the game of medicine

Is this going to happen to me?

My doctor knows I'm a med student so she seems comfortable spilling her guts to me. (even though this was only my second visit to her ever!) For example, today she walked into my exam room with a look on her face that said she was annoyed with someone's stupidity. Then she proceeded to complain about how her partner couldn't get the hang of the new electronic charting and it was slowing her down too. 

So anyway, I was just in for a follow-up and vaccination, which I guess doesn't pay well. So she says she's going to do a review of systems. I thought, 'oh god this is going to take an hour', based on what we're taught in school. But no one's videotaping her and marking off a checklist for every question she asks like they do in school, so she sticks to the basics. She probably hit something from every system, but it was like, 'no difficulty sleeping, no chest pain, shortness of breath, diarrhea, constipation...'- aka exactly what we're not supposed to do. Granted, there's nothing wrong with me- I've never taken any medications other than quick antibiotics and the most serious problem I've had was "slight" pneumonia when I was 6. But I kind of wanted the full patient experience and get my money's worth. She told me she only had to do this because it would take the exam to a 'higher level of care' for the insurance company. Otherwise, my visit would only get her $20.

I appreciated her honesty- I guess she felt like I would understand- if not now, then someday soon. And I don't really care- as long as my insurance pays it.  But I hope I never have to do that. Thinking about it now... I was there a total of 45 minutes, 35-40 of which I probably spent waiting. So $20 for 5 minutes is $240/hour. Clearly she isn't seeing a patient every 5 minutes, so she makes much less than that, but it made me think. I ignore money as much as possible now, but I can't keep that up forever. I'm not sure I'll have to worry about this if I work in a hospital- which is the plan. But I don't want to have to think about how I can squeeze the most money out of the insurance companies, possibly compromising care and wasting patients' time. 

To get more out of my 5 minute interaction, I asked for advice about taking the boards... she said she couldn't remember taking them, but she does remember that she met her husband while studying. Now THAT I hope happens to me :)