As I described in an earlier blog post, I had recently visited my 80+ year old mom, Donna, who lives 1000 miles away and came away with many insights about health care and the elderly. During my visit, I accompanied my mom to a medical appointment she had arranged several days before my arrival. My mom had set up this appointment to simply pick up a blood test order and to drop off a record of her blood sugar readings. I call these appointments “visiting the doctor” because when made, my mom had no physical complaint (apart from the usual pain of arthritis) warranting a face-to-face consultation with a highly trained medical doctor. In “visiting the doctor” appointments, the doctor does not need to diagnose or treat any medical problem. Unlike my visits with my mom, the doctor, armed with a handful of medical codes, does charge for the “visiting the doctor” appointments. With my mom’s consent, I was going to accompany her into the examination room so that I can serve as her patient advocate (i.e., someone who takes my mom’s interests over all others).
Until my most recent interaction with my mom, I didn’t understand why she insisted on making “visiting the doctor” appointments when it was inconvenient and required asking someone else for transportation (something my mom doesn’t like to do). In the past, my mom scheduled an appointment with her doctor to simply let the doctor know that a new supplement (CoQ10) she was taking was making her feel much better! In 2015, my mom saw her family doctor four times, two of those times might be labeled “visiting the doctor”.
The Psychology Behind “Visiting the Doctor”
I think I have pieced together my mom’s need for “visiting the doctor” appointments. We all know that doctor’s appointments are rarely pleasant encounters—you are sick, after all, and would usually do anything not to be. As one gets older and the body deteriorates toward its natural end, every doctor or hospital interaction might be the beginning of the end. Thoughts about potential life-ending diseases are never far from the surface. Like others her age, my mom does not fear death, but fears illnesses that will be prolonged and make her a burden on her family. For the less robust elderly, sickness is particularly disorienting and often requires the help of others to simply function with daily life. Many sick, elderly patients are in no position to actively engage in their health care and benefit greatly with a patient advocate by their side.
My 80+ year old mom’s loves her “visiting the doctor” appointments precisely because she is not debilitatingly sick during them and can engage fully in her care. She would never make this type of appointment when her arthritis pain is particularly acute. During these appointments, my mom might tell the doctor about something she has learned (e.g., how CoQ10 has helped her) so that the doctor can use the information for effective future treatment. My mom feels in control during her “visiting the doctor” appointments. She loves her family doctor because she listens to her and gives her the opportunity to make many healthcare choices herself. Her family doctor treats her like a whole person and gives her enough medical information to reassure her that all is well.
My mom never makes “visiting the doctor” appointments with her other doctor, a cardiologist. In fact, every year before her annual checkup, she threatens to stop seeing him permanently. The cardiologist does not treat my mom like she is whole person, but rather a part (the heart) to be billed. It was obvious to me during a visit two years earlier that he barely knows my mom’s cardiac history (let alone her full medical history) when the appointment starts. This cardiologist practices the “time is money, do I have the right codes to get paid, and I won’t think about you again until your next paying appointment” form of medicine. My mom’s family doctor understands that my mom’s health is not purely governed by the maintenance of individual parts and that her feelings and thoughts are vital to good health.
Are “Visiting the Doctor” Appointments a Good Thing?
The taxpayer in me has tried to explain to my mom that a face-to-face appointment with her medical doctor is only necessary when one has symptoms to report, needs to be diagnosed, and requires appropriate treatments or medications. I have repeatedly told her in the past that a medical doctor charges way too much for “visiting the doctor” appointments.
I have changed my mind about the benefits of these appointments for my mom. I feel that the psychological benefits derived from “visiting the doctor” appointments actually saves on health spending and improves my mom’s outcomes over time. The mind plays a very important role in good health. While I feel that my mom does not abuse the “visiting the doctor” appointments (no more than two a year), I do plan on gently encouraging her to save her blood sugar results, her insights into her care, and other bits of wisdom for her annual checkups.
Could the doctor be more aware and responsive to my mom’s need for patient engagement (and respect) in every appointment? Yes. Would this reduce my mom’s need for “visiting the doctor” appointments? Probably. As I am writing this post, I can’t help wondering if the doctor’s interactions are different when my mom is alone and doesn’t have a patient advocate with her.
The Actual Visit
Because my mom was experiencing rectal bleeding on the day before her scheduled “visiting the doctor” appointment, she now had a bona fide reason (symptoms) to consult with a medical doctor. Given my mom’s past problems with diverticular complications, her recent ingestion of a pound of strawberries, and her final description of the amount of rectal bleeding, I was pretty sure that there was no need for immediate medical attention (see my earlier blog post for more details). A further investigation by a medical professional would ease my mom’s mind that a more serious problem was to blame.
The highlights of the conversation between the family doctor and my mom follows:
Doctor: How much bleeding are you experiencing and what color is it?
Mom: Not much and it is red
Doctor: You have to watch it over the next few days and if it gets to be heavier, we need to make an appointment with a gastroenterologist to investigate further. You remember your earlier experience when we had to put you in the hospital. Your problem could also be caused by hemorrhoids and I can examine you today to eliminate that possibility. Would you like me to examine you?
Mom: No, thanks. I do not think that is necessary
Doctor: I will include a check for anemia in your blood test to make sure you have not lost too much blood from the rectal bleeding.
The Bottom Line
My mom sees her doctor a couple of times a year for appointments I call “visiting the doctor”. She is actually engaging in her healthcare during these appointments. When evaluated by the payers (the government) in our healthcare system, a “visiting the doctor” appointment is labeled as unnecessary healthcare. The Medicare bureaucrats reason that my mom’s lack of a direct cost-share makes her reckless and prone to healthcare overuse. My mom, who bought a Medigap F policy, pays plenty for the privilege of not having to take money out of her purse every time she sees a healthcare provider.
My mom has never been reckless with money and seeks value at every turn. My mom does need to be reminded (perhaps with TV commercials) how much doctor’s appointments cost, what doctor’s appointments are meant to do, and how she is paying for all doctor’s appointments indirectly through higher Medicare deductibles and Medigap premiums. If our healthcare system provided less expensive ways to engage in healthcare before sickness, perhaps the need for “visiting the doctor” appointments would cease.
Blaming patients for overuse of medical doctor services is misdirected. If my mom had to open her purse every time she saw a medical professional, she would probably consult with them less–that includes for reasons when she truly would benefit from their care. Will this solution improve patient outcomes or decrease the total cost of health spending? I think not.
Perhaps the Medicare bureaucrats should spend more time correcting the problem that doctors, armed with multiple diagnosis codes for elderly patients, pose for overuse of medical doctor services.
My mom’s rectal bleeding subsided soon after her appointment and she has sworn off strawberries for good. Her blood test showed no signs of anemia. I am sending my mom a list of foods that can irritate her diverticula.