Trust Dynamics: Unpacking the Profound Effects of 10 Minutes on Trustworthiness

As is common in health care today, I’m currently in a Black Rock Coffee Bar drinking an Irish Coffee hoping that this will be the post that breaks through and changes healthcare for the better. Unfortunately, due to the high pain levels in my neck, the anxiety of pain is causing me to lose interest in almost everything else I need to get done today. Anyway, I thought I would share a recent experience I had while at a recent routine rheumatology appointment. This has been a slow burn in my mind for days now.

To begin with I want to make something perfectly clear. I like and greatly respect my rheumatologist. He provides me with excellent care, considers my knowledge as expert, and is a practitioner of active listening. This is by no way an attack, complaint, or criticism of him or his practice. What I’m about to share is a systemic healthcare system problem, not a private practice issue. Like me, he is a victim of a system that puts a higher value on business and revenue instead of human centered care. Since this could potentially be a controversial subject, I won’t be using my rheumatologist’s name. I want any ideation my post causes to be about the issue at hand, not my doctor.

What on earth am I talking about you are probably asking yourself right now? It’s a fair question. While checking in for my appointment, the front desk gave me an addendum to the financial agreement I signed when I first became a patient with the clinic. The addendum stated that if I was more than 10 minutes late to an appointment the clinic would level of $50 fee, and I would have to reschedule my appointment. 10-minute window of opportunity is all I now get before I lose access to my doctor, 10 lousy minutes.

Let’s backtrack for a second so I can describe to you where my doctor’s office is located. Location is important for this discussion. My rheumatologist’s office is on the campus of St. Luke’s Medical Center – Meridian. For those of you not familiar with Idaho, Meridian is just west of Boise. In fact, with Boise’s growth Meridian is now essentially a suburb of Boise. The main and easiest access to the campus of St. Luke’s Meridian is by Interstate-84, it’s probably a 20-to-25-minute drive from downtown Boise with little to no traffic or weather. Since I-84 is the main throughfare for the entire Treasure Valley (which includes Boise, Meridian, Nampa, and Caldwell), there is essentially no time where the traffic isn’t bad on the interstate. Just to give you an idea, it is not uncommon to have a major accident on the interstate once every week to 10 days, like an accident that backs up traffic for 2 to 4 hours bad.

Now that you know where my doctor’s clinic is located, here is a quick narrative about who my doctor is as a person. My doctor has a well-established reputation for being late. When I mean late, I mean a 45 to an hour wait is not uncommon. He knows it and will even allow me to give him crap for it too. His front desk also knows it and will often give me a warning if he is extra behind. Based on my experience, I know he runs behind because of the time he takes to get to know his patients. In addition, he allows time for his patients to get to know him as a person too. Like I said in the beginning, his human centered care is the ideal normally found in wishful thinking discussions at conferences like Stanford University’s Medicine X (#Medx) Conference.

His desire to get to know his patients is contrary to the requirements of most health insurance companies. If you are not aware, most health insurance companies require in their contracts with providers, like my rheumatologist, that they either see so many patients per hour or have revenue requirements for the clinic. From what I understand, the requirements are often difficult to meet and put a huge amount of unnecessary pressure on patient care. Its either patient care or loss of revenue. It’s important to remember that health insurance companies are in the business to make money, patient care is not why they exists. This is why I stated that I believe my doctor’s new 10-minute rule to be a systemic healthcare problem and not bad mojo by the clinic.

If my doctor doesn’t meet these predetermined benchmarks by health insurance companies, I and the rest of his patients will lose access to a great rheumatologist. Also, we need to remember that if my doctor doesn’t meet these requirements his staff will lose access to their jobs. Loss of revenue also means loss of paychecks in this case. This is a systemic healthcare issue, sorry not sorry if you are getting tired of reading the phrase “systemic healthcare issue” but it’s a point worth emphasizing in my opinion.

Let’s talk about the $50 for a spell. If a patient takes home roughly $50 grand a year the late fee is roughly 2 hours of work. Now if a patient makes significantly less than the $50, the fee equates to a 90-day supply of Leflunomide which is one of two meds I take for my rheumatoid arthritis. It’s easy to dismiss $50 as not much money until you put into context. The $50 fee could mean 3 months of a lower quality of life if I must choose between paying the fee or buying my Leflunomide prescription.

In terms of work, the new 10-minute late window will probably mean that I would have to leave work an extra 30 minutes earlier than I normally would. This means utilizing an extra 30 minutes of paid sick leave just so I can avoid the $50 late fee. As any chronic patient will tell you, paid sick leave is a scarce resource since we often have multiple doctor appointments each month. Over the last several years it was been common for me to burn through my sick leave by summer which means utilizing my vacation pay for the rest of the year to be able to see my doctors since they are only open when I’m at work. I’m pretty sure going to doctor appointments is not a vacation in most people’s minds.

Economic implications aside, there is a higher point that should be considered. 10 minutes is a stop light, it’s a boss asking an extra question in a meeting, it’s an extra car in line at Black Rock Coffee Bar, you mean to tell me I’m not worth 10 minutes. You mean that after 10 plus years of being a loyal patient, who has consistently paid my bill on time, who has patiently waited hours upon hours in your waiting room, I’m not worth the same courtesy in return. Trust isn’t a top-down idea, trust only works if it’s a two-way enterprise. What this says healthcare is that I’m not even worth 10 minutes of trust. Tell me again why I should allow you to inject me with a needle, recommend powerful medications for which I must trust you since I don’t understand the chemistry, or even surgery when you are telling me I’m not worth the trust of 10 minutes. This is why the us vs them mentality on social media explodes and thus affects other patients who are just trying to raise their own quality of life! There is a ton of consequence in those 10 minutes for which you are willing to magnify for a lousy $50.