A common misconception that many people have with doctor, dentist and veterinarian relationships

[NNN0LHI]

Going through life I have noticed that many people I know look at their doctor, dentist and veterinarian relationships as friendships when it really is not. Its a business relationship. Not a friendship.

I have never considered any of these people my friends. I considered them the same as a plumber, furnace man or any other person I needed to hire for a job. It was a business deal. Not a friendship.

Yet over and over I run across people who don't seem able to understand this concept. Like they don't want to believe that a doctor, dentist or veterinarian has the exact same goal as any of us workers have. Make some money to pay our bills. We do it. They do it. Everyone does it.

Yet I run into people who get very offended when they think a doctor, dentist or veterinarian is trying to make some money off of them. Its as if they want to believe that the people in those jobs do it out of the good of their hearts. Like they are out doing Mother Teresa's work or something.

Anyone else ever run across people with this misconception that the people in those jobs are their friends? Is this common?


I am sure someone will come up with an anecdotal instance of when a doctor or some other professional was actually someones friend or a friend of their family, but that is a rare situation.

Don

[XanaDUer]

1. Yes

but I find that Americans have a tendency to not have appropriate boundaries about a lot of things. Like, just b/c you work in a place, that does not make your co-workers your friends, either.

I was a public librarian, paid to help people use the library, and it was amazing how many library users actually thought that entitled them to dating, counseling, and a buddy-buddy relationship with you.

I'm not sure why this is. Americans spend so much time at work they are turning their work and co-workers into their homes/family/friends?

[Orrex]

2. It might not be a friendship, but it's not simply a business relationship, either.

To call it a business relationship is, in essence, to buy into the Conservative meme that we are "consumers" of healthcare.

[wtmusic]

5. Agree. Completely different level of trust.

If your plumber doesn't get the roots out of your main line, your toilet backs up during your big party. Bummer. You call someone else.

If your Dr. misses that tumor on your x-ray because he's only allowed 7 minutes to review it, you're dead. Bigger bummer.

[NNN0LHI]

10. No its not

Plumber runs a gas line half assed could blow the entire house up. If the furnace man screws up the furnace my entire family could die in our sleep from carbon monoxide poisoning.

I will take the plumber or furnace men I can trust over the ones I am friends with any day.

Don

[MattBaggins]

11. 7 minutes? You must have one of those gold plans.

I had a really good plan from a fortune 500 company. In three years of going to one practice for my diabetes the actual Endocrinologist I am a patient of; has come into the room exactly one time for 15 seconds to look at the numbers on the screen and tell the NP how much drugs to give me. He didn't even bother to acknowledge my existence.

[wtmusic]

16. If a $3,000 deductible and $19,000/year for the family in premiums is gold

then yes, my Anthem/Blue Cross plan is one golden sunuvabitch.

And your experience is more typical for me. Last time I had to call a recorded message for lab results, which my Dr. recorded in such a hurry I couldn't understand WTF he was saying.

[iamtechus]

23. Similar experience

My semi-useless HMO doctor referred me to an endocrinologist clear across town so I went there ... twice. Both times I spent a few minutes talking to a NP. I never did see the actual dr and couldn't say for sure that he even exists. I just figured that my insurance co and I didn't need to pay premium rates to drive that far and talk to a NP so I never went back.

The HMO doctor never asked me about it and didn't mention diabetes again. I have since been pronounced non-diabetic by a couple of other doctors. I suspect the referral was just a scam to rip off me and the ins co.

[shrike]

31. I do have one of those "Gold" Plans

Courtesy of the United Steel Workers of America. I've had a lot of contact with doctors over the past few years because of my husband's heart problems and my cancer (breast). The time the doctor spends with you seems to depend on the doctor -- there are doctors who are assholes, doctors who are gems.

Docs are also asked by their profession not to cross certain boundaries, so I've been told. They are supposed to be their patient's doctor, not their friend. As I understand it, this is because there is such a position of trust between doctor and patient they are not to abuse it. I'm not talking about doing anything inappropriate. Like my sister, an RN, says, "I'm there to save their life, not be their friend." (She's a blunt talker, but a great nurse. Hope that doesn't offend anybody.)

I've had doctors treat me in such a condescending manner I never went back. (That's what I really hate, being treated like an idiot for asking questions; I have a right to know, it's my body.) But on the other hand, I recently went to see one of the top surgeons in the country about my knee. It's just arthritis; I was a little embarrassed because this guy specializes in sports medicines. Treats Pro athletes. But he spent more time with me than most GPs do, explaining just what physical therapy would do to help me. It did help, and during my follow-up he just came in to say hello, after the resident had met with me. (It's a teaching hospital.) He gave me a little more advice, work on the quadricep. Told me to come back if I had more problems.

My oncologist is a doll, and so was my plastic surgeon. But I notice during my visits Onc never talks about anything personal, other than me. Plastic surgeon got chatty for a while, then dialed it back. I understand that. I agree with the OP, it's not a friendship.

[JuniperLea]

20. Yeah... it depends on which plumbing you're concerned with!

I must say NONE of my other "business" relationships are anywhere near this intimate.

I think some of us need to think of our doctors as friends in order to get past the ick factor of having a non-sexual relationship with someone who sees, touches, and knows all about your... parts. That said, I have a great doctor... I go to a womens health clinic; all women doctors (not just the girl bits doctors) and all about women. And my doctor hugs me every time I see her.

OT - Love your sig pic!!! I swear to Goddess I saw those posts!

[wtmusic]

26. Well, I've had it with my GP.

I'm considering switching to a female GP, who is highly recommended. Not worried about privacy, although I think a man can relate better to the male anatomy.

Hehe, yes you probably did see those posts...I'm nowhere near imaginative enough to make something like that up. :D

[MattBaggins]

34. In my younger stupider days I went to a few strip clubs

The girls would run up and hug me and smile; tell me how much they loved me. At 1am when the place was closing they gave you the cold shoulder and the "why are you still here" looks.

I'm just being a smart ass here though. Your docs are probably very nice and actually love their work.

[JuniperLea]

39. Being a smart ass myself...

I totally get what you're saying, and actually had the same kind of thoughts in the beginning. But when I saw house-calls and personal phone calls from the doctor, not the staff, I became a believer.

I think all professions are that way. There will always be slackers... doctors, teachers, plumbers, mechanics, whatever... but there will always be those who are in it because that's what they like to do. My veterinarian is the same way. I've heard about her taking sick animals home with her... sleeping in her bed with her so she could keep close watch on them through the night. I don't even know pediatricians who do that, but I hope to Goddess there are some.

[Gormy Cuss]

36. It is a business relationship under our current system.

One's relationship with the medical professional is dictated by the insurance plan, and sometimes even the choice of which medical professional is limited by the nature of that plan especially in closed HMO systems like Kaiser. Most of the PCPs in the local Kaiser are first or second year docs and the chance that you'll have the same PCP for three consecutive physicals is low. It's not uncommon to have a new PCP assigned each year. Patients are widgets.

[Orrex]

37. It is constrained by the demands of our capitalist system, but

that doesn't mean that it's a business relationship. At least not in a pure or primary way.


The relationship between the insurance carrier and the doctor is a business relationship.

The relationship between the insurance carrier and the patient is a business relationship.

The relationship between the doctor and the patient is a medical relationship.



I don't doubt that you can cite many anecdotes in support of the claim that the doctor/patient relationship is a business relationship, but I can cite at least as many that contradict the claim. For one thing, every ER in the land that accepts patients unable to pay their bills is a direct refutation of the doctor/patient business model.

[Gormy Cuss]

47. The relationship between a lawyer and client is a legal relationship.

Et cetera.

I'm not dismissing the fact that there is a special significance to a doctor-patient relationship when the trust and mutual respect is developed, but increasingly there are barriers to the formation of such a relationship in part because of the idiosyncratic dictates of insurers and for-profit medical corporations. When an appointment with your PCP feels like speed dating it's hard to develop a trusting medical relationship.

I'm all for a medical relationship that's markedly different from a pure business relationship but even with a good medical relationship the patient should remember that it's a business relationship too -- when the physician's office is chaotic and appointments never start on time, when the billing is screwy and the office staff aren't accessible to clear up problems, those are problems with the business relationship and should be treated as such.

On ERs, I was in an ER as a patient last year for the first time in decades and was surprised at the way we went through the entire visit before someone asked about insurance. I was told later that by law in this state that's the way it must be handled. It was so refreshing to have the focus on care first.

[Orrex]

52. That's a good analogy about lawyers.

I guess my chief objection to reducing the doctor/patient interaction to a "business relationship" is that it arbitrarily gives primary significance to one comparatively minor aspect of a much more complicated process. Sure, there's a necessary business element to it, and there are certainly going to be dirt-ball physicians motivated by money, but it still isn't a business relationship at its core.

[jtrockville]

3. Making a living vs making a killing.

I don't think anyone expects medical providers to operate in the red. But why do we expect these folks to turn a profit? Why isn't it enough to earn a living and cover the costs?

[SlimJimmy]

6. Because "earning a living" is the profit part. Everything else is "covering costs" (nt)

[jtrockville]

19. Medical providers don't earn a salary?

[SlimJimmy]

55. No, not all of them. Actually, not even most of them. Their compensation

is tied to the profit margin or they have a relatively small salary that depends on a bonus to make up the difference; and that bonus is tied to profit margin. But, you already knew that.

[kestrel91316]

13. If I don't earn a profit, I DONT EAT. Profit is what I get to live on after

all my business espenses are paid. I have a sole proprietorship and am NOT a corporation with myself on payroll like the big guys do.

Did you have to take special lessons to get this clueless?

[kestrel91316]

14. Oh, and BTW, since I have invested hundreds of thousands of dollars

(instead of paying myself much) in my practice over the years, I am also entitled to a RETURN ON MY INVESTMENT in theory. Not that THAT is ever gonna happen. I'll be lucky if I can sell it for what I paid for it when I finally retire, given the way things are going.

[wtmusic]

22. Onward toward the unproductive argument of what a "living wage" is

Why deny physicians a profit motive? Physicians are being squeezed by insurance companies and by hospitals. Patients exploit the system (one woman I knew had no insurance but would go to the emergency room when she had the flu to get free treatment).

My sister, who is a graduate of Harvard Med and was the president of the Chicago Board of Health, left medicine because she was told by her hospital she was allowed 7 minutes per patient, and not a second more. Insurance was constantly beating her down to accept less. Take it, or leave it.

IMO the problem is exactly analogous to the derivatives/loan scandal on Wall St., and can best be summed up as lack of transparency. From anyone's point of view there is no connection between with how much is paid to services rendered.

[guardian]

53. All good points

It's tough to own a small business, and a professional practice is no different. I think many people overlook that professionals such as yourself spent many years studying your butt off while others were partying on the weekends. You went into debt $100K to $200K just to get your degree. Then you take the risk and go into debt by investing hundreds of thousands of dollars. Then you work more than a 40 hour week practicing medicine, plus all the administrative stuff and dealing with employees, competition, dealing with rising rents and supply costs, etc.

Then some "clueless" people think you should work for free. I congratulate you and appreciate what you and other professionals do everyday.

[Donnachaidh]

4. Doctors don't have a problem thinking of YOU as a car payment

As someone who has been in long-term chronic pain programs, I've found that my doctors could give two shits about my life, and on at least one occasion they tried to shill me into a program for a disease I don't have - because they get money for *volunteers* they brought in. They stopped pushing that nonsense at me because I confronted them on it, and asked what was in it for THEM.

Doctors long ago stopped being the family friend. People need to realize this.

[NNN0LHI]

7. This is something I don't think a lot of people want to realize to be honest with you

Had people become downright hostile when trying to explain this to them. Like they don't want to believe it.

Funny world, eh?

Don

[Donnachaidh]

21. you know, I grew up with my doctor's kids, went to school with them

And my brother was still being treated by him when he retired - he was closing in on 90 years old. THAT doctor was our family friend. He had taken care of three+ generations of my family. Saved me from lead poisoning. I sent him a photo of my kid, so he could see the 4th generation of the family. He IS a family friend.

But I've NEVER found another doctor who had his integrity - he was STILL making housecalls at 80!

I think the legend of *doctors as our friends* was ingrained into the public psyche with Marcus Welby and other doctor shows. But the legend is just that -- a legend. With NO substance and no parallel in the real world anymore.

[riderinthestorm]

8. While I rarely go to the doctor (fortunately) or dentist (unfortunately)

so I don't have any kind of relationship with them, I do spend hours and hours with my vet(s).

With 40 horses, 3 dogs, and 4 cats, there's a lot of vet work. There are two field service agencies with 5 vets total between them plus we also frequently haul to the local equine clinic for extensive xrays and other diagnostic work. This leads to hours and hours of time waiting for tranquilizer to work, scrubbing joints for injections, setting up xrays, chiropractic exams, acupuncture etc. All of the vets definitely ARE my friends, and we know a shocking amount of personal information about each other. We give hugs, have loaned cars to each other when in need, exchanged financial and personal tips, know the names of our kids and what they are doing. 2 of the field service vets live fairly close by and we've been to each others houses.

That said, I don't expect them to work for free, nor do I expect a discount. I expect they will charge me for their services and I'll pay promptly. The vet/client relationship is weird because the animals are like your children and you want the vet to be there for you in that way - caring, concerned and definitely "knowing" your pet and your philosophy about animal care. But just like our clients that are at our barn: we go for dinner, socialize, spend hours at shows and competitions so we know each other pretty intimately... and yet they are expected to pay a great deal of money to us each month promptly.

Not sure where I'm going with this but thought I'd share our personal situation to clarify how and why I think of my vet as a friend (and business professional).

[NNN0LHI]

18. As I said there will be some rare anecdotal instances as you describe

Little piece of advice, take it for what its worth.

Start building up a relationship with a doctor you can trust while you are still healthy. Look around until you find one you are comfortable with. Then go see that doctor about once a year for just a check up and some blood tests. That will be the best decision you will ever make because some time down the line chances are you will need a doctor you can trust. Not one that is your friend. One that you can trust with your life.

Because if the day does come when you really need that doctor for something you want to have a good working relationship with that person. Being able to communicate with each other is essential. Your life could depend on it.

Don

[riderinthestorm]

32. Thanks for the tip but without health insurance, I'm SOL for now.

My husbands premium is more than $15k/yr with a $25k deductible. We're barely making his payment let alone another one for me. I'm hoping 2014 can bring some relief and I can finally go through a day without that flash of anxiety about getting hurt, or getting really sick, or getting into a car accident.... I'll hopefully be able to get into a regular routine with someone when (please help it be "when", not "if") soon in the future.

[NNN0LHI]

43. I have good health insurance

About the only thing it never covered was routine office visits so that has always come out of my own pocket.

Even in that situation I have always seen a doctor at least yearly since I was in my teens. Just for the check-up.

Now that I have a lot of different stuff wrong with me I sure am glad I spent that money building that working relationship with a doctor I trust with my life. My current doctor is the same age as me so hopefully he will outlive me.

It was well worth the investment. Believe me.

Don

[shrike]

33. As a cancer survivor, all I have to say is

Amen, amen, amen.

[Raschel]

57. So true. When I switched health plans I stumbled upon a doctor who actually took time to talk to me.

He asked questions about ME. Got to know me. I felt rather foolish that I had accepted disengaged doctors for so long.

It's not easy to find the good ones, I got lucky, but they're out there.

[a la izquierda]

28. My vet bawled his eyes out...

when we put our dog to sleep in May. He and my husband sat there and cried, and I tried not to have a total meltdown. We were one of his first clients, and my dog one of his first pet-clients. He shared our sadness.
Now, it's not like I'm inviting him over for dinner, but I have his cell number to call on the weekends in an emergency. I have only used it once. I'd consider him a friend, and him me, but we also don't abuse that relationship.

Our vet is an amazing human being, and a friend.

[NNN0LHI]

45. If I were your friend and I needed some help and you helped me out would you charge me for it?

Does your vet charge for the help he provides you and your pets? Even the vet that cried? Took the money didn't he?

See the difference?

Don

[a la izquierda]

50. Our good friend owns a bike shop...

we bring our stuff in for repair or tune-ups, and he charges us for it. He's one of my husband very best friends. But in your world, it doesn't work like that? Or am I missing something?

Life ain't all black and white. You're making an argument that vets/docs/dentists, etc., can't be friends with people with whom they have a business relationship (on a provider/consumer level). That's just simply not true. Many of my friends have businesses...and we're charged for the goods/services we get. My good friend is a tattoo artist. I don't get tattooed for free! We even pay to board our dog at the kennel my husband manages...which is owned by his friend. Just because they are our friends does not entitle us to some kind of benefit that would take food out of the mouths of our friends' families. Likewise, my friends would have to pay for boarding services when my husband opens his kennel (whenever/wherever that will be).

[MattBaggins]

9. I start nursing school this week

My long term plan is to get at least a masters in nursing maybe even go for a CRNA.

I am doing it for the Benjamins.

[InvisibleTouch]

29. I do appreciate your honesty.

And let's face it, if there was no decent pay, we'd have far fewer medical professionals. Not every medical service requires a "friend" to hold our hand through it; it just needs to be done competently. Nothing wrong with that. I think some of the objections come in when the costs spiral out of control, way beyond a reasonable expectation of profit.

[kestrel91316]

12. "Anyone else ever run across people with this misconception?"

LOL, every day, my friend. EVERY DAY.

While it is true that some of my good longstanding clients have become personal friends, one does not gain admission to my circle merely by being a client.

My least favorite thing is when someone who has brought their cat in MAYBE twice in a 5 year period decides they are a special friend and insists on calling me by my first name instead of "Dr. Kestrel" like virtually everyone does. Presumptious and offensive, and a blatant ploy to wheedle special treatment (aka discounts) from me. Sigh.

[pipi_k]

15. People have trouble with boundaries I guess....

I've been seeing the same therapist for panic/anxiety issues since 1990.

We are friendly, but we are not "friends".

We do occasionally forward funny email stuff to each other...maybe three times a year. I can email her to confirm or cancel appointments.

But it's still a therapist/patient relationship even after all these years.


Actually I've always felt the same way about coworkers. Can't say as I ever made any real friendships on the job. Sometimes I wonder if maybe that wasn't carrying the boundary thing a little too far...oh well... :shrug:

[Javaman]

17. I don't know, in my job description is states nothing about, "first do no harm"..

:rofl:

[NNN0LHI]

46. Right at the top of my job description was "don't get yourself or any fellow employees injured"

They stressed that more than anything else in the factory I worked in. Because occasionally people were killed there.

And I was a just a lowly machine repairman.

Don

[InvisibleTouch]

24. There's some personal responsibility on the part of the patient/parent too, though.

Yes, the medical professional has to make a living, but especially with veterinary services I have noticed in the last decade or so that they have really become rapacious about trying to push services and treatments that are not needed, at exorbitant prices. I used to have great love and respect for the veterinary profession; lately, not so much anymore. Maybe I've just run into some bad apples, and they are spoiling the barrel for me.

Yes, like every other business I suppose they have the right to try and rake in as much as they possibly can, but that doesn't mean I have to let them gouge me. It's *my* responsibility as a "consumer" to educate myself and look into alternatives. For instance I know that it's absurd on numerous levels to give heartworm medicine year-round in a climate where mosquitoes are active for less than half the year - but I've had vet techs try to scare me into buying unneeded and questionably safe products. I know that I can give routine vaccines and do microchipping myself, at a minuscule fraction of what it would cost me at the vet's (my first litter of 6 puppies cost me $600+ for their first set of shots and microchips from the vet; after that I said "never again," and ordered my vaccines and microchips online). Having a working knowledge of herbal and homeopathic treatments for minor conditions is absolutely indispensable in my household. And feeding a species-appropriate raw diet pretty much eliminates tooth problems and lowers the chances of major health issues. There are things we cannot treat ourselves, and there the medical professions have their place - but they might generate more loyalty if they kept the routine services at reasonable rates.

[spanone]

25. i realized that recently when my doctor sold his business to vanderbilt

i couldn't even get through the phone bullshit....press 1 for, press 2 for, press 3 for,

i found a new doctor

p.s. he'd been our family doctor for 22 years...sent out no notices....had no apologies when i complained....

[InvisibleTouch]

27. Another thought: compare them to auto repair shops.

There's one repair shop that found some expensive "fix" on my vehicle *every single time* I went in for an oil change. Knowing pretty much zilch about cars, I had no way to know if it was legit or not, but it seemed like every time I intended to spend $20 for an oil change, I got hit with a much higher bill. End result, I stopped going to that repair shop.

Now, do the repair shops have the right to "find" additional problems (which may not be entirely legit, or may be something that can be put off without any safety issue) just to up their profits? I suppose technically they do, and maybe I should know enough about my own vehicle to be able to judge for myself if they're scamming me. Lacking the technical know-how, though, and the time to acquire it, I still had the option of going to another shop.

So, sure, they have the right to try it. But that doesn't make it admirable, it doesn't generate customer loyalty, and that doesn't mean people won't exercise their options if they start to feel gouged - be that for a physical service or a medical one.

[slackmaster]

30. Thanks Don. You've made an excellent point.

I'm off to the doc right now. If she doesn't cough up some pain meds, I might fire her.

[NNN0LHI]

41. If you need pain meds you should get pain meds. There should be no question about it

If the doctor won't prescribe them fire her and hire another one that will.

That is what I would do in that situation.

Don

[slackmaster]

49. Scored X-ray series for my damaged ribs, and 20 Vicodin!

:toast:

[NNN0LHI]

51. I had just a bruised rib once and it was one of the most painful things I can remember

Slipped climbing down into my crawlspace and hit it hard. Every time I took a breath it was like a knife was being twisted.

Happy for you.

Good night and sleep well.

Don

[shrike]

35. I've spent a lot of time in the health care system lately, and I'd have to say, you're right

Doctors are people, too, though, and some are nicer than others. There are surely some doctors that I've liked more than others. I've noticed that some of the good ones are real good at keeping the boundaries up; they can do so without hurting your feelings.

[Blue_Tires]

38. well, doctors and dentists were close friends in my case

but then again I am the son of a doctor...

[LanternWaste]

40. I imagine it depends on the character of individuals...

I imagine it depends on the character of individuals themselves rather than on a theoretical business model.

I certainly do not think that profit and friendship are mutually exclusive, but then I try not to maintain much secular dogma.

[Lucian]

42. I wouldn't trust a banker to shove a scope up my ass.

I trust doctors more than I trust my friends and family. To have that level of trust, there's more there than just a business relationship. Sure, doctors make excellent money, but they have to have an interest and a like for that before they even think about the money. The reason most go through med school and the debt is because they like what they're doing.

[NNN0LHI]

44. You wouldn't ask your doctor for financial advice either would you?

And they may very well like what they are doing as you suggest, but how many of them are doing it for free?

I am not sure what you are getting at?

Don

[nadinbrzezinski]

48. Some are actual friendships

most... not so much... but they go beyond a simple bidness because of the level of trust.

[Liquorice]

54. I haven't seen that very often. What irritates me is when doctors forget

that they are simply hired to do a job, and are not in a position of authority or power over their patients. I can't stand doctors with God complexes.

I am not friends with my health care providers, but I genuinely like my doctor and dentist (and vet) because I choose very carefully, and if I don't like a doctor's attitude, I drop him/her like a rock. Health care is too important to leave in the hands of a self-important jerk.

[SlimJimmy]

56. I changed PCPs recently because of that. He might have a degree in medicine, but

that doesn't mean he could do my job (which also required a degree). So this, "I am God" attitude was not cutting it as far as I was concerned.

[Raschel]

58. Agree. They're not doing us any 'favors'. WE pay THEM. Just like any other service.