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Every appointment shall be scheduled as either a 15-minute appointment or a 30-minute appointment. If you have one or two problems to discuss or one or two medicines to refill (refills often require an assessment of the success/failure/side effects of the treatment) then please schedule 15 minutes. If you have three or four problems to discuss or three or four medicines to refill, then schedule 30 minutes. If you have five or more issues, we frankly admit that we do not think we can practice good medicine covering so many issues in only 30 minutes - we ask you to schedule a second appointment on another day soon thereafter to address the additional issues. We choose to not schedule appointments for more than thirty minutes because inaccessibility of the physician for so long is hard on other patients and staff.
Insurance companies now distinguish between doing a General Physical Exam and doing a problem-solving visit. Believe it or not, most insurance companies do not pay physicians to do both during the same visit, so it is not feasible for us to do both during the same visit. And it is usually impossible to do both well during the same visit. It is common that patients have to schedule two separate appointments to cover both. For example, in a typical General Physical Exam Dr. Hindes and the patient will review the overall medical history, generating a list of issues that need to be addressed in the coming year: individual diagnoses are listed, current drug doses reviewed, preventative tests discussed, done, or arranged. What are your risks for developing heart disease? - for cancer? We may do a Pap smear, set up colonoscopy, a DEXA scan, or give a pneumonia vaccine or a tetanus booster
. Is daily low dose aspirin to prevent heart disease and colon cancer recommended? Daily calcium and Vitamin D to prevent osteoporosis? Does your lifestyle impose serious health risks (smoking, alcohol excess, high-risk sex
). There is much to discuss without ever getting to any immediate complaints such as your knee pain. So once we have the big picture, we'll schedule a problem-solving visit to actually start discussing individual issues in detail and writing the prescriptions as necessary. We too wish we could do it all in one day, but we simply can't.
When patients call in for a refill of a medicine, without actually coming in to be seen, we will decide if we can do that or not depending on the level of risk that is involved by giving more medicine without having seen the patient to re-assess the issue. Refilling diabetes medicine, for example, without having seen recent blood sugar levels may be very unwise. On the other hand, thyroid function is unlikely to change significantly over several months (depending on circumstances) and may be refilled long after the last visit. We have an explicit policy that covers nearly all the drugs that people may call us about. We ask for your understanding - needing to see you before we refill a prescription is sometimes medically necessary.
We acknowledge that it would be very convenient to the patient if the doctor would simply come to the phone and answer questions for the patient. When we have tried that, we have found the volume of calls for the physician to be so large (often 20-40 requests for a physician discussion each day) as to be impracticable. To have a conversation with a health care provider, please expect that you will be asked to make an appointment. Exceptions are made, according to the circumstances of the day, but not as often as patients may wish. Again, we wish we could meet the expectation of physician accessibility by phone, and we regret that we have never found a way to do that and to still be available to the patients who wish to see the physician for an appointment.
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