August - A Three-Part Screenplay

Scene One

Setting: Rural family practice clinic.  Zoe and her boss-of-the-month, Dr. Attending, are going over how to chart.  Or perhaps how not to chart...

Zoe: So, uh... how did you... well, know... that she had normal breath sounds when you were listening to her lungs over her sternum, over a sweater, while talking?
Attending: Well, she didn't mention a cough or any trouble breathing, so I just chart everything associated with no trouble breathing. -clickety click- I really just kinda make up stuff until I get to the coding level I need.


Scene Two

Setting: ER hallway.  Dr. Attending has just refused to give a patient any medication for his chronic pain, although that is his CC.  Patient is old and near tears, and when researched in the state's narcotics database, has no suspicious practices (e.g. getting meds from lots of different doctors, going through huge amounts of narcotics in a short time, etc).

Zoe: So, uh... refusing to give that patient any pain meds just seemed... well... how do you decide when to give patients medication and when to refuse?  Is there a hospital protocol?  What is your system?
Attending: -brief laughter- Nah, there's no protocol.  It really just depends on my mood.



Scene Three

Setting: Rural family practice clinic.  Doctor's office.  Zoe and Dr. Attending are discussing Medicaid patients and how much everyone should obviously hate how terrible they are.  Or... wait, what?

Attending: They're just very difficult.  And if you do educate them, it's like it won't even help. Not to mention the billing hassle.
Zoe: Why do you accept Medicaid?  If the patients are so difficult and the billing is so difficult, why not just do what the other doctors in the area do and refuse to take it? [Zoe gets a hopeful expression, as though she is expecting an answer indicating some sort of felt responsibility for the poor, especially in a remote area where no one else takes that patient population]
Attending: I didn't want to take them.  But after my first year, I wasn't making enough money, so I figured accepting Medicaid would increase my income a lot.  And now I need them, and even once I stop accepting new Medicaid patients, which I want to do in the next few years, I can't just fire all the Medicaid patients I already have.


THE END
~~~~

In August, I was under an attending who:

1. makes up patient visit information so she can bill for a more involved visit than she actually performed 
2. sometimes refuses to give old men pain medication because she doesn't feel like it that day, and 
3. may detest the poor, but they have their uses, so she'll keep them around for a while.

As a nice touch, she had Scripture hanging in all of her exam rooms.  -facepalm-