A traditionally trained physician who has chosen to practice integrative medicine, Dr. Fred Pescatore is the head of the Centers for Integrative and Complementary Medicine in New York City. Along with his books, The Allergy and Asthma Cure and Thin for Good, he is also the author of The Hamptons Diet and Feed Your Kids Well. A sought-after speaker and nutrition expert, Dr. Pescatore has been featured in the New York Times and has appeared on the “Today Show” and “The View.” He is the host of the radio show “On Call with Dr. Pescatore” which teaches the value of moving beyond a medication-only paradigm and into empowering the body to heal itself.
Throughout his career Dr. Pescarore’s primary commitment has been and continues to be a hands on partner with each patient in establishing and maintaining optimum health.
It wasn’t too long ago that one’s family physician was justthat—a pseudo member of your family. Someone who you may invite to dinner, share your most personal thoughts, seek out their opinion in areas of your life that were not related to your health; and, someone who knew and probably took care of your entire family—from children to grandparents.
Unless one lives in a truly rural part of the United States, that scenario has virtually ceased to exist. Although, I must admit this is how I operate my practice. I see entire families of patients and therefore I am allowed to create much better treatment regimens for them as I know so much more about them, their habits, their family structure and support mechanisms—basically I know what their ability to maintain and sustain healthy habits will be. That art form of medicine is almost completely lacking and for a few moments allow me to explain why and then perhaps offer a few simple solutions that you can do to get that back and to truly be nurtured by your physician because that is when true healing can take place.
Have you ever gotten to your physician’s office after 11 AM? And cringed with the number of people waiting to see your doctor? Most patients know if you want the doctor to be on time, the best way is to schedule an early visit before the doctor gets behind schedule due to the sicker patient, the many phone calls from hospitals or other doctors that can’t wait or quite simply, overbooking or the patients being late themselves, assuming the doctor is going to be running behind schedule.
I am not one to make excuses for physician’s inappropriate behavior. In fact, I am one of the few physicians who actually run on time unless a patient is late. I feel it is important to respect a patient’s time and they will respect yours. There are few things more frustrating than having to wait in a physician’s office without ever knowing exactly what time you are going to be seen.
However, there are circumstances that perhaps the patient is unaware of, which may cause waiting time to occur. In the era of managed care, the way that was seen to reduce health care costs was to decrease the amount of money paid to physicians by insurance companies. This had two effects on our relationship. One, we had to increase the number of patients seen and secondly had to decrease the amount of time spent with each patient in order to maintain the same income with increasingly spiraling business costs.
Then came along the whole notion of billing codes, diagnosis codes, denial forms, pre-authorization forms, etc. The list is truly endless. By attempting to decrease health care spending, what we did was to shift where the dollars were spent. The money went from the physicians who dedicate their lives to healing you and are liable for anything that may go right or wrong; to the big organizations. The insurance companies now needed to employ an entire staff of people to tell a doctor their patient can’t have a test that the educated physician thinks is needed in order to properly take care of the patient. I will give you an example. My assistant once spent 45 minutes on the phone with an insurance company to get authorization for an ultrasound—an inexpensive procedure that was totally justified.
The entire system is broken because the office staff is spending countless hours that could be spent on human relations, customer service and generally keeping the patient/client happy, on inane, ridiculous paperwork that makes no sense. Insurance claims are denied because a decimal point is out of place. Ill patients can’t argue with their insurance providers because they don’t have the strength. And, try getting an insurance company to pay you within a reasonable time frame. It is one big game to them but they fail to see the bigger picture of how it pollutes the experience you receive at your doctors office. Although the actual time spent with a patient may be 15 minutes or less, the amount of time spent on paperwork is quite longer and electronic patient files and electronic prescriptions are not the answer to this—getting the insurance companies to change their evil ways is what needs to occur.
A perfect example of this occurred recently. The largest insurance carrier used a secondary company to determine what is a “reasonable and customary” charge for a specific office visit or procedure. It then came out the insurance carrier owned the company who was determining what they would pay. The insurance company had to pay a 45 billion dollar fine. There is some justice sometime. The point is—the souring of the relationship between the doctor and the patient goes well beyond the lack of bedside manner.
The physician’s time is spent on everything but patient care these days and many physicians go home each evening wondering if they did the right thing by the patient. There is a reason why applications to medical schools have decreased every year for the past decade. As a smart person, why go into a profession where your hands are tied in every direction. We are told how much to charge, how to treat a patient, what drugs to use, and there is always a governmental agency looking over our shoulder to make sure we make no mistake—and let’s not even discuss the entire medico-legal ramifications of everything we do and every patient encounter. Imagine going to your supermarket or hairdresser and telling them what you are willing to pay. I would never want my children to spend all that money on their education and all the time and not be in control of their own destiny. It is a crime that the most educated Americans are now choosing a career in the entertainment business rather than in what was once considered one of the most desirable occupations in the world.
I guess what I am trying to convey is, please understand it is not just our staff, or ourselves that are to blame in the way you are sometimes treated. There is a lot that gets in the way of just you and me in that examining room.
Now let’s switch to something more positive and how to improve the relationship we have together. I am a big believer in the patient needs to be in charge, or if not in charge then a participant in their own care. Patients need to question their physician and be comfortable with the answer and their treatment regimen—if you are not comfortable, how are you ever going to stick with it or believe in it enough to make you well. If you don’t understand something keep asking us until you do. There is no need to be challenging or offensive—just simply ask the question. We like that.
Bring along a family member if it is something more complicated than a common cold. Two heads and two sets of ears are better than one—even record the session if you are discussing life or death matters so there is no miscommunication. In my experience, most women come to see me alone and most men will often bring along their companion.
With so much information on the Internet, today’s patient comes into the office armed with more information on certain conditions than even the doctor may know. Don’t see that as a sign of weakness—just know it is your illness so you are critically attuned to the condition; whereas the doctor must be sensitive to perhaps 20 or 30 different conditions each day. If your doctor is good, he or she will want that information to better serve you.
So, I personally am encouraged and excited to see each patient on my schedule. There is not a day that goes by I don’t learn something from my patients—it’s an exciting time. Doctors make mistakes as we are only human after all. But I truly believe in my soul we do our best not to be careless and most physicians painstakingly go out of their way to avoid errors of any kind; but, they will invariably happen.
This, I feel is the main reason we have so many specialists. Every doctor is afraid to make a mistake so they tend to focus or specialize in one very particular part of the body and therefore can’t be blamed for anything that goes wrong in any other part. The human body unfortunately is a fine tuned living organism that works in concert with each different part. It is impossible to separate the parts most of the time and expect the machine to function at its best. That is where a good internist or family practitioner comes in play. They are the ones who put all the pieces together for you and tend to make the necessary adjustments to your treatment protocol that the specialist doesn’t see. Although you may be seeing specialists, it is crucial to keep the lines of communication open with the one person who should know everything about you—your GP.
There are many factors which create the dynamic experience of what are a doctor-patient relationship; many on our end and many on yours. Let’s keep the dialogue open. That is the best way to have a long-term honest relationship with your physician—we’re no different than your other significant relationships. We need mutual trust, understanding, caring and respect.