

      If the economic realities of being a doctor is too much for you then you can quit. Lots of other licensed professionals who discovered their chosen field wasn't all that have dropped out. Many of them lately have opened cupcake and cookie stores. Maybe you'll enjoy the economic realities of selling junk food more that being a doctor. What YOU need to realize is that it has only been within thhe last generation and maybe e latter part of the last generation that doctors were essentially guaranteed a $100k+ income. Most doctors, even as recently as the 50s and 60s, outside of the metropolitan areas of this country made bupkis. They often took their pay in trade. Quite your whining. Do your job or give it up. But you have no one but your own self for your predicament.

      September 19, 2011 at 22:51 | Report abuse |
  9. Renait

    There are many, many, many reasons why doctors can't spend as much time with patients as they would like – and they all have th word "insurance" attached to them.

    September 19, 2011 at 12:27 | Report abuse | Reply
    • Elspeth

      With the sole exception of "malpractice" in front of that dirty word. The malpractice carriers do NOT like hearing doctors say "I couldn't not be negligent because of the insurance co" it's a sure way to a big loss for them.

      September 19, 2011 at 22:55 | Report abuse |
  10. DAN

    I am a primary care Doctor of Internal Medicine ( doctor for adult patients). I can tell you that the root of the time problem is related to increased government regulations and cutbacks in insurance reimbursements. I practice high quality, evidence based medicine. This takes time. I spend that time with my patients. I have seen the result of Doctors who do not spend enough time with patients. It leads to missed diagnoses and patient non-compliance. However, I am an employed Physician, and I have to fight on a weekly basis about how much time that I spend with each patient with " business people " who employe me and know nothing about medicine. My well visit physicals are 45 minutes. A patient newly diagnosed with diabetes is 30 minutes. Most other " routine " visits are 15 minute, but this is patient dependant. I am a very good doctor, but after 14 years of practicing medicine, I am starting to get burned out due to the constant fight over time. If you think things are bad now, you have no idea of how bad things will get if insurance companies and the government are allowed to continue to dictate to doctors on how to practice. By the way, you can give a bad doctor more time with a patient and it will not improve the care given. However, if you take time away from a good doctor, the care given to patients will suffer.

    September 19, 2011 at 12:44 | Report abuse | Reply
    • Not All Docs Play Golf

      I, too, am an intenist and FACP and pride myself on evidence-based quality. And I, too, was previoulsy employed as you before I struck out on my own. While it has some advantages in terms of autonomy, I hate to burst your bubble, but if you had to run your office overhead completely on reimbursement of your work, you would go bankrupt giving 45 minute well-visits. Employed docs, although I hated to admit it when I was employed, are "subsidized" by the hospital or clinic. That's not the reality when on your own. You could not afford to spend 45 minutes on well-visits. Now, instead of some business suit telling me how many people to see, I have my bills telling me.

      September 19, 2011 at 13:14 | Report abuse |
    • Elspeth

      And your statements are the exact reason that the corporate practice of medicine should be criminally outlawed. Medicine is supposed to be a Profession. That's with a capital P not a lowercse p. Professions require that each individual who hold a license to practice, be it medicine, law, accountancy, or engineering, made independent decisions based upon their OWN professional judgment.

      The corporate practice of medicine interferes with this independence. When administrators who are not doctors are tasked with making decisions for shareholders who are not doctors negligence runs amok.

      I am not suggesting that doctors should only be permitted to practice alone. Small group practices are often beneficial to patients as there is often "back up" and there is the opportunity for doctors to consult with each other over difficult cases.

      But the Kaiser Permanentes and the Catholic Healthcare of the Wests need to disappear.

      I would also advocate for preventing accounting firms and law firms from becoming giant conglomerates for the exact same reason. When the almighty $$$ takes precedent bad things happen. Enron wouldn't have happened without Andersen and a lot of the robosigning of the mortgage/foreclosure crisis couldn't have happened without a couple of large multi-state law firms. Corporate practice of any Profession is just plain wrong.

      September 19, 2011 at 23:20 | Report abuse |
  11. Grammar

    Please fix it.

    September 19, 2011 at 12:49 | Report abuse | Reply
  12. Larry

    Hate to say it, but a child might be better off not being determined to be ADHD or
    autistic. In both cases they will most likely get unneeded drugging. What we really
    need is some help for parents to deal with children who need extra attention. Not
    drugging to make them easier.

    Many of histories great scientists, artists and musicians would today be classified
    in childhood as ADHD, bipolar or autistic. Then subjected to drugging. Would Einstein
    have made his discoveries if given Risperdal at an early age for autism? Or subjected
    to abusive behavioural "therapy" to make him act more "normal"?

    September 19, 2011 at 12:56 | Report abuse | Reply
    • Srah

      Right, because NOT diagnosing autism would help that child to get the appropriate early intervention services necessary to help them to develop languge/communication and social skills???? This is an asinine statement. Yes, ADHD may be incorrectly diagnosed at times and improperly medicated, but autism is a whole different story.

      September 19, 2011 at 18:20 | Report abuse |
  13. LovieDovie

    Yeah, these doctors think we can now just "Google" our questions and/or concerns. That's why quality of care has declined terribly.

    September 19, 2011 at 13:05 | Report abuse | Reply
  14. fuyuko

    Everyone is different. Ive had doctors who run into the room, make a flip diagnosis and then leave, I've had doctors who want to chat to the point of the nurse knocking to tell them he has other patients, to the rude young doc, who thought making jokes about patients clothing was funny. I've had docs that you can't even see, because they have a dragon nurse who does the majority of the work. etc. Doctors are people, but I've found if the practice overbooks, or accepts emergency appointments (and in some fields that is neccesaary), inevitably, your regular appointment is bumped for someone's 'emergency' appointment. I have one doc who is chronically late, sometimes up to a 1/2 hour. He always overbooks, and is very chatty. I like him, but if you go to see him expect to WAIT. When you do get him though, he gives you a lot of time.

    September 19, 2011 at 13:14 | Report abuse | Reply
  15. DOC's are whining b!tch3s

    Serious ..

    You think you are all that.. when it comes down to it.. I can go to Cuba and get better medical care and someone who actually cares.

    September 19, 2011 at 13:52 | Report abuse | Reply
    • Not All Docs Play Golf

      Good luck with your trip. And don't forget to bring back some of those cigars for your friends.

      September 19, 2011 at 15:00 | Report abuse |
  16. JLB

    I have yet to have a Pedi that was worth spending 15 minutes with except for one that I saw when my son was sick. Their whole goal during the welness visit seems to be to vaccinate my child and move onto the next kid. My son had issues with dry skin and actually got an infection needing antibiotics because of it. The dr I saw when he was sick was wonderful and gave me a list of things to do to prevent the dry skin issues (such as using non-alergenic soaps etc). Her advice sounded simple, but within a month my son's skin was almost normal! Meanwhile when I had asked my dr what I could do about the dry skin she said "Dry skin is chronic, so there really is no reason to treat it." She held her ground after the infection saying there was no reason to prevent the dry skin and that infections happen. Why would I not do simple things like use non-alergenic soaps and lotions when it is cheap and prevents cracked skin leading to an infection! I know many people will say to switch if I am not happy, but the first Pedi had was WORSE (he messed up my son's vaccination schedule and tried to tell me it didn't matter because you can always 'catch up' vaccinations...my concern was if they can't even figure out how to vaccinate a child what else are they missing?). I don't want to seem like the parent who is dr shopping.

    September 19, 2011 at 14:04 | Report abuse | Reply
    • Not All Docs Play Golf

      Nothing wrong with shopping for the right doctor. "Doctor shopping" is a negative connotation only when you've seen multiple doctors or shopping for someone to tell you what you want to hear. Checking for a good doctor is not a bad thing unless it is habitual and you are never satisfied no matter what.

      September 19, 2011 at 15:03 | Report abuse |
    • Elspeth

      Doctor shopping doesn't matter a wit unless you are doing it to get controlled drugs you don't need, then in most states you aee committing a crime.

      Doctors are arrogant. They think you should be happy with what they tell you and not one wit more. If your not you are somehow bad. If you go look for a doctor that more fits your needs they label you.

      What is more important than your health? Not much, huh? Well if you wouldn't keep a barber, manacurist,or auto manchanic that you are not pleased with, why ever keep a doctor you aren't pleased with. Having a wanna be doctor who refuses to use a NAME to post under but rather uses an obxinous assertion that he doesn't fit some archaic stereotype about doctors to post under tell you that not being please or that doctor shopping except for reasons prohibited by law allows the medical industry to label you bad or in any negative way is BUNK!

      Frankly, we should be at least as picky over our doctors as we are our life mates. Our health is at least important as who we marry or don't.

      September 20, 2011 at 00:28 | Report abuse |
  17. DAN

    In response to the last entry " DOC'S are whining..." You are free to go to Cuba for your medical care. Please do. It will free up one more appointment spot for someone who actually appreciates good medical care. And while you are there, you will see that medical care in a third world country sucks ! So do us all a favor and move to Cuba.

    September 19, 2011 at 14:06 | Report abuse | Reply
  18. skeptical

    As much as I would love to have full faith in a pediatrician, after trying out 4 or 5 of them, we no longer have one. For the run of the mill cold, we use the urgent care clinic, and for the big stuff, specialists. I've had so many missed diagnoses and bad advice. For a peanut allergy, I was prescribed a nasal allergy medicine. For excema, I was given a cream that got a black box warning two months later. For an allergic reaction to ibuprophen, I was given antibiotics for a sinus infection. For a developmental problem, I was told I was paranoid (until I demanded an MRI). Expensive? Yes, but I have been failed too many times. I know there are good ones out there, I just haven't lucked into finding one.

    September 19, 2011 at 16:05 | Report abuse | Reply
    • fwc

      Why are you going to an URGENT CARE clinic for a cold? Unnecessary visits like these bog down all clinics I've ever worked in...

      September 19, 2011 at 16:46 | Report abuse |
    • nortel11

      Because fwc, when I call my doctor for an appointment for something, he can't see me until next tuesday. (First I tried a different doctor every year for 3 years, then I tried sticking with one for 3 years. Neither technique has worked to get faster appointments–I see my regular doctor only once a year for a physical and urgent care for anything that can't wait 3 days like an ear infection or strep or Montezuma Revenge).

      September 19, 2011 at 17:28 | Report abuse |
    • TP and the PA

      Nortel, Streptococcus infections go away all on their own and only very rarely develop into Scarlet Fever (systemic Step). Best thing for that is practicing extremely stringent hygiene in the household and keeping the infected person the hell away from everyone else. Montezuma's Revenge is always best treated with ample toilet paper, time and stringent good hygiene. It goes away all by itself. Booking time at the office not only wastes a space for someone who really needs it, it exposes everybody at the office to those highly communicable germs. Stay home, stay alone and cherish your time at the porcelain alter. You will lose some weight, not spend any money and not infect anyone else. Sometimes drugs are not the answer.

      September 19, 2011 at 18:50 | Report abuse |
    • Elspeth

      Maybe tp and the PA shouldn't practice medicine here. People go to the doctor because they don't fearing know what they have. I would bet dimes to donuts he was describing SYMPTOMS and not actual diseases. Lay people do this all the time to describe a "condition" that encompases a whole host of symptoms. Either that or poster is describing what the dx was after going to the doctor. Bacterial Meningitis looks like the common flu, sometimes even to the best doctors, but usually people don't get bacterial meningitis, they get the flu. Unless one goes tothe doctor one doesn't know one has something that will get better on it's own vs something that can kill then in a day left untreated. Would you really tell someone they should just stay home if they didn't know for 100% possibility if there was any reasonable possibility they would otherwise die? No, how bout if you knew that people with the flu often don't practice great contagion control and that bacterial meningitis is super contagious and if they heed your stupid advice you and your kids will likely get bacterial meningitis and die or become seriously disabled.

      September 20, 2011 at 00:45 | Report abuse |
  19. Poodles

    They should talk about how you should not put your dingaling in a blender, pencil sharpener, electrical outlet, or a family member's ear. These are important bits of info to pass on to kids.

    September 19, 2011 at 18:04 | Report abuse | Reply
  20. TFGMD

    It seems like every healthcare blog I read turns into a doctor bashing exercise! A few things to consider if you are unhappy with your medical provider: What kind of coverage do you have ? If its Medicaid, I wouldn't expect much and its most likely going to get worse. In our area Medicaid=ER. Other govt. coverage including Medicare may become inadequate in terms of allowing the providers to provide good service in the near future due to the relentless budget cutting. If you have decent insurance (not discount managed care) you may be seeing a doc who has too many pts with Medicare, Medicaid or crappy managed care and you should find another doc with a better payor mix. Does your doc have hospital duties and therefore have to answer ER calls? If so, he/she is probably always sleep deprived and distracted. 2 weeks ago I was rounding on 10-15 pts every day before and after clinic and 1/2 of them were uninsured (NO PAY). Every 5th weekend I round on 20-30pts a day + see consults and answer calls all night ,Fri-Sun, only to go back to the office on Mon. Think I'm tired? The ER is the entry point of all uninsured pts and if a Dr has hospital privileges , he/she can't ecape them. Maybe you should consider seeing a doc who doesn't admit to the hospital. Of course, then you can't complain when your doc doesn't visit you in the hospital!
    Contrary to common internet belief, high school science nerds are not transformed into uncaring ,greedy idiots in Med school. Most docs are just trying to do the best that they can, but it's getting harder every month. IMO, the cost of care is much higher because healthcare is dominated by huge organizations. Don't complain about your doc if they are just an employee of some big clinic or HMO.
    There are docs out there who care about their pts, but they learn quickly that they can't see everyone and they sure can't make everyone happy.

    September 19, 2011 at 18:33 | Report abuse | Reply
    • Elspeth

      Doctors do not get to practice bad medicine on poor people because of poor reimbursement rates. That's called discrimination (likely arguably race based) and it's calle gross negligence. Doctors doing so will be disciplined by their licensing boards for ethics violation.

      Essentially, a medicade doctor displeased with the amount of reimbursement can only refuse to see such patients. Seeing them but not giving them the same care others get is the fasest path to liscense suspension and/or revocation and huge malpractice payouts.

      September 20, 2011 at 00:51 | Report abuse |
  21. fuyuko

    My only real complaint is that docs these days seem to think people are prescription drug addicts. I wish they could keep track of what you have been prescribed from all medical visits during the cours of the year, to see, that nope I'm not a drug abuser.

    September 19, 2011 at 19:31 | Report abuse | Reply
  22. Tom, Tom, the Piper's Son

    What have I got to lose? A lot less than you, ya boob. You've been reported.

    September 19, 2011 at 21:28 | Report abuse | Reply
  23. Ralph

    The problem is the insurance company. No matter how much your monthly premium you pay remember that the Dr does NOT get that. Almost all Dr's are in a fee for service world. Just because you pay money to the insurance company the Dr still gets paid the same amount from most insurance companies for the visit. Because I want to be paid for my work should be common sense to a patient. After all every business expects to get paid, would any patient do their job for free?

    September 19, 2011 at 21:37 | Report abuse | Reply
  24. Megan S

    Another take on this entirely is that perhaps doctors are not necessarily the best qualified people to give parenting advice. Where are their years of training on this subject?

    Ask parenting questions of parents that you want to be like and leave the rest behind. Sorry, but my doctor is NOT qualified to give parenting advice until I meet their kids and see how they interact with them. Try again.

    September 20, 2011 at 01:39 | Report abuse | Reply
  25. Katie

    There is nothing like a doctor who doesn't listen when he says at the end of a visit "any questions?" and you have some. And how sad is it that people are told to write them out in advance because the doctor may be too rushed to give you a moment to think? I've had to stand in front of the door so the guy didn't run out of the room before I was finished speaking. I even had one pediatrician sit there fiddling with his watch and his phone, clicking his pen while I tried to get him to understand that this illness my son was going through was the same thing he went through last month, that whatever the problem was, it was still happening. Then we switched to someone who practices holistic medicine. He's an MD, with an FNP and PA on staff, but they all have the philosophy that they need to listen to you to figure you what's going on. They ask questions too, don't try to fit your symptoms in a one-size-fits-all category, give you time to think and to discuss. And guess what? Sometimes it does only take fifteen minutes for a visit – it just isn't in a hurry.

    September 20, 2011 at 06:53 | Report abuse | Reply
  26. gabor47

    About 20 years ago I wrote an about 60 page analysis why and how healthcare will decline in USA. Everything came through exactly the way I predicted. Obviously I can't share the article due to its length, but I can tell one conclusion: the real cause is NOT the physicians (directly). I sent that article to the Hillary group which at around that time tried to "fix" health care. I didn't even get a word of response. Life goes on and so is the decline of health care. Keep criticizing doctors, the result will be further decline. The population in general doesn't have the sufficient average intelligence to see the depth of this issue, probably never will.

    Signed,

    Dr. G.L.

    September 20, 2011 at 07:48 | Report abuse | Reply
  27. TFGMD

    Elspeth, I don't think you understand the problem with medicine. Those of us who practice it day and night fully understand the dangers of lawsuits and reporting to state agencies. You state that a Dr can refuse to see pts with poor reimbursement. That is not correct when dealing with hospitals and/or ERs. The Medicaid and NO PAY pts are flooding the system and if you work in a hospital you can't escape them. When called from the ER, federal law requires followup in the office in some cases even for NO PAYs. This harms the office financially and leads to staff burnout, reducing service for others.

    September 20, 2011 at 10:14 | Report abuse | Reply
  28. Dr. Scott

    My 3 children chose not to follow me into medicine. They took a good look during college, saw my paperwork increase every year and my reimbursement drop every year. One plainly said that the people in this country no longer value a doctor's care. 4 generations of doctors are coming to an end.
    They will make far more money than I do in business and finance, and will fulfill their desires to help people by volunteering, which won't come close to what they could have done to help people by entering medicine. It's quite sad.

    September 20, 2011 at 10:35 | Report abuse | Reply
  29. Dr Otheym

    The biggest problem is that there are not enough pediatricians and primary care providers to care for the growing numbers of patients [insured and uninsured]. When specialists make up to FIVE times what a primary care physician makes, what you get is a glut of specialists and a lack of pediaticians and primary care physicians.
    By 2020, there will be a shortage of 200,000 physicians in this county.
    Too much demand and too little supply leads to shorter office visits.
    Until we get more primary care doctors, this will only get worse.

    September 20, 2011 at 10:52 | Report abuse | Reply
    • Me

      In my town there are plenty of pediatricians to go around, but that doesn't mean they stay there any longer. A 5 minute visit costs as much as a 20 minute one.

      September 20, 2011 at 13:00 | Report abuse |
  30. TFGMD

    I am a 4th gereration doc as well. None of my 3 kids are interested; way too much work. Their smart friends want to be Dentists!

    September 20, 2011 at 11:03 | Report abuse | Reply
  31. justahappy1

    I am so thankful my son's pediatrician takes time with us. Yes it means a longer wait in the waiting room but I don't care because I know that other kids are getting the time and care they deserve. We have never spent less then 15 or 20 minutes with her talking with her. She is fantastic.

    September 20, 2011 at 11:16 | Report abuse | Reply
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      March 4, 2012 at 13:32 | Report abuse |
  32. Me

    17 minutes? The longest my daughter has ever been in the presence of her pediatrician has got to be close to 5 minutes.I just read that kids are supposed to get their vision checked by the ped every visit through age 5 or something. He's never checked her vision once. He hasn't even commented on her height and weight being off the charts. He just says "Everything looks normal" and off he goes.

    September 20, 2011 at 12:42 | Report abuse | Reply
  33. PandoraDoggl

    And while we're at it, I want my auto insurance to cover refueling and regular oil changes and tune ups, and I want my home owner's insurance to cover landscaping and changing my light bulbs.

    September 20, 2011 at 16:56 | Report abuse | Reply
  34. Leah

    I would never waste my or a pedi's time asking about sleep, discipline, potty training, or my kid's socialization. They just aren't medical issues, they are parenting issues. For breastfeeding questions I would only consult an IBCLC- medical school is generally woefully lacking in DECENT breastfeeding education.

    September 21, 2011 at 00:49 | Report abuse | Reply
    • Jean

      Dear Stanley and Arthur,A beatled happy New Year to you both. I hope you have a safe trip to Poland and I look forward to hearing from you both when you arrive there. Say hello to my friends in the Netherlands.

      February 1, 2012 at 01:40 | Report abuse |
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    November 23, 2011 at 17:51 | Report abuse | Reply
  37. Good column , I'm going to spend more time reading about this subject

    Linda,I would like to reiterate that it's not the costs/prices of veterinary procedures themselves which have remained fairly steady. Our premiums are based on the average cost of healthcare given to the average pet like yours.For example, should there be an increase in foxtails in your area next spring and lots of dogs like yours are needing surgery to get them removed, then you would likely see an increase in your premium.If, the following spring, there were rarely any foxtails in the area and dogs were making much fewer trips to the veterinarian, then you would likely see a decrease to your premium.

    November 29, 2011 at 20:53 | Report abuse | Reply
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