JUST SAYIN’


It’s time again for my annual urology appointment.  Well, more like every 15 months.  After each visit, I am told that they will call me for my annual appointment, but when they call and I set up the time, I hear how busy the doctor is and end up being scheduled about 6 weeks past the year.  It is adding up.  Hope I don’t have a high PSA this time around and hear “You should have been seen sooner.”  Just sayin’.

This time, I got an email telling me I would have a chance to check in online.  If I did that, I could arrive 15 minutes earlier; otherwise I would have to come 30 minutes earlier. I could arrive on time and be just fine, since I will probably have to wait. Last year it was about 45 minutes; again, my physician is very busy.

In any case, I checked in online, which started off quickly by my proving who I was and how I wanted my medical information received. I appreciated that the date of birth could be typed right in and it would appear after the slashes, rather than having to use drop down menus for months (I’m at the bottom), dates (closer to the top), and year (long, long ways down). I also appreciated that I could type my phone number in without parentheses or hyphens. Or country that began with US/Canada and not Afghanistan. I could have done without the comments “we are mandated to do xxx by the federal government.”  Yes, you are, and because my medical profession didn’t pay sufficient attention to privacy, had sloppy record keeping, and medical personnel blabbed about patients in public places. I remember those days.  Just sayin’.

Then I got to the review of systems (ROS), with a surprising limitation of choices.  I have a lot of conditions that I could mention, like my palpitations, but the past year has been good, and I couldn’t state that.  There was no place I saw for sleep issues, and that plus its treatment have direct bearing on one of my urological issues. As a result, my ROS seems nondescript when it isn’t.  “How has your health changed since the last time you were seen here?” Is a much better question, but there are no boxes to check for that.  Just sayin’.

I had to check “None” to each one by hitting a dropdown box, when in fact it would have been faster and saved me time to have to hit one button than to click the drop down menu and hit the None button.  Apparently, however, the default for recreational drug use was “Yes,” and I kept trying to write “None.”  Young people have no problem with these forms because (1) they are used to them or (2) perhaps many are using such drugs.  Not really sure.  Just sayin’.  Anyway, I finally found the “No” button, which could have been more prominent.

The problem with these sorts of ROS is that nobody learns much from them.  There’s no time. But I have long learned that coding is important in medical practices these days, and a big part of getting more money is having a ROS documented.  I know, because ROS was never much part of a dictated H&P (History and Physical) after physicians were in practice until it was reimbursed at a higher code back in the late ‘80s.  Then the (hospital/doctor’s offices) wanted it.  By having the ROS filled out beforehand, one can save 5-10 minutes of often boring questioning, maybe more, upcode and bill more, without having to do anything. Everybody is busy. 

Interestingly, I noted that there were no questions about sexual problems, and this is a urology office.  Sexual function and urology go together. They do in embryology and they do in adulthood. Now, maybe I didn’t look carefully enough, but hey, I’m the patient, so if I have trouble, someone else may, too. After all, many patients who see urologists are old.  Then again, sexual dysfunction may not be high on the radar. Be glad you are alive, old timer. Don’t push your luck. Just sayin’.

At the end, after requiring my agreement to release of privacy information (if I wanted to be seen), I was taken to a form for release of genetic code for research.  This stopped me for a minute.  I don’t have a problem with research, but I have a sense—not totally rational perhaps, but it’s still my sense—that there are privacy issues and someone’s getting free material from me without donor recompense.  I ended up signing it anyway and moved on to the last part, the use of material by PR (not their real name), the company that owned the checkin software.  I started to copy and paste the material into “Pages” to do a quick word count (just curious) when I saw the word “advertising.”  

Whoa.  What’s this?

The company would then be able to send me marketing materials (that’s advertising.)  Well, I checked the definite NO on the form, but I wonder how many my age just checked it YES, because they felt they had to. I looked up PR online and learned that it was a software company.  Going further,  I looked at Web pages that didn’t have the name of the company and might give me a more unbiased look at who they were.

Many of the responses in a survey were from happy medical office workers.  Lot of 5s out there and glowing testimonials.  But I looked at the “cons” and read that young people liked this approach, whereas older people (like me) had more trouble (like trying to check “No” on substance abuse).  When I hit the worst evaluations, there were comments about this program not working in their office and difficulty severing a relationship with the company. 

What surprised me, besides my realization yes, I really am old, is why this urology practice would use software that the elderly didn’t like.  As I said, every year I see a lot of real old people in there from my vantage, and if I am having trouble, I can only imagine what difficulties they are having.  Except not sexual ones, judging by the lack of pertinent questions.  Glad we’re still here.  Just sayin’.

Last year, in addition to seeing the doctor, whom I do like and who is good, he had a scribe, so he could actually look at me and not the screen. It’s disquieting to have a doctor focused on the screen and not me.  The physician is missing something, no matter what he/she thinks.   Some look at a patient because they were told that eye contact mattered and they needed to do it so that the patient would check the right button in the inevitable survey afterwards. I always looked at a patient, because in neurology looking is how we made the diagnosis.  I still quietly diagnose people in public.  

Those of us old-fashioned docs used to ask nurses, “Does the patient look sick because a good nurse could answer it quickly, accurately and it mattered.  The scribe took away some of the privacy, and these days privacy is disappearing about as quickly as wilderness.  It’s a little strange to be having a prostate exam with a young woman on the other side of a thin curtain.  At least I find it strange.  Could she be in another room? I think it would help.  Just sayin.’

Anyway, the presenter of a scribe takes away privacy.  Yeah, yeah, I know.  It will be kept private.  

Like Facebook.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s


%d bloggers like this: