The Truth is in the Story

The Truth is in the Story...

They teach us in medical school that 80% of the diagnosis comes from listening to the patient.

Wow.

That's fairly low-tech in these times of amazing diagnostic techniques!

Listening to the patient.  When a doctor applies the details of a person's "story" to their education, training and experience... 80% of the time, an accurate diagnosis pops out.  So the doctor is the diagnostic device. 

Lets compare that to the fact that the third-party-payer system (insurance) which drives healthcare trends, policies and practices... they don't pay for listening.  Hmmm.  That's a real disconnect.  In fact, if an insurance-covered doctor were to listen (i.e., spend more than 7 minutes with a patient) all day long... and not get paid for that time... soon the math wouldn't work on paying the rent, nurses and administrative staff salaries and the doors would quickly close. 

I know what you are thinking - "just call it a procedure and bill for that."  First... that is an integrity breech because it is lying.  Moreover... did you know that when charting and charging don't match - that is a criminal offense associated with jail time for the doctor?  Yeah - that is serious and seriously why, while I believe in my heart of hearts that all doctors went into their profession to take care of and help people, that is why they don't "listen" and why they simply can not spend more than that 7 minutes with you.

So they order labs, conduct procedures and they do the best they can with what they have.  No doubt you have experienced them stretching that 7 minutes to 10 or, gasp, 15 minutes.  You probably felt like you won the doctor-lottery that day!  You did, trust me, it cost them in more ways than you know.  Why do they do it?  Because they really do care.  Of course they do.

Now - to be fair... I appreciate the labs and high-tech diagnostic techniques.  I love information.  The more the better when I am trying solve a medical mystery in my patient's case.  However, some situation require more labs than others. 

Hormone prescribing and labs:  Here's the thing... people like labs.  Cash-based bio-identical medical doctor practices designed to move the doctor out of the insurance-covered rat-race love labs too.  It is just that as these patients eventually end up in my office I see a trend.  EVERY woman gets the labs... they all show that their hormones are some variation of low and they are often routinely prescribed the same "hormone coctail" that was likely taught at the seminar their doctor attended, on the hopes of breaking out of the insurance game and getting into something more satisfying. 

This makes me wonder... why the labs?  At the end of the day... any bio-identical prescriber that is worth their "salt" in prescribing knows that while the labs are all virtually the same, the women are all unique and it is in the listening that you can truly choose the most accurate starting place and through the listening that you make the necessary prescription adjustments in order to return that woman to the place she deserves to be... herself again.