Chocolate Factory Appointment

“Honey, I have an appointment at the Chocolate factory this afternoon. I may be late for dinner so you might want to bring some take out home for dinner” says Christina to her husband.

Fee-for-service primary care physicians, slaves to managed care contracts, make so little money per patient encounter they have to make up for it in volume. Adding insult to injury they spend 40% of their gross income or more filing, posting and tracking claims to the benefit of their puppet masters, the managed care cartel.

It starts with appointment setting.

“Hello, Dr. Smith’s office. How may I help you today?” barks the snarling clinic operator. “Yes, I have a really bad cold and would like to see the doctor today” answers the wheezing and barely audible patient.

“PLEASE HOLD………...elevator music plays in background……..waiting…..minute one goes by, minute two progressing to minute #3………

Hello. How may I help you today? I understand you want to see Dr. Smith” says the VOICE on the other end.

“Yes, I’m dying and need to see Dr. Smith right away!” screams the wanna be patient.

“Oh darling, that’s just not possible. You see Dr. Smith is completely covered up today and won’t be able to see you until tomorrow afternoon at 2:30” purrs the VOICE. “May I put you down for that hon?”

“Yes, if I live that long!” sputters the patient.

The next day, promptly at 2:15 the patient shows up for her appointment, waits in the registration line, then handed a clip board with paperwork to complete and directed to sit in the waiting room full of wheezing, coughing and vomiting patients until called.

Christina (not her real name due to PHI concerns) begins her paperwork assignment, exposing every health care event she has had since birth. “Have you ever had surgery? Did your parents ever have and die from any of the following diseases? Do you take illegal drugs? Are you pregnant? Are you an American indian? Are you White, Hispanic, or both? Do you have any of the following 46 conditions (check the YES or NO box).

Finally finishing her homework, she returns the clipboard to the front desk and returns to the waiting room. Her chair is now occupied and there is not another empty chair in the room. So she stands by the bulletin board and reads about her patient rights, memorizing the entire document while she waits to be called.

Finally, around 4:00 she hears her name being called by nurse Ratchet “Christina (last name redacted due to PHI concerns), come with me!”

In quick order Christina’s weight and height is recorded, blood pressure and temperature taken (184 lb, 155/82 bp, 99.3 temp.)

“So, what brings you in today?” asks nurse Ratchet as her fingertips hover over the computer board in anticipation, ready for action.

“I’m feeling really bad. Sore throat, coughing, cold chills, diarrhea. It started two days ago” pants Christina as Ratchet pounds her keyboard in rapid succession.

“Ok, the doctor will be right in to see you” says nurse Ratchet as she leaves the room and closes the door.

With nothing else to do Christina studies the anatomy chart on the wall. Quickly bored she turns her attention to the patter of feet outside her room expecting any moment THE DOCTOR will be coming in to cure her.

Minutes tick by. Then more minutes tick by. The half hour mark passes. Now time is moving towards the 40 minute mark.

After a light knock, the door opens and GOD immerges. “Hi, I’m Doctor Smith! I understand you’re feeling puny today. Tell me about it. Be pithy.” So Christina repeats what she told Ratchet as the doctor eyes the wall clock in the corner.

Ok, I’ve got good news for you! Everyone seems to have come down with the same thing so you’re not alone. That should make you feel better already! Misery loves company. I’m going to give you a prescription. After three days if you’re not feeling better give me a call” his voice trailing off while making a hasty retreat into an adjoining examining room.

Christina stands in line to check out while the fat lady at the front of the line fumbles in her purse for her check book.

Finally at the head of the line, the nice receptionist says “Hi Christina, you have a $45 credit from your last visit. Do you want to apply it today?”

Such is the world of fee-for-service primary care.

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