How “indirect” patient care creates conflict between doctors and patients

Staff Members at Cognitive Psychiatry of Chapel Hill

This morning I met with two young, enthusiastic psychotherapists hoping to start their own private practice. I was not surprised to hear their frustrations regarding the poor communication they receive from psychiatrists, primary care doctors, and other health care providers. We agreed that most providers want to help their clients but that they often avoid lengthy phone calls with other providers because it is considered “indirect” patient care and cannot be billed. I shared that I often spend 1-3 hours a day on “indirect” care in emails, phone calls, faxes, etc. and that this is the norm for most doctors. We both discussed how “indirect” contacts are essential to good patient care, and how we often feel resentful, angry, and prefer to avoid “indirect” contacts because we are unable to be compensated for our time.

As a patient, I personally have been very frustrated when I need to ask my doctor a question and am unable to reach him/her. When I have had an urgent need, I have been told to : 1) talk to the nurse who will relay information to the doctor, 2) come in for an appointment, or 3) go to the emergency room. I have also been annoyed when one doctor will order lab work and then will not communicate this to another doctor, and will not send me my lab results directly; I often have to do the same test twice!

So what is the solution? In my practice I offer multiple ways for you to reach me – by appointment, by email, by phone, and by videophone. I will speak with any doctor, therapist, or family member that you request. I will answer your requests as fast as possible and I will not rush you. My solution is simple – I bill both “direct” and “indirect” services at the same hourly rate. I believe this is a fair and simple solution to the conflicts I have experienced as both a doctor and a patient. I am also investigating ways in which you can have increased online access to your medical records so you are an informed partner in your care and can reduce the need for “indirect” services.

Live Mentally Healthy,
Cognitive Psychiatry of Chapel Hill

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