Monday, May 03, 2004

Doing things myself

I'm barely getting started in my new solo practice and I'm already losing a patient. Someone whom I did a physical on about a month ago called me last week to ask if I accepted Blue Cross HMO. He was planning to switch from Blue Cross PPO at $130/month to the HMO plan at $40/month. Since he is a struggling student, he obviously prefers the less costly option. I told him I didn't plan to accept any HMO (meaning capitated) plans, but that I would look into their reimbusement policy. I've learned from talking to one of Blue Shield's reps that an "HMO" plan is not always synonymous with "capitation", and that their HMO actually functions like a fee-for-service plan.

I attended part of our city's "Relay for Life" charity event on Saturday. It was an organized 24 hour walk around the high school track in order to raise money for cancer research. At one time, I had considered being an event sponsor for a significant donation, and maybe setting up a tent to hand out free water since it was expected to be a hot day. However, in retrospect, I'm glad I didn't. It was nice to spend the day instead with my family, continue our 2 week long Monopoly game, and not worry about rushing around. Eventually we arrived at the high school track after it had cooled off and joined friends who were already walking.

I keep hoping that word of mouth from friends and patients about my practice will gradually build, reach a critical mass and start bringing in more patients. I feel a little awkward every time someone asks, "So, how's the new practice going?" My wife (hi honey!) keeps telling me to be positive and say something like: "Business is doing great, thanks for asking!" rather than what I usually say: "Slow. Really slow." She's got a point, I guess. Success breeds success, and the perception of success is as good as the real thing.

I sometimes suspect if I had set myself up as a "concierge practice" that I could have garnered a lot of publicity and more people would be signing up with me just because of the perception that they are getting into something "exclusive". Who knows? I think there are many people who when given the choice will rather choose the more expensive "brand name" over the cheaper alternatives because they perceive that they are getting more value for their money.

Speaking of value for their money, I think I might have saved Kaiser some money. I was working Friday afternoon, and as usual finished late. I noticed a note pinned to the computer screen about a patient calling for their CT results from about a month before. Apparently he had been dealing with a non-resolving otitis externa. The note was from 2 weeks ago, and the CT report hadn't come back yet. Out of curiosity, I checked the computer to see if the report was back yet. It had been dictated just the day before. The radiologist thought there was a parotid mass spreading into the ear canal, suspicious for neoplasm. Uh oh.

After checking the patient's chart, I couldn't find any indication that he had been notified, so I had to assume he hadn't. I managed to get a hold of the ENT specialist on call who agreed that the patient should be seen sooner rather than later. But since it was Friday evening, the appointment service was closed for the weekend. The specialist would try to arrange an ENT appointment on Monday. I left a message for the patient to call me at his earliest convenience about his CT results, and I left my cellphone number. When I was working full-time at Kaiser, I would NEVER give out my cellphone, as that would mean a loss of my privacy. Now, I figure I'm giving out my cellphone number on my business cards, so what difference does it make to give it out to one more person. Besides, I really did want him to reach me. I did eventually reach him an hour later when I tried his number again. ("Jim Jones? No, he's not here." "I'm a doctor calling from Kaiser." "Oh, hold on a second." (a few seconds of silence then the same voice comes on) "This is Jim Jones." Why do people do this?) Fortunately he seemed pretty calm when I told him the results.

I speeded up the process by a few, maybe several, days. Will it make a difference? Probably not. According to this website, 80 percent of all salivary gland tumors are benign, and even if it is malignant, the 5 year survival rate is 85 percent. But I didn't know that at the time. And even if I had known, the right thing to do still would have been to arrange a consultation ASAP. Because you never know when it might actually be cancer. Or giants.

Today I checked out direct mail (or what most people refer to as "junk mail") from the U.S. Postal Service website. While they don't do direct mail themselves, they link to companies that do (and pay for postage, hence the connection). For me to purchase a direct mail list of 11000 names in my local city, it'd cost about $1000 or about 9 cents per name. Or I could rent a mailing list for about $130 but I could only use it once. Supposedly they put decoy names in the list as a way of detecting unauthorized use of the mailing list. Personally, I think this would be fairly easy to circumvent unless they have agents that live in my small town who report directly to the mailing list company any time someone sends them unsolicited mail. Unlikely.

It then occurred to me, seeing as I have a lot of time on my hands, that I could easily walk around the city dropping off flyers and brochures advertising my practice. Heck, I always wondered what it'd be like to be a mailman. Plus what better way to introduce myself to those in the community? But I think there are some who would consider this a rather stupid idea (hi honey!). As stupid as, say, a doctor answering his/her own phone. Or giving his own shots. Or doing his own medical billing. Ha, ha. Yeah, who'd be that dumb?

Oh. Right.

Hmmm. Should I carry some dog repellent?