The Truths about Your Doctor You'll Never See on TV

By Dr. Halee Fischer-Wright

What makes a drug-addicted people-hating doctor with zero regard for laws so popular that millions of people chose to spend time with him every week?

Who am I talking about? Gregory House, MD. For eight years, we loved every episode. One year, House was the most watched television show on the entire planet. The newest medical drama, The Good Doctor, also has a main character who struggles to connect with patients. Yes, we love the human stories, but we also spend time with fictional doctors to escape to a perfect healthcare world where our deepest fantasies are realized.

Like most other TV doctors, House was a miracle worker. Patients in these shows get the focused attention of a team of physicians and nurses working round the clock to cure them—no matter how inoperable the brain tumor. Even when flawed, they are almost always caring, compassionate, attentive, and willing to do whatever it takes.

The real fantasy, though, is that the patients don’t have to do the hard work we in the real world have to do. No telephone tag or time spent on hold. No research on in-network doctors. No worries about bills. Ah, healthcare heaven.

The truth is, as I’ve explored in my book, Back to Balance, patients and physicians are both fed up with the things that interfere with their relationship and their ideal experience: doctors staring at computer screens; confusion about copays and deductibles; and never enough time to really listen or communicate. The danger of medical dramas is that they don’t explore these tough realities. They shape our expectations without addressing what’s happening behind the curtain for the physician—things that your doctor will never talk to you about.

If we want to be empowered to create our own great healthcare experiences, we need to understand the reality from all sides. To help, I’m going to share some truths that you’ll never see on TV.

Why do I get thirteen minutes with my doctor?

The truth is that most physicians want to spend more time—to be less rushed, listen more, and feel more satisfied in their work. Relationships are one of the most rewarding parts of the job. And studies show that patient frustration goes down and outcomes improve with the amount of time spent.

But while patients are stuck with feelings of neglect, doctors and practices are stuck in a time-money crunch. The costs of running a practice are incredibly high—expensive technology and equipment, four or five people to support each doctor—and insurance plans pay a limited amount for each visit. If they don’t see a minimum number of patients each day, they can go out of business. My husband, as a partner in a practice, has had to skip paychecks when any of the doctors weren’t “productive” enough.

Before you say, “Doctors make a ton of money!” you should know that primary care doctors really don’t, especially when you consider their massive medical school debt (about equal to a big, 20-year mortgage) and their malpractice insurance.

Why does she spend more time looking at a screen than at me?

It’s true. Your doctor actually spends twice as much time on administrative work as she does actually seeing patients. She has to get a head start while in the exam room. Plus, she needs to capture an incredible amount of information in real time.

Insurers are demanding more and more proof of the level of care delivered, which means your doctor has to write lengthy notes and click hundreds of boxes to make sure the practice gets paid. If she leaves anything out, the claim might be rejected—and then you’ll get the bill.

Each of the boxes she clicks also helps generate the practice’s “quality measures.” It has to track them for insurers, state and federal agencies, and other organizations. If they haven’t tracked them well and the scores aren’t high enough, they can be penalized and lose money.

And finally, with new regulations, doctors who accept Medicare have to use certified electronic health record (EHR) technology, and use it in very specific ways. If they don’t, they’ll take a hit on what Medicare pays them for every patient—one reason many doctors are deciding to stop accepting Medicare.

Why do I get surprise bills?

You have one insurance plan. Your doctor’s office submits hundreds of claims every week to hundreds of different insurance plans. To do so, they have to use a surreal list of tens of thousands of medical codes to explain why you were seen and how you were treated. They have to use middlemen to translate their claims for specific insurance companies. And they have to respond to questions from insurers quickly or the claim might not be paid.

It’s not surprising that they don’t have much time left to explain the nuances of your insurance plan to you so that you aren’t surprised when your deductible kicks in.

Here’s another truth.

The patient-physician relationship has dramatically changed over the past 30 years, and the system now expects patients to be “engaged partners.” That’s not a bad thing, but to make this new relationship work, knowledge and empathy need to flow in both directions.

In the real world, the complexity of healthcare can pull patients and doctors away from each other. With understanding, we can come together to achieve the vision we all want