Results over the phone

My poor receptionists are going nuts. They don't know what to do. They however get very fit running between the front desk and my door.

- Knock, knock!
- Grrrrh ....
- Sorry, doc. What can I tell this irate person on the phone about her pathology results? Are they back and normal? Are they not back but predicted to be abnormal? Are they missing? Are they back but not yet confirmed? Is it urgent? Should she come today or next year? She's on her way to Africa for 1 year, ...
- Who's she?
- Errr ... I'll ask ... wait a sec ... (running to the front for 20 seconds) ... Sorry, she hung up. She sounded very angry. I am so sorry.
- Grrrrh ....

So it goes on and on, day after day, week after week ...

Our practice protocol says that we do not give results over the phone. I know it is a crazy waste of effort and gross inconvenience for patients to come and sit and wait and wait and wait just to be told ..."Hi. All is well. Thanks. Goodbye."

But the flip side of this is detrimental: an abnormal results not well explained or a normal result misunderstood.

Remember poor George in Seinfeld? The sorry guy could not sleep for days because his doctor had rang him and said his test was "negative". In his pessimistic world, "negative" was just a polite way to say "you're dead".

A "negative skin biopsy" is good news. A "positive blood culture" is not as good.

There was a story circulated in the early 1990s of a suicide after the patient heard over the phone that he was "AIDS positive". The report was that his blood group was "A Positive (rhesus+)". It was not known if the receptionist on the other end of the line had had any weird accent. Nonetheless, this could have been true and obviously not a very funny story.

Some doctors let their staff tell patients if the results are normal. While I think this is reasonable enough, I also think discussing results face-to-face presents an opportunity to earn more Medicare rebate look for other hidden issues. Often people come to see me and ask for tests for "feeling tired" but the real issue is their troubled marriage.

I confess sometimes I tell people their results over the phone. But usually I call them (and not the other way around) - mostly for more pressing results like pregnancy tests or abnormal clotting results.

So before you tear my dotty receptionists to pieces, please remember poor George Constanza.

Medicare Dental Referrals

I get really peeved every time I see the advertisements about Medicare funded dental care on the local papers. They are blatantly and unethically misleading.

The deal is this: You want your teeth whitened. You read the ad. You go see me (your GP). I write up a piece of a joke called a "care plan". You take that to your dentist. Voila! Your teeth get whiter. Your dentist get $4250 richer from Ms Roxon. I get $110 richer from Ms Roxon. Everybody's happy! Right?

NO! NO! and one more time ... NO!

The care plan is for major dental/denture works ONLY for those who are chronically ill. These are the people with poorly controlled diabetes, siginificant heart failure, kidney failure, severe asthma, bronchitis, active cancer therapies, etc.

This means: NOT YOU with the slightly coloured teeth!

And the bruised little toe on your left foot after you fell over 6 weeks ago at the pub does not qualify as a chronic illness.

What bugs me is that we, the general practitioners, somehow get this job of deciding who qualify for this stupid scheme. And we lose both ways: If we refuse we are accused of being mean (a few of my patients have abused me for being unhelpful). If we reluctantly go along then we are accused of rorting the system ... and for what ? 110 bucks?

And it gets worse ...

If the "care plan" was ever found out to be fraud, the doctor pays back $110, AND the $4250 the dentist had spent on the white powder. The doctor also cops a lot of guilt/shame, not counting the fines, etc. ... and for what ? 110 bucks?

And the dentist keeps the money - because he "only follows orders" from the crook doctor!

The government wins because they appear generous.
The dentist wins because he is on your side.
I , your GP, lose because I don't think your teeth are as yellow as you see them.

So if you are inflicted by some real chronic illness and you have rotten teeth, see your DOCTOR first then ask him/her to direct you to the ethical dentists he/she knows.

A good dentist is one who helps you chew your food well.

Having a Hollywood smile does not improve your diabetes.

If the government is serious about dental care for the public, they should pay dental care for everyone. And stop using us GPs as bouncers.

And one more thing. I don't do this plan not because I am afraid of being caught by Medicare. The thing that I am most scared of, the thing that will cause so much guilt for me to lose sleep, the thing that chews me up every time I do something silly, is .... me!