Thursday, August 11, 2005
Courtesy is a two-way street

By Dr. Anthony Policastro Nanticoke Memorial Hospital

There are some things that we do out of courtesy. Saying "please" and "thank you" are examples of this. The same thing is true in medicine. We expect to be treated by our physicians with courtesy. Physicians should meet that expectation. However, courtesy is a two-way street. As physicians we expect our patients to behave courteously as well. That does not always happen. The most obvious example of this is showing up on time for an appointment. It is courteous to the physician who is trying to stay on schedule. It is also courteous to the patients who come after you to keep their wait as short as possible. A second related example is appointment cancellations. Most physicians do not have enough appointment slots for the patients who want to be seen. However, patients often do not show up for appointments. They give no notice when that happens. The result is that the physician has a hole in the schedule. That hole could have been filled with another patient who needed an appointment. Thus, when we do not show up for an appointment, we are being discourteous to both the physician and the other patients who need appointments. Some patients get upset when an appointment is not available. They get upset when one is not available in the time frame that they need it. The person who tells them this is usually the scheduling receptionist. The result is that the patient gets upset with that individual. The receptionist does not control the number of appointments. Being rude to that individual will not get an appointment. It will only upset the individual. When I am on call, I often call patients from home. Many people have caller ID. Some of them then decide that they can use that to call me whenever they want. That is not appropriate.

I often have patients call me up to ask that I call in a prescription for them. Sometimes this makes sense. Sometimes, it is important to see the patient to find out what is really wrong. That way I can prescribe the correct medicine after doing a full evaluation. Since I am the one who is accountable for any medication that they take, it is important that I know for sure what is wrong. Some patients object to having me see their child. They only want a prescription. They do not want the hassle of doing the correct thing and getting seen. They do not realize that it is rude to tell me what I have to prescribe and then refuse to let me see the patient to make sure that is correct. I am not rude in return. I could tell them that if they know what they need, they can write the prescription themselves. There are times when I am on call at home and receive a call from a patient. Their problems sound like they need to be seen. I instruct them that they need to go to the emergency room. Sometimes the response I get is unexpected. They do not want to wait in the ER. Therefore, they want me to come in from home and see them so they do not have to wait in the ER. What they do not understand is that if it were not an emergency, I would see them the next morning. If it is an emergency, then they need the services that the ER has to offer. They are looking for what is convenient for them rather than what is right. Courtesy needs to be a two-way street. Fortunately, it is in most cases. However, there are instances in which patients do not even realize that they are being discourteous to their physicians and to other patients.

Commissioner hopes system will reduce health-care costs A new system to track the results of medical malpractice claims is in place, with the goal of lowering medical costs by proving to insurance companies that rates for Delaware doctors should be lower. Insurance Commissioner Matt Denn said that his office had reached an agreement with the Delaware Board of Medical Practice on a system that will be used for reporting resolution of medical malpractice cases to the Insurance Commissioner's office. The initiative is one of several steps Denn has taken to try to address the cost of health care. Under the statute requiring these reports, the information identifying doctors and patients will be kept confidential. The reports will be used to generate statistical information about the Delaware malpractice environment. The insurance commissioner notified all insurance carriers of the new system in a July 20 bulletin. "There is no single solution to the growing cost of health care, but this initiative is another important step we can take," Denn said.